FS-LASIK与SMILE术后角膜高阶像差变化比较  

Comparison of corneal higher order aberration after femtosecond laser-assisted laser in situ keratomileusis and small incision lenticule extraction

作　　者：刘明娜 史伟云 高华 李娜 陈彤 Liu Mingna;Shi Weiyun;Gao Hua;Li Na;Chen Tong(Eye Institute of Shandong First Medical University,Eye Hospital of Shandong First Medical University(Shandong Eye Hospital),State Key Laboratory Cultivation Base,Shandong Provincial Key Laboratory of Ophthalmology,School of Ophthalmology,Shandong First Medical University,Jinan 250021,China)

机构地区：[1]山东第一医科大学附属眼科研究所,山东第一医科大学附属眼科医院(山东省眼科医院),山东省眼科学重点实验室-省部共建国家重点实验室培育基地,山东第一医科大学眼科学院,济南250021

出　　处：《中华实验眼科杂志》2023年第8期755-762,共8页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金面上项目(81870639);山东省自然科学基金面上项目(ZR2020MH171);山东省重点研发计划项目(重大科技创新工程)(2022CXGC010505)。

摘　　要：目的分析并比较飞秒激光辅助准分子激光角膜原位磨镶术(FS-LASIK)和飞秒激光小切口角膜基质透镜取出术(SMILE)术后角膜高阶像差(HOA)变化。方法采用非随机对照研究方法,纳入2018年4月至2020年1月于山东省眼科医院接受FS-LASIK或SMILE矫正的近视患者60例60眼,均收集右眼数据纳入分析。FS-LASIK组30例30眼,术前等效球镜度为(-5.36±1.11)D;SMILE组30例30眼,术前等效球镜度为(-4.93±1.03)D。分别于术前和术后1、3、6、12个月采用Pentacam三维眼前节分析系统测定直径6 mm范围的角膜前表面、后表面和全角膜HOA,获取患者角膜总HOA、球差、彗差和三叶草像差,以均方根值(μm)表示,比较2个组不同时间点各指标差异。结果术前及术后1、3、6、12个月FS-LASIK组角膜前表面HOA分别为(0.428±0.126)、(0.775±0.169)、(0.811±0.194)、(0.759±0.214)、(0.704±0.199)μm,SMILE组分别为(0.409±0.094)、(0.656±0.148)、(0.681±0.161)、(0.668±0.175)、(0.648±0.160)μm,总体比较差异均有统计学意义(F_(分组)=5.652,P=0.024;F_(时间)=107.169,P<0.01)。与SMILE组相比,FS-LASIK组术后各时间点角膜前表面总HOA、球差明显增大,差异均有统计学意义(均P<0.05);2个组术眼术后各时间点角膜前表面总HOA、球差明显大于术前,术后6个月和12个月角膜前表面总HOA小于术后3个月,术后12个月角膜前表面球差明显小于术后1个月和3个月,差异均有统计学意义(均P<0.05)。手术前后不同时间点角膜前表面彗差、三叶草像差总体比较差异均有统计学意义(彗差:F_(时间)=47.848,P<0.01;三叶草像差:F_(时间)=2.497,P=0.046),其中与术前比较,2个组术眼术后各时间点角膜前表面彗差明显增大,差异均有统计学意义(均P<0.05)。2个组间手术前后不同时间点全角膜总HOA、球差总体比较差异均有统计学意义(总HOA:F_(分组)=8.093,P=0.008;F_(时间)=125.019,P<0.01.球差:F_(分组)=4.771,P=0.037;F_(时间)=34.033,P<0.01),�Objective To analyze and compare the corneal higher order aberration(HOA)after femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)and small incision lenticule extraction(SMILE).Methods A non-randomized controlled study was conducted.Sixty myopic patients(60 eyes)who underwent FS-LASIK or SMILE correction at Shandong Eye Hospital from April 2018 to January 2020 were enrolled and the data from the right eye were collected for analysis.Thirty cases(30 eyes)who received FS-LASIK in FS-LASIK group and 30 cases(30 eyes)who received SMILE in SMILE group had a preoperative equivalent spherical diopter of(-5.36±1.11)D and(-4.93±1.03)D,respectively.The HOA of the 6-mm anterior surface,posterior surface,and whole cornea were measured before surgery and at 1,3,6,and 12 months after surgery using Pentacam.The root mean square values(μm)of total corneal HOA,spherical aberration,coma and trefoil were obtained.Differences in the above root mean square values at different time points were compared between the two groups.The study protocol adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Shandong Eye Hospital(No.SDSYKYY20180306).Written informed consent was obtained from each subject.Results The preoperative and 1-,3-,6-,12-month postoperative total HOA of the anterior corneal surface were(0.428±0.126),(0.775±0.169),(0.811±0.194),(0.759±0.214),(0.704±0.199)μm in the FS-LASIK group and(0.409±0.094),(0.656±0.148),(0.681±0.161),(0.668±0.175),(0.648±0.160)μm in the SMILE group,with a significant overall difference(F_(group)=5.652,P=0.024;F_(time)=107.169,P<0.01).Compared with SMILE group,the postoperative total HOA of anterior corneal surface and spherical aberration at different time points were increased in FS-LASIK group,showing statistically significant differences(all at P<0.05).Compared with before surgery,the postoperative total HOA of the anterior corneal surface and spherical aberration at different time points were increased in both groups,showing statistically s

关 键 词：近视 角膜激光手术 角膜波前像差 飞秒激光辅助准分子激光角膜原位磨镶术 飞秒激光小切口角膜基质透镜取出术 高阶像差 

分 类 号：R779.63[医药卫生—眼科]