2mm与4mm切口SMILE术后视觉效果对比  

Effects of a 2 mm versus 4 mm incision width on visual outcomes after SMILE

作　　者：马晶[1] 夏丽坤[1] 刘鹤南[1] 杨飏[1] 杜长虹[1] 张桂新[1] 

机构地区：[1]中国医科大学附属盛京医院眼科,沈阳110004

出　　处：《中华眼视光学与视觉科学杂志》2016年第11期665-670,共6页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的探讨行2mm与4mm口的飞秒激光小切口角膜基质透镜取出术（SMILE）患者术后的视力、屈光度、高阶像差和角膜地形图的变化。方法前瞻性对照研究。接受SMILE手术矫正近视和近视散光的患者34例（68眼），按手术中切口大小分成2mm切口组（44眼）和4mm切口组（24眼）。分别测量并记录患者术前，术后1周，术后1、3、6个月的裸眼远视力（UCVA）、最佳矫正视力（BCVA）、屈光度、总高阶像差（HOAs）、球差（Z40）、垂直彗差（z3）、水平彗差（Z3）、角膜前表面散光、角膜不规则指数（CIM）和形状因子（SF）等。应用重复测量方差分析比较2组之间手术前后各参数的差异。结果2组之间各个时间点的UCVA、BCVA和屈光度差异均无统计学意义。术后1周时，4mm切13组的Z3较2mm切口组大（t=-2．031，P〈O．05）；术后1周和1个月时，4mm切口组的角膜前表面散光较2mm切口组高（t=-2．126、-2．108，P〈0．05）；术后1周和1个月时，4mm切口组的CIM较2mm切口组大（t=-2．360、-2．395，P〈0．05）。结论在角膜前表面散光、Z3。和CIM方面，2mm切口的SMILE比4mm切口的SMILE更有优势。Objective To evaluate the effects of incision width on visual outcomes by comparing visual acuity, refractive error, higher-order aberrations and corneal topography parameters after femtosecond small-incision lenticule extraction （SMILE）. Methods This was a prospective case-control study. Thirty-four patients （68 eyes） who underwent SMILE to correct myopia and myopic astigmatism were included. We divided them into two groups by a side cut of 2 mm or 4 mm. Twenty-two patients （44 eyes） were in the 2 mm side-cut group while 12 patients （24 eyes） were in the 4 mm side-cut group. All patients underwent routine examinations before the surgery in case of surgical contraindications. Preoperatively and 1 week and 1, 3 and 6 months postoperatively, we measured UCVA, BCVA, refractive error, total higher-order aberrations （HOAs）, spherical aberrations （Z）, vertical coma （Z3-）, horizontal coma （Z3-）, anterior corneal surface astigmatism, corneal irregularity t （CIM） and shape factor （SF）. A repeated measures analysis of variance was used to compare the differences in these data between the two groups and between pre- and post-operation. Results No differences were found in UCVA, BCVA or refractive error between the two groups at any time point. For Z-1, the outcomes in the 4 mm side-cut group were higher than in the 2 mm side-cut group at 1 week postoperatively （t=-2.031, P〈0.05）. For anterior corneal surface astigmatism, the outcomes in the 4 mm side-cut group were higher than in the 2 mm side-cut group at 1 week and 1 month postoperatively （t=-2.126, -2.108, P〈0.05）. For CIM, the outcomes in the 4 mm side-cut group were higher than in the 2 mm side-cut group at 1 week and 1 month postoperatively（t=-2.360, -2.395, P〈0.05）. Conclusion When considering Z3-1, anterior corneal surface astigmatism and CIM, SMILE with a 2 mm side cut has advantages over SMILE with a 4 mm side cut.

关 键 词：近视 散光 屈光外科手术 飞秒激光小切口角膜基质透镜取出术 像差 角 膜不规则指数 

分 类 号：R779.63[医药卫生—眼科]