SMILE与FS-LASIK术后屈光状态偏差原因分析及结果评价  

Analysis of the causes of deviations in refractive status after SMILE and FSLASIK and evaluation of the results

作　　者：李颖[1] 徐江保 范淑琪 吴泽德 李俊[1] Li Ying;Xu Jiangbao;Fan Shuqi;Wu Zede;Li Jun(Department of Ophthalmology,Lishui Central Hospital af-filiated to Wenzhou Medical University,Lishui 323000,China;Department of Ophthalmology,The Quzhou People’s Hospi-tal,Quzhou 324000,China)

机构地区：[1]温州医科大学附属丽水市中心医院眼科,323000 [2]温州医科大学附属衢州医院,324000

出　　处：《临床眼科杂志》2024年第4期298-303,共6页Journal of Clinical Ophthalmology

基　　金：浙江省医药卫生科技项目(2020RC151)。

摘　　要：目的观察飞秒激光制瓣联合准分子激光原位角膜磨镶术(FSLASIK)与飞秒激光小切口角膜基质透镜取出术(SMILE)术后屈光状态偏差,并分析其结果和原因。方法回顾性临床研究。按照手术方式分为两组,FSLASIK组300例(600只眼),按照手术时间再分为pre FSLASIK 200例(400只眼),FSLASIK 100例(200只眼),SMILE组100例(200只眼),术前球镜度-0.75~12.25 D,柱镜度0~3.75 D,均未预留度数,最佳矫正视力(BCVA)≥1.0,分别于术前、术后1 d、1周、1个月、3个月、6个月复查并记录所有患者非接触眼压测量、裸眼视力(UCVA)、BCVA、等效球镜(SE)、电脑验光、裂隙灯显微镜检查。对因素进行相关分析得到结果后,建立回归模型,进行回归分析,根据结果进一步分析。结果术后屈光状态主要受手术方式及术前柱镜的影响(P<0.05),FSLASIK术后患者右眼柱镜结果与SMILE术后患者右眼柱镜结果在术后7 d、1个月、3个月、6个月差异均有统计学意义(P<0.05),左右眼术后屈光状态无相关性。结论SMILE术后患者平均右眼柱镜欠矫程度较FSLASIK术后患者多0.25~0.50 D,主要与SMILE手术方式、眼球自旋以及角膜上皮重塑行为有关,建议高度数患者采用FSLASIK手术或更改SMILE手术方式为扫描后即刻取镜。Objective To observe the deviation of refractive state after femtosecond laser valving combined with excimer laser in situ keratomileusis(FS-LASIK)and femtosecond laser small incision lens extraction(SMILE).Methods Retrospective clinical study.According to the operation method,the FS-LASIK group was divided into two groups:300 cases(600 eyes),and then divided into pre FS-LASIK 200 cases(400 eyes),FS-LASIK 100 cases(200 eyes),and SMILE group 100 cases(200 eyes).The preoperative spherical diopter was-0.75~12.25 D,and the columnar diopter was 0~3.75 D,with no degree reserved.The best corrected visual acuity(BCVA)≥1.0,respectively,before and at 1 day,1 week,1 month,3 months after the operation.The non-contact intraocular pressure measurement,uncorrected visual acuity(UCVA),BCVA,spherical equivalent refraction(SE),computer optometry and slit lamp microscopy were reviewed and recorded in the 6-month follow-up period.After the results of the correlation analysis of factors were obtained,a regression model was established for regression analysis and further analysis was carried out according to the results.Results The postoperative refractive status was mainly influenced by the surgical method and preoperative cylindrical lens(P<0.05).At 7 days,1 month,3 months and 6 months after the operation,there were significant differences between the results of the righteye cylindrical lens after FS-LASIK and those after SMILE(P<0.05)Conclusions The average uncorrected degree of right ophthalmoscope in patients after SMILE was 0.25~0.50 D more than that in patients after FSLASIK,which was mainly related to SMILE operation mode,eye spin and corneal epithelial remodeling behavior.It was suggested that patients with high altitude should adopt FS-LASIK operation or change SMILE operation mode to take out the lens immediately after scanning.

关 键 词：飞秒激光制瓣联合准分子激光原位角膜磨镶术 全飞秒激光小切口角膜透镜取出术 屈光状态偏差 屈光参差 

分 类 号：R779.63[医药卫生—眼科]