SMILE与改良去瓣Epi-LASIK矫正近视的疗效比较  

Therapy comparison between sMILE and Off-Flap Epi-LAsIK

作　　者：陈祥菲[1] 陆燕[2] 王春红[2] 杨丽萍[2] 黄振平[2] Xiangfei Chen;Yan Lu;Chunhong Wang;Liping Yang;Zhenping Huang(Department of Endocrinology, Geriatric Research Center, Jinling Hospital, Nanjing General Hospital of PLA, School of Medicine, Nanjing University, Nanjing 210002, China;Department of Ophthalmology, Jinling Hospital, Nanjing General Hospital of PLA, School of Medicine, Nanjing University, Nanjing 210002, China)

机构地区：[1]南京军区南京总医院干部内分泌科,210002 [2]南京军区南京总医院眼科,210002

出　　处：《中华眼视光学与视觉科学杂志》2018年第5期297-305,共9页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：南京军区南京总医院科研基金（2016061）;江苏省青年医学人才项目（QNRC20160905）;国家自然科学基金（81270979）

摘　　要：目的：比较飞秒激光小切口角膜基质透镜取出术（SMILE）与改良去瓣机械法准分子激光原位角膜上皮瓣下磨镶术（Epi-LASIK）矫正近视术后1年的临床效果.方法：回顾性病例对照研究.选择2013年3月至2014年8月在南京总医院行SMILE的近视散光患者52例（103眼）作为SMILE组,行改良去瓣Epi-LASIK的近视散光患者43例（86眼）作为Epi-LASIK组.分别在术前,术后1d、1周、1个月、3个月、6个月、1年测量患者的裸眼视力（UCVA）、最佳矫正视力（BCVA）、残余散光、等效球镜度（SE）,并于术后1年测量2组的对比敏感度（CS）、调制传递函数（MTF）、波前像差等.采用重复测量方差分析、t检验和卡方检验对数据进行分析.结果：术后1d及1周,SMILE组UCVA优于Epi-LASIK组,差异均有统计学意义（t=5.065、5.994,P〈0.001）,余时间段2组间UCVA差异均无统计学意义.术后1年,2组间SE在±0.50D和±1.00D范围内的眼数百分比差异均无统计学意义,SMILE组柱镜度在±0.50D范围内的眼数百分比高于Epi-LASIK组,差异有统计学意义（χ2=10.734,P=0.001）.术后1年,SMILE组在有眩光低空间频率（3、6cpd）的CS高于Epi-LASIK组,差异均有统计学意义（t=4.106、3.848,P〈0.001）;2组在有眩光余空间频率和无眩光所有空间频率的CS差异均无统计学意义.在4mm瞳孔直径下,2组间全眼像差、低阶像差、高阶像差、球差、慧差、三叶草像差及MTF值在各空间频率上的差异均无统计学意义.在6mm瞳孔直径下,SMILE组的高阶像差、球差低于Epi-LASIK组,差异均有统计学意义（t=3.881、6.843,P〈0.001）,2组间其他像差差异均无统计学意义;SMILE组在低空间频率和高空间频率（5、20、25、30cpd）的MTF值均高于Epi-LASIK组,差异均有统计学意义（t=3.272,P=0.001;t=2.926,P=0.004;t=3.280,P=0.001;t=3.975,P〈0.001）,其他空间频率差异均无统计学意义.结论：SMILE与改良去瓣Epi-LASIK矫正近视均�Objective： To compare one-year clinical outcomes between small incision lenticular extraction （SMILE） and off-fap epipolis laser in situ keratomileusis （Epi-LASIK） for myopia. Methods： In this retrospective case-control study, choosing from Nanjing General Hospital of PLA between March 2013 and August 2014, 103 eyes of 52 patients underwent SMILE, and 86 eyes of 43 patients underwent off-fap Epi-LASIK. Uncorrected visual acuity （UCVA）, best corrected visual acuity （BCVA）, residual astigmatism, and spherical equivalent （SE） were evaluated preoperatively, at 1 day, 1 week, at 1, 3, and 6 months, and at 1 year postoperatively. Contrast sensitivity （CS）, modulation transfer function （MTF）, and wavefront aberrations were evaluated at 1 year postoperatively. Data were analyzed using repeated measures analysis of variance, independent-samples t-tests, and Chi-square tests. results： At 1 day and 1 week after surgery, the UCVA for the SMILE group was signifcantly better than for the Epi-LASIK group （t=5.065, 5.994, respectively, P〈0.001 for both）; however for all other follow-up times, there were no signifcant differences in the UCVA between the two groups. At 1 year postoperatively, there was no significant difference in the frequency of eyes SE within ±0.5 diopter （D） or within ±1.0 D between the two groups respectively. However, the frequency with which the SMILE group attained a cylindrical refractive error within ±0.5 D was clearly higher than for the Epi-LASIK group （χ2=10.734, P=0.001）. The CS with glare at low spatial frequency [3 and 6 cycles per degree （cpd）] in the SMILE group was signifcantly higher than for the Epi-LASIK group （t=4.106, 3.848, P〈0.001）. However, there were no signifcant differences in CS at other spatial frequencies, with or without glare between the two groups. Total order aberrations, lower-order aberrations, higher-order aberrations, spherical aberrations, coma, trefoil aberrations, and MTFs at all spatial frequencies with

关 键 词：飞秒激光小切口角膜基质透镜取出术 准分子激光原位角膜磨镶术 对比敏感度 调制传递函数 像差 

分 类 号：R779.6[医药卫生—眼科]