SMILE和ICL矫正中低度近视术后角膜前后表面和总角膜高阶像差的变化

Changes of the anterior, posterior corneal surface and total cornea high order aberrations after SMILE or ICL correction for low and moderate myopia

摘要:

目的：对比分析飞秒激光小切口角膜基质透镜取出术(small incision lenticule extraction，SMILE)和有晶状体眼人工晶状体植入术(implantable collamer lens，ICL)矫正中、低度近视术后角膜前表面、后表面和总角膜高阶像差的变化。

方法：回顾性研究，选取2017-11/2018-02在西安爱尔眼科医院屈光中心行SMILE手术及ICL手术矫正中、低度近视患者各35例70眼。术前及术后1、3、6mo应用基于Ray Tracing技术的Scheimpflug成相评估6mm直径的角膜前表面、后表面和总角膜高阶像差，采用重复测量方差分析对不同时间点角膜彗差、球差和总高阶像差均方根进行比较。

结果：术后1、3、6mo SMILE组和ICL组患者裸眼视力均达到或超过术前最佳矫正视力。术前两组患者各项角膜像差差异无统计学意义(P>0.05)。术后1mo，SMILE组角膜前表面高阶像差较术前显著增加，差异有统计学意义(P<0.05)，而ICL组角膜前表面高阶像差无显著变化，差异无统计学意义(P>0.05)； 术后两组患者角膜后表面高阶像差差异无统计学意义(P>0.05)，两组间患者彗差、球差和总高阶像差比较差异无统计学意义(P>0.05)。

结论：相比SMILE手术，ICL术矫正中、低度近视在短期内引入的角膜前表面高阶像差更小。

Abstract:

AIM: To compare and analyze the changes of the anterior corneal surface, posterior surface and total corneal high-order aberration between femtosecond small incision lenticule extraction(SMILE)and implantable collamer lens(ICL)in the correction of moderate and low myopia.

METHODS: Retrospective Study. Patients underwent SMILE surgery(n=35)or ICL surgery(n=35)with moderate or low myopia were selected in the refractive center of the Xi'an Aier Eye Hospital from November 2017 to February 2018. Before and 1, 3 and 6mo after surgery, the Scheimpflug phase formation based on Ray Tracing technology was applied to evaluate the anterior corneal surface, posterior surface and total corneal high-order aberration with a diameter of 6mm. Repeated measurement ANOVA was used to analyze the mean square root of corneal coma, spherical aberration and total high-order aberration at different time points.

RESULTS: The post-surgery uncorrected visual acuity of both the SMILE group and the ICL group at 1, 3, and 6mo reached or exceeded the pre-surgery best corrected visual acuity, and the pre-surgery corneal aberrations of the two groups were not statistically significant(P>0.05). One month after surgery, the precorneal high-order aberration of the SMILE group was significantly increased(P<0.05), while the precorneal high-order aberration of the ICL group was unchanged(P>0.05). Post-corneal aberration of the two groups was not statistically significant(P>0.05). After surgery, and the differences of coma, spherical aberration and total high-order aberration between the two groups were not significantly(P>0.05).

CONCLUSION: Compared with SMILE surgery, precorneal high-order aberration induced by ICL is less for moderate and low myopia in the short term.