SMILE与FS-LASIK矫正高度近视术后5年屈光结果及眼内散射分析  

Refractive results and intraocular scattering 5 years after high myopia correction:a comparison between SMILE and FS-LASIK surgeries

作　　者：郎敏 张娇[1] 陶露莎 余婷 潘娇 刘明明 叶剑[1] LANG Min;ZHANG Jiao;TAO Lusha;YU Ting;PAN Jiao;LIU Mingming;YE Jian(Department of Ophthalmology,Daping Hospital,Army Medical University(Third Military Medical University),Chongqing,400042,China)

机构地区：[1]陆军军医大学(第三军医大学)大坪医院眼科,重庆400042

出　　处：《第三军医大学学报》2021年第24期2698-2704,共7页Journal of Third Military Medical University

摘　　要：目的比较飞秒激光小切口角膜基质透镜取出术(small incision lenticule extraction,SMILE)和飞秒激光制瓣的准分子激光原位角膜磨镶术(femtosecond laser-assisted LASIK,FS-LASIK)矫正高度近视及散光术后5年屈光结果以及散射相关视觉质量的差异。方法回顾性分析2011年12月至2013年7月在我科行飞秒激光角膜屈光矫正术的高度近视患者58例,按患者选择的手术方式不同分为SMILE组30例(30只眼)和FS-LASIK组28例(28只眼),仅左眼纳入研究。将术前,术后3个月、6个月、1年和5年的数据进行统计分析,观察患者裸眼远视力(uncorrected distant visual acuity,UDVA)、最佳矫正远视视力(corrected distance visual acuity,CDVA)、等效球镜度(spherical equivalent,SE),双通道视觉质量分析系统(Optical Quality Analysis System,OQASⅡ)检查统计眼内客观散射指数(objective scattering Index,OSI)、调制传递函数截止频率(modulation transfer function cutoff frequency,MTF_(cutoff))、斯特列尔比值(Strehl ratio,SR)、对比度为100%、20%和9%时的视力(VA100%、VA20%、VA9%)。结果术后5年,安全性指数SMILE组1.136±0.099,FS-LASIK组1.128±0.129,两组比较无统计学差异(P>0.05);有效性指数SMILE组1.072±0.151,FS-LASIK组1.063±0.145,两组比较无统计学差异(P>0.05);术后5年UDVA达到1.0及以上的SMILE组占77%,FS-LASIK组占71%;可预测性SMILE组在±0.50D以内的占87%,FS-LASIK组占75%。SMILE组等效球镜度术前为(-7.22±0.91)D、术后5年为(-0.12±0.38)D,FS-LASIK组术前为(-8.01±1.09)D、术后5年为(-0.31±0.44)D,协方差分析两组术后5年SE有统计学差异(P<0.05)。术后5年两组MTF、SR、VA20%、VA9%比较差异均无统计学意义(P>0.05),但两组OSI、VA100%相比差异有统计学意义(P<0.05)。结论 SMILE与FS-LASIK两种手术方式矫正高度近视5年具有相似的有效性、安全性、可预测性和稳定性,SMILE术后对眼内散射的影响略小于FS-LASIK手术。Objective To compare the refractive results and scattering-related visual quality between small incision lenticule extraction(SMILE) and femtosecond laser-assisted LASIK(FS-LASIK) surgeries in 5 years after correction of high myopia and astigmatism.Methods A retrospective analysis was performed on 58 patients with high myopic who underwent corneal refractive correction surgery in our hospital from December 2011 to July 2013.The patients were divided into the SMILE group(n=30) and FS-LASIK group(n=28) according to their received surgical methods,only the left eyes being included for each patient.The preoperative and postoperative data at 3 and 6 months and 1 and 5 years were compared and analyzed.The observation indicators included uncorrected distant visual acuity(UDVA),corrected distance visual acuity(CDVA) and spherical equivalent(SE),and the parameters such as objective scattering Index(OSI),modulation transfer function cutoff frequency(MTF_(cutoff)),Strehl ratio(SR),VA100%,VA20% and VA9% were examined using Optical Quality Analysis System(OQAS Ⅱ).Results During the follow-up of 5 years,the safety index was 1.136±0.099 in the SMILE group and 1.128±0.129 in the FS-LASIK group,and the efficacy index were 1.072±0.151 and 1.063±0.145 respectively,with no significant difference between the 2 groups(P>0.05).About 77% of treated eyes in the SMILE group and 71% in the FS-LASIK group obtained a postoperative UDVA of 1.0 or better.Predictability within ±0.50 D accounted for 87% in the SMILE group and 75% in the FS-LASIK group.The SE of the SMILE group was(-7.22±0.91)D before surgery and(-0.12±0.38)D in 5 years after surgery,and those of the FS-LASIK group were(8.01±1.09)D and(-0.31±0.44)D respectively,indicating significant difference(P<0.05).Moreover,there was no difference in MTF,SR,VA20% and VA9% between the 2 groups(P>0.05),while the differences in OSI and VA100% were significant(P<0.05).Conclusion SMILE and FS-LASIK have similar efficacy,safety,predictability and stability in 5 years after high myopia co

关 键 词：飞秒激光小切口角膜基质透镜取出术 飞秒激光制瓣的准分子激光原位角膜磨镶术 高度近视 术后5年 视觉质量 散射 

分 类 号：R195.4[医药卫生—卫生统计学] R778.11[医药卫生—卫生事业管理]