SMILE、FS-LASIK和ICL矫正高度近视术后视觉质量的比较  

Comparison of postoperative visual quality after SMILE,FS-LASIK and ICL for high myopia

作　　者：万超 王素华 王科 高利霞 姚春莲 杨于力 WAN Chao;WANG Suhua;WANG Ke;GAO Lixia;YAO Chunlian;YANG Yuli(Department of Ophthalmology,the First Affiliated Hospital of Army Military Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院眼科,重庆400038

出　　处：《检验医学与临床》2024年第21期3126-3131,3136,共7页Laboratory Medicine and Clinic

基　　金：国家自然科学基金面上项目(82271055);重庆市科卫联合医学科研项目面上项目(2022MSXM051)。

摘　　要：目的比较小切口角膜基质透镜取出术(SMILE)、飞秒激光辅助准分子激光原位角膜磨镶术(FS-LASIK)与有晶体眼人工晶体植入术(ICL)矫正高度近视的效果及视觉质量。方法回顾性分析2017年1月至2019年1月在该院近视手术中心接受屈光矫正的高度近视手术患者102例(180眼)的临床资料,术后随访时间为6个月。根据手术方式的不同将患者分为3组:SMILE组35例(60眼)、FS-LASIK组30例(60眼)、ICL组37例(60眼)。使用视觉质量分析仪(OPD-ScanⅢ)测量3组患者术前及术后6个月6 mm瞳孔直径的全眼总像差、全眼总高阶像差、全眼彗差、全眼三叶草差、全眼球差和4个空间频率(10、15、30、45 cpd)的对比敏感度,同时收集并比较患者裸眼视力(UCVA)、最佳矫正视力(BCVA)、等效球镜度数(SE)、安全性指数和有效性指数等视觉指标。结果术前3组患者的UCVA、BCVA、SE、全眼总像差、全眼总高阶像差、全眼彗差、全眼三叶草差、全眼球差和4个空间频率(10、15、30、45 cpd)的对比敏感度比较,差异均无统计学意义(P>0.05)。术后6个月,3组患者的SE绝对值、全眼总像差均较术前明显降低,UCVA、BCVA、全眼总高阶像差、全眼彗差、全眼球差均较术前增加,差异均有统计学意义(P<0.05)。术后6个月,3组患者UCVA和BCVA比较,差异均无统计学意义(P>0.05)。术后6个月,3组全眼总像差、全眼总高阶像差、全眼彗差、全眼球差、全眼三叶草差比较,差异均有统计学意义(P<0.05)。术后6个月,ICL组全眼总像差、全眼彗差低于其余两组,差异均有统计学意义(P<0.05);SMILE组全眼球差低于其余两组,差异均有统计学意义(P<0.05);FS-LASIK组全眼三叶草差低于其余两组,差异均有统计学意义(P<0.05)。结论SMILE、FS-LASIK和ICL 3种屈光矫正手术方式矫正高度近视安全性高、术后屈光预测性佳、视觉质量好。Objective To compare effect and visual quality of small incision lenticule extraction(SMILE),femtosecond laser in situ keratomileusis(FS-LASIK)and implantable collamer lens(ICL)implantation for high myopia.Methods The clinical data of 102 patients(180 eyes)with high myopia who underwent refractive surgery from January 2017 to January 2019 in the hospital were analyzed retrospectively.The postoperative follow-up period was six months.The patients were divided into three groups according to the surgical modality:35 cases(60 eyes)in the SMILE group,30 cases(60 eyes)in the FS-LASIK group,and 37 cases(60 eyes)in the ICL group.The total ocular aberration,total higher-order aberration,coma aberration,trefoil aberration,spherical aberration,contrast sensitivity at four spatial frequencies(10,15,30,45 cpd)for a 6 mm pupil diameter were measured by OPD-ScanⅢanalyzer,both preoperatively and six months postoperatively.Additionally,uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA),spherical equivalent(SE),safety index and efficacy indexes were collected and compared among the three groups.Results There was no significant difference in UCVA,BCVA,SE,total ocular aberration,total higher-order aberration,coma aberration,trefoil aberration,spherical aberration and contrast sensitivity at four spatial frequencies(10,15,30,45 cpd)among the three groups preoperatively(P>0.05).At 6 months postoperatively,the absolute value of SE and total ocular aberration in those three groups were significantly decreased compared with the preoperative period,and the UCVA,BCVA,total higher-order aberration,coma aberration and spherical aberration were increased with statistically significant differences(P<0.05).There was no statistical significantly difference on the UCVA and BCVA among the three groups at 6 months postoperatively(P>0.05).At 6 months postoperatively,total ocular aberration,total higher-order aberration,coma aberration,spherical aberration and trefoil aberration were compared among these three groups,and the differe

关 键 词：高度近视 飞秒激光 有晶体眼人工晶体植入术 像差 对比敏感度 

分 类 号：R778.1[医药卫生—眼科] R779.6[医药卫生—临床医学]