SMILE、FS-LASIK和TPRK术后高阶像差的变化和比较  

Comparison and Observation of Higher-Order Aberrations after SMILE,TPRK and FS-LASIK

作　　者：汪凌 陈俐君 朱叶 陈世豪 Ling Wang;Lijun Chen;Ye Zhu;Shihao Chen(National Clinical Research Center for Ocular Diseases,Eye Hospital,Wenzhou Medical University,Wenzhou 325027,China;Zhongshan Torch Development Zone People's Hospital,Zhongshan 528437,China)

机构地区：[1]温州医科大学附属眼视光医院国家眼耳鼻喉疾病临床医学研究中心(眼部疾病),温州325027 [2]中山火炬开发区人民医院,中山528437

出　　处：《中华眼视光学与视觉科学杂志》2025年第1期46-55,共10页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：温州市基础性科研项目(Y2020349)。

摘　　要：目的:观察分析并比较飞秒激光小切口角膜基质透镜取出术(SMILE)、飞秒激光制瓣的准分子激光原位角膜磨镶术(FS-LASIK)、经上皮的准分子激光屈光性角膜切削术(TPRK)术后6个月内高阶像差的变化、差异及影响因素。方法:前瞻性非随机临床研究。连续选取2020年7月至2021年6月在温州医科大学附属眼视光医院屈光手术临床中心行SMILE、FS-LASIK、TPRK的近视或近视伴散光患者55例(55眼),均纳入右眼,根据手术方式不同分为SMILE组16眼、FS-LASIK组19眼、TPRK组20眼。除常规检查外,术前及术后1、3、6个月测量波前像差,从Pentacam眼前节分析仪中获取角膜前表面Q值及中央角膜厚度(CCT),根据术前和术后CCT的差值获得实际基质切削深度,采用切线差异法获得有效光学区直径。3组间术前基线数据、术后Q值和CCT等比较采用单因素方差分析;3组间像差比较采用双因素重复测量方差分析,LSD-t检验用于组内和组间的进一步比较;术后像差与各影响因素的相关关系采用Pearson相关性分析。结果:在组内,3组术后各随访时间点角膜总高阶像差(HOAs)、球差、彗差均较术前明显增大(均P<0.05);FS-LASIK组内术后3、6个月及TPRK组内术后各随访时间点全眼HOAs均较术前明显增大(均P<0.05),FS-LASIK组、TPRK组术后全眼球差均较术前明显增大(均P<0.001);SMILE组和FS-LASIK组术后眼内HOAs、TPRK组术后眼内球差、SMILE组术后眼内彗差、FS-LASIK组术后眼内三叶草像差均较术前明显减小(均P<0.05)。在组间,FS-LASIK组术后1个月的角膜球差明显大于SMILE组(P=0.013),FS-LASIK组和TPRK组术后3、6个月的角膜球差均明显大于SMILE组(均P<0.05)。SMILE组的有效光学区直径明显大于FS-LASIK组和TPRK组(均P<0.05),SMILE组角膜中央6 mm的Q值明显小于FS-LASIK组和TPRK组(均P<0.05)。3组的有效光学区直径与全眼球差、角膜HOAs、球差均呈负相关(均P<0.05);实际切削深度�Objective:This study aims to observe and analyze the changes and trends in higher-order aberrations within 6 months postoperatively following three distinct refractive surgeries:small incision lenticule extraction(SMILE),femtosecond laser-assisted in situ keratomileusis(FS-LASIK),and transepithelial photorefractive keratectomy(TPRK).Additionally,this study aims to compare the differences among these surgeries and explore the potential correlations between these changes and patient outcomes.Methods:This prospective nonrandomized clinical study consecutively enrolled 55 patients(55 eyes)with myopia or myopic astigmatism who underwent SMILE,FS-LASIK or TPRK at the Refractive Surgery Center,Eye Hospital,Wenzhou Medical University from July 2020 to June 2021.Only the right eye of each participant was selected,and patients were categorized into three groups based on the surgical intervention:the SMILE group(16 eyes),the FS-LASIK group(19 eyes),the TPRK group(20 eyes).In addition to routine examinations,preoperative and postoperative wavefront aberrations were measured at 1,3,and 6 months.Corneal anterior surface Q value and central corneal thickness(CCT)were obtained from Pentacam anterior segment analyzer.The actual stromal ablation depth was derived from the difference in CCT values between preoperative and postoperative assessments.Effective optical zone diameter was determined using the tangential difference map.Preoperative baseline data,postoperative Q-values,and CCT were compared among the three groups using one-way analysis of variance(ANOVA).Wavefront aberrations across the groups were analyzed using two-way repeated measures ANOVA,with LSD-t tests for further intragroup and intergroup comparisons.The correlation between postoperative aberration and various influencing factors was assessed using Pearson correlation analysis.Results:Within each group,the total higher-order aberrations(HOAs),spherical aberrations,and coma aberrations of the cornea significantly increased postoperatively at all follow-up time poi

关 键 词：近视 飞秒激光 角膜磨镶术 表层切削 高阶像差 屈光手术 

分 类 号：R779.63[医药卫生—眼科]