飞秒激光小切口角膜基质内透镜取出术与飞秒激光LASIK术后高阶像差改变的对比研究  

Wavefront analysis and comparison between small incision lenticule extraction and femtosecond laser in situ keratomileusis

作　　者：武志清[1] 王雁[1] 张琳[1] 耿维莉[1] 金颖[1] 左彤[1] 

机构地区：[1]天津市眼科医院天津医科大学眼科临床学院天津市眼科研究所天津市眼科学与视觉科学重点实验室,300020

出　　处：《中华眼科杂志》2015年第3期193-201,共9页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金（81170873）;天津市卫生局攻关项目（10KG109）

摘　　要：目的 通过对比飞秒激光小切口角膜基质内透镜取出术（SMILE）与飞秒激光辅助的LASIK术后的全眼高阶像差,分析两种手术方式术后高阶像差的变化特点.方法 前瞻性病例对照研究.入选SMILE屈光手术患者共34例（34只眼）作为SMILE组,飞秒激光辅助的LASIK屈光手术患者29例（29只眼）作为对照组,均选取右眼进行研究分析.所有患者术前常规屈光手术术前检查,接受Pentacam 三维跟前节分析诊断系统的检查,并利用WaveScan像差仪分别测量进行两种屈光手术患者术前,术后1和术后3个月的像差,应用配对样本t检验,独立样本t检验,Pcarson线性相关分析等统计学方法对所采集数据进行研究分析.结果 在术后1个月时,SMILE组初级垂直彗差（C3-1）、三叶草（C33）、分别为-0.205±0.199、0.027±0.071,高于对照组（t=-3.141,2.216;P＜0.05）;对照组总高阶像差Sh、其他S4、S5、S6,初级球差（C04）、分别为0.609±0.199、0.403±0.196、0.117 ±0.065、0.092±0.0038、0.343±0.253,高于SMILE组（t=-3.492,3.461,-3.449,-5.301,-2.103;P＜0.05）;术后3个月时,SMILE组仅C-13为-0.177±0.175,高于对照组（t=-2.476,P＜0.05）;对照组总高阶Sh、其他S4、S5、S6各阶,初级球差C04、C24、四叶草（C44）、次级三叶草（C-35）、次级球差（C06）等各项均高于SMILE组（t=-3.935,-3.788,-2.049,-4.405,-3.576,2.494,3.879,2.642,4.784;P ＜0.05）;相关性分析中,对照组术后1个月与3个月,Sh、C04与术前预矫正球镜度均存在负相关（术后1个月：r=-0.433,-0.476;P ＜0.05;术后3个月：r=-0.418,-0.447;P ＜0.05）.结论 SMILE术后显示良好的光学质量,相对于飞秒激光辅助的LASIK所引起的全眼像差改变更小,但同时存在其特殊性,可能与其手术方式或角膜伤口愈合有关.Objective To investigate and analyze the characteristic changes of high order aberrations before and after small incision lenticule extraction （SMILE） and femtosecond laser in situkeratomileusis （FS-LASIK）.Methods Prospective study.Thirty-four patients （16 men and 18 women） underwent SMILE,and 28 cases （15 men and 13 women） underwent FS-LASIK,aged 18 to 39 years.Only the right eye was selected to be analyzed from each patient.All patients had conventional and Pentacam cxaminations preoperatively,and the ocular higher order aberrations were measured with the Hartman-Shack wavefront analyzer before surgery and at 1 month and 3 months postoperatively.The paired t test,independent t test,and Pearson correlation analysis were used to analyze the collected data.Results At the 1 month after SMILE group,C31 、C33 （-0.205 ± 0.199、0.027 ± 0.071） were higher than the FS-LASIK group （0.004 ±0.316、-0.022 ±0.104） （t =-3.141,2.216,P ＜0.05）,for FS-LASIK group Sh 、S4、S5 、S6 、C40 （0.609 ± 0.199,0.403 ± 0.196,0.117 ± 0.065,0.092 ± 0.038,0.343 ± 0.253） were higher than the SMILE group （0.461 ± 0.130,0.271 ± 0.096,0.074 ± 0.028,0.053 ± 0.018,0.239 ± 0.121） （t =-3.492,-3.461,-3.449,-5.301,-2.103,P ＜0.05） ;At the 3rd month of SMILE group,C31 （-0.177 ±0.175） was higher than the FS-LASIK group （-0.012 ±0.337） （t =-2.476,P＜0.05）,In FS-LASIK group,however,the data for Sh、S4、S5 、S6、C04 （0.626 ± 0.215,0.421 ± 0.200,0.108 ± 0.066,0.082 ± 0.036,0.393 ± 0.207） were higher than the SMILE group （0.457 ± 0.113,0.270 ± 0.106,0.082 ±0.031,0.051 ±0.017,0.243 ±0.115） （t =-3.935,-3.788,-2.049,-4.405,-3.576,P ＜ 0.05）.With the correlation analysis,at the postoperative 1 st and 3rd month of FS-LASIK group,Sh 、C04 had negative relationship with the attempted myopic corrections （1 month post-op：r =-0.433,-0.476,P ＜ 0.05 ;3 month post-op：r =-0.418,-0.447,P ＜ 0.05）.Conclusion SMILE resulted in good optical quality early after op

关 键 词：屈光外科手术 角膜磨镶术 激光原位 激光 飞秒 角膜基质 近视 角膜波前像差 

分 类 号：R779.63[医药卫生—眼科]