SMILE与FS-LASIK矫治近视术后功能性光学区及角膜形态变化比较  

Comparison of changes in functional optical zone and corneal morphology between SMILE and FS-LASIK in myopes

作　　者：吴博文 吴加钦 汪凌 陈世豪 Wu Bowen;Wu Jiaqin;Wang Ling;Chen Shihao(Eye Hospital,Wenzhou Medical University,Wenzhou 325027,China)

机构地区：[1]温州医科大学、温州医科大学附属眼视光医院,温州325027

出　　处：《中华实验眼科杂志》2023年第9期891-897,共7页Chinese Journal Of Experimental Ophthalmology

基　　金：浙江省自然科学基金项目(LY20H120005)。

摘　　要：目的比较飞秒激光小切口角膜基质透镜取出术(SMILE)与飞秒激光辅助准分子激光原位角膜磨镶术(FS-LASIK)矫治近视术后功能性光学区(FOZ)及角膜形态的变化特点。方法采用队列研究设计, 选取2021年3-12月在温州医科大学附属眼视光医院行SMILE或FS-LASIK手术的近视患者94例94眼, 根据手术方式不同将患者分为SMILE组46例46眼和FS-LASIK组48例48眼, 随访6个月。评估主要结局指标为术后角膜功能性光学区及Q值变化, 次要结局指标为中央角膜厚度(CCT)和平均角膜曲率(Km)变化。采用Pentacam眼前节分析系统记录术前及术后1 d、1周、1个月和6个月的角膜Q值、FOZ水平径及垂直径、CCT、Km, 比较2个组间各参数差异及变化趋势。结果 2个组术后不同时间点FOZ水平径和垂直径总体比较差异均有统计学意义(水平径:F分组=7.06, P<0.001;F时间=64.18, P=0.001。垂直径:F分组=11.08, P<0.001;F时间=77.14, P<0.001)。SMILE组术后各时间点FOZ水平径和垂直径测量值均显著大于FS-LASIK组, 差异均有统计学意义(均P<0.001);SMILE组和FS-LASIK组术后1周、1个月和6个月FOZ水平径测量值均明显低于术后1 d, 术后1周和1个月FOZ垂直径测量值明显低于术后1 d, 差异均有统计学意义(均P<0.05)。2个组术后不同时间点Q值总体比较差异有统计学意义(F分组=53.11, P=0.019;F时间=29.18, P<0.001)。FS-LASIK组术后1 d、1周、1个月Q值显著大于相应时间点SMILE组, 差异均有统计学意义(均P<0.05);SMILE组术后1周Q值明显大于术后1 d, 差异有统计学意义(P<0.001);FS-LASIK组Q值随术后时间延长而逐渐减小, 各相邻时间点Q值比较差异均有统计学意义(均P<0.001)。各组术眼不同时间点间CCT总体比较差异有统计学意义(F时间=21.43, P<0.01)。FS-LASIK组术后1周CCT较术后1 d下降, 术后6个月CCT较术后1周明显增加, 差异均有统计学意义(均P<0.05);SMILE组术后1周至术后6个月CCT均较术后1 d�Objective To compare the changes in functional optical zone(FOZ)and corneal morphology in myopes between femtosecond small incision laser lenticule extraction(SMILE)and femtosecond laser-assisted in situ keratomileusis(FS-LASIK).Methods A cohort study was performed.A total of 94 patients(94 eyes)who underwent FS-LASIK or SMILE at Eye Hospital,Wenzhou Medical University from March to December 2021 were enrolled.The selected patients were divided into a SMILE group(46 cases,46 eyes)and an FS-LASIK group(48 cases,48 eyes)according to the surgical procedure,and the follow-up period was 6 months.The primary outcome measures were postoperative changes in corneal FOZ and Q-value,and the secondary outcome measures were changes in central corneal thickness(CCT)and mean corneal curvature(Km).Corneal Q-value,horizontal and vertical FOZ diameters,CCT,and Km were recorded before surgery and at 1 day,1 week,1 month,and 6 months after surgery using the Pentacam anterior segment analysis system,and the differences in each parameter and the trends of changes between the two groups were compared.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Eye Hospital,Wenzhou Medical University(No.2021-034-k-27).Written informed consent was obtained from each subject.Results There were statistically significant overall differences in the postoperative horizontal and vertical FOZ diameters between the two groups(horizontal diameter:Fgroup=7.06,P<0.001;Ftime=64.18,P=0.001;vertical diameter:Fgroup=11.08,P<0.001;Ftime=77.14,P<0.001).The horizontal and vertical FOZ diameters were significantly larger in SMILE group than in FS-LASIK group at various postoperative time points,and the differences were statistically significant(all at P<0.001).In the two groups,the postoperative 1-week,1-month and 6-month horizontal FOZ diameters and the postoperative 1-week and 1-month vertical FOZ diameters were smaller than the postoperative 1-day ones,and the differences were statistically significant(all at P<0.05).The

关 键 词：近视 飞秒激光小切口角膜基质透镜取出术 飞秒激光辅助准分子激光原位角膜磨镶术 角膜非球面性 功能性光学区 

分 类 号：R779.6[医药卫生—眼科]