T-PRK与SMILE矫正低度近视的视觉质量观察  

Visual quality observation of transepithelial photorefractive keratectomy and femtosecond small incision lenticule extraction for the correction of low myopia

作　　者：林敏 姚浩英 张浩润 王锐 赵静静 付梦军 Min Lin;Hao-Ying Yao;Hao-Run Zhang;Rui Wang;Jing-Jing Zhao;Meng-Jun Fu(The First School Clinical Medicine of Binzhou Medical University,Binzhou 256603,Shandong Province,China;The Second Medical College of Binzhou Medical University,Yantai 264100,Shandong Province,China;Weifang Eye Hospital,Weifang 261000,Shandong Province,China)

机构地区：[1]滨州医学院第一临床医学院,山东省滨州市256603 [2]滨州医学院第二临床医学院,山东省烟台市264100 [3]潍坊眼科医院,山东省潍坊市261000

出　　处：《国际眼科杂志》2023年第4期648-654,共7页International Eye Science

基　　金：潍坊市软科学研究计划项目(No.2021RKX160)

摘　　要：目的:观察经上皮准分子激光角膜切削术(T-PRK)与飞秒激光小切口角膜基质透镜取出术(SMILE)矫正低度近视的角膜像差变化及视觉质量特点。方法:前瞻性队列研究。选取2021-04/2022-04于潍坊眼科医院行T-PRK手术32例32眼及SMILE手术45例45眼的低度近视患者,比较两组术后裸眼视力(UCVA)、最佳矫正视力(BCVA)、等效球镜(SE)、角膜高阶像差(HOAs)及客观视觉质量。结果:所有患者均顺利完成手术,未见感染等并发症。术后3mo,T-PRK组与SMILE组的安全指数分别为1.13±0.16和1.16±0.17(P=0.48),有效指数分别为1.10±0.20和1.15±0.18(P=0.27)。T-PRK组和SMILE组UCVA(LogMAR)≤0的占比分别为94%和98%。两组残余SE在±0.50D内的占比分别为88%和87%。两组患者HOAs和球差均显著升高(P≤0.01),且两组间增加量无差异(P=0.31、0.89)。两组患者水平彗差、水平三叶草、垂直三叶草均无显著性变化(P>0.05)。SMILE组垂直彗差显著升高(P<0.001),而T-PRK组无显著性变化(P>0.05),且SMILE组的增加量明显大于T-PRK组(P<0.001)。两组间OSI、MTF_(cut off)、SR、VA100%、VA20%、VA9%比较均未见差异(P>0.05)。结论:T-PRK与SMILE矫正低度近视均有良好的安全性、有效性和视觉质量,SMILE手术与T-PRK手术相比诱导更多的垂直彗差。AIM:To observe the changes in corneal aberrations and the characteristics of visual quality after transepithelial photorefractive keratectomy(T-PRK)and femtosecond small incision lenticule extraction(SMILE)in the correction of low myopia.METHODS:Prospective cohort study.A total of 32 cases(32 eyes)with low myopia who underwent T-PRK surgery and 45 cases(45 eyes)of SMILE surgery at Weifang Eye Hospital from April 2021 to April 2022 were selected.The uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),spherical equivalent(SE),corneal higher-order aberrations(HOAs)and objective visual quality were compared between the two groups.RESULTS:All patients completed the surgery successfully without complications such as infection.At 3mo postoperatively,the safety index was 1.13±0.16 and 1.16±0.17(P=0.48)and the efficacy index was 1.10±0.20 and 1.15±0.18(P=0.27)in the T-PRK and SMILE groups,respectively.The percentage of UCVA(LogMAR)≤0 in the T-PRK and SMILE groups was 94%and 98%,respectively.The percentage of the residual SE within±0.5D was 88%and 87%in the two groups,respectively.The HOAs and spherical aberration in both groups were significantly increased(P≤0.01),and the increase was not statistically significant between the two groups(P=0.31,0.89).There was no significant change in horizontal coma,horizontal trefoil and vertical trefoil in both groups(P>0.05).The vertical coma in SMILE group was significantly increased(P<0.001),while there was no significant change in T-PRK group(P>0.05),and the increase was significantly greater in SMILE group than in T-PRK group(P<0.001).There was no significant difference in objective scattering index(OSI),modulation transfer function cut off frequency(MTF_(cut off)),Strehl ratio(SR),visual acuity(VA)100%,VA20%and VA9%between the two groups(P>0.05).CONCLUSION:Both T-PRK and SMILE showed good safety,efficacy,and visual quality in correcting low myopia,while SMILE induced more vertical coma than T-PRK.

关 键 词：经上皮准分子激光角膜切削术(T-PRK) 飞秒激光小切口角膜基质透镜取出术(SMILE) 低度近视 角膜像差 双通道客观视觉质量分析系统Ⅱ 

分 类 号：R778.11[医药卫生—眼科]