SMILE切口大小对患者术后散光及高阶像差的影响  

Effect of the incision size on astigmatism and higher-order aberrations after small incision lenticule extraction

作　　者：田彩霞 王雁[1,2] 赵新恒 张佳媚[2] TIAN Caixia;WANG Yan;ZHAO Xinheng;ZHANG Jiamei(Clinical College of Ophthalmology,Tianjin Medical University,Tianjin 300020,China;Tianjin Eye Hospital,Tianjin Eye Institute,Tianjin Key Laboratory of Ophthalmology and Visual Science,Tianjin 300020,China)

机构地区：[1]天津医科大学眼科临床学院,天津市300020 [2]天津市眼科医院,天津市眼科研究所,天津市眼科学与视觉科学重点实验室,天津市300020

出　　处：《眼科新进展》2023年第9期717-721,共5页Recent Advances in Ophthalmology

基　　金：国家自然科学基金(编号:81873684)。

摘　　要：目的探讨不同切口大小的飞秒激光小切口角膜基质透镜取出术(SMILE)术后散光效果及高阶像差的差异。方法回顾性研究。纳入2021年2月至12月在天津市眼科医院屈光手术中心行SMILE的近视散光患者99例(99眼)。其中行2 mm切口SMILE者48例作为2 mm切口组,行3 mm切口SMILE者51例作为3 mm切口组,均选取右眼进行研究。对比分析术前及术后3个月两组患者的视力、屈光度和高阶像差。采用Alpins矢量分析法分析两组患者术后散光变化。结果两组患者间术前、术后3个月的球镜度、柱镜度和等效球镜度差异均无统计学意义(均为P>0.05)。2 mm切口组与3 mm切口组患者术后3个月的裸眼视力≥0.8的眼数分别为48眼(100.00%)和49眼(96.08%)。散光矢量分析结果显示,各散光矢量参数之间差异均无统计学意义(均为P>0.05)。2 mm切口组患者术后3个月的水平彗差、垂直彗差和总高阶像差均较术前增大(均为P<0.05)。3 mm切口组患者术后3个月的水平彗差、垂直彗差、球差和总高阶像差均较术前增大(均为P<0.05)。2 mm切口组患者术后3个月的垂直彗差、球差和总高阶像差均明显低于3 mm切口组(均为P<0.05)。结论两种不同大小切口的SMILE在矫正近视散光方面皆是安全且有效的。术后3个月时,2 mm切口SMILE对角膜的垂直彗差、球差和总高阶像差的影响优于3 mm切口。Objective To explore the effect of the incision size on astigmatism and higher-order aberrations(HOAs)after small incision lenticule extraction(SMILE).Methods In this retrospective study,99 patients(99 eyes)who underwent SMILE surgery due to myopic astigmatism in the Refractive Surgery Center of Tianjin Eye Hospital from February to December 2021 were included.According to the incision size,these patients were divided into two groups:2 mm incision group(48 patients)and 3 mm incision group(51 patients).The right eyes were selected for the study.The visual acuity,diopter,and HOAs were measured and compared preoperatively and 3 months postoperatively.The postoperative astigmatism changes were analyzed by the Alpins method.Results There were no significant differences in the sphere,cylinder,and spherical equivalent between the two groups preoperatively and 3 months postoperatively(all P>0.05).Three months after surgery,48 eyes(100.00%)in the 2 mm incision group and 49 eyes(96.08%)in the 3 mm incision group had the uncorrected visual acuity larger than or equal to 0.8.Alpins results showed that there were no significant differences among the astigmatism parameters(all P>0.05).The horizontal coma,vertical coma,and total HOAs in the 2 mm incision group increased at 3 months after surgery compared with those before surgery(all P<0.05).Similarly,the horizontal coma,vertical coma,spherical aberration,and total HOAs in the 3 mm incision group increased at 3 months after surgery compared with those before surgery(all P<0.05).Three months postoperation,the vertical coma,spherical aberration,and total HOAs in the 2 mm incision group were significantly lower than those in the 3 mm incision group(all P<0.05).Conclusion Both SMILE incisions are safe and effective in correcting myopic astigmatism.In terms of the vertical coma,spherical aberration,and total HOAs,the 2 mm incision is better than the 3 mm incision at 3 months after surgery.

关 键 词：飞秒激光小切口角膜基质透镜取出术 近视 散光 矢量分析 高阶像差 

分 类 号：R778.1[医药卫生—眼科]