SMILE和FS-LASIK术对高度近视患者术后早期角膜高阶像差的影响

Effects of SMILE and FS-LASIK on early postoperative corneal higher order aberrations in patients with high myopia

摘要:

目的：研究飞秒激光小切口角膜基质透镜取出术(SMILE)和飞秒激光辅助的准分子激光原位角膜磨镶术(FS-LASIK)对高度近视患者术后早期角膜高阶像差(HOAs)和视觉质量的影响。

方法：以2018-08/2020-08在我院接受角膜屈光手术的高度近视患者102例204眼为研究对象进行前瞻性研究，随机分为SMILE组(51例102眼)和FS-LASIK组(51例102眼)，比较两组患者术后视力、角膜HOAs和客观视觉质量，分析角膜HOAs与客观视觉质量的相关性。

结果：术后1mo时，SMILE组和FS-LASIK组患者等效球镜度数均明显降低(P<0.05)，且两组患者术后裸眼视力优于术前最佳矫正视力患者占比无差异(95.1% vs 92.2%，P>0.05)； 两组患者角膜各高阶像差均明显升高(P<0.05)，且SMILE组总球差(SA)、三叶草像差(trefoil)和高阶像差(HOAs)低于FS-LASIK组(均P<0.05)； 两组患者客观散射指数(OSI)明显升高，MTF截止频率(MTF_cutoff)、斯特列尔比(SR)、对比度视力(VA100%、VA20%、VA9%)均明显降低(均P<0.05)，且SMILE组OSI低于FS-LASIK组，MTF_cutoff和VA9%高于FS-LASIK组(均P<0.05)； 高度近视患者术后角膜各高阶像差与MTF_cutoff均呈负相关性，与OSI均呈正相关性(P<0.05)。

结论：SMILE和FS-LASIK术均可有效矫正高度近视，且SMILE术后早期角膜HOAs升高幅度更小，对减轻视觉质量损害具有重要意义。

Abstract:

AIM: To study the effects of small-incision lenticule extraction(SMILE)and femtosecond laser-assisted excimer laser in situ keratomileusis(FS-LASIK)on early postoperative corneal higher order aberrations(HOAs)and visual quality in patients with high myopia.

METHODS:Totally 102 patients(204 eyes)with high myopia who underwent corneal refractive surgery between August 2018 and August 2020 in the hospital were selected as study subjects for the prospective study, and they were randomly divided into SMILE group(51 cases, 102 eyes)and FS-LASIK group(51 cases, 102 eyes). The postoperative visual acuity, corneal HOAs and objective visual quality were compared between the two groups, and the correlation between corneal HOAs and objective visual quality was analyzed.

RESULTS: At 1mo after surgery, the spherical equivalent degrees in SMILE group and FS-LASIK group were significantly reduced(P<0.05), and there was no statistically significant difference in the proportion of patients with postoperative uncorrected visual acuity≥preoperative best corrected visual acuity between the two groups(95.1% vs 92.2%, P>0.05). The corneal HOAs in the two groups were significantly increased(P<0.05), and the overall spherical aberration(SA), trefoil and higher HOAs in SMILE group were lower than those in FS-LASIK group(all P<0.05). The objective scattering index(OSI)was significantly increased in the two groups while the MTF cutoff frequency(MTF_cutoff), Strehl Ratio(SR)and contrast visual acuity(VA100%, VA20%, VA9%)were significantly decreased(all P<0.05). The OSI of SMILE group was lower than that of FS-LASIK group while MTF_cutoff and VA9% were higher than those of FS-LASIK group(all P<0.05). The corneal HOAs in patients with high myopia were negatively correlated with MTF_cutoff and were positively correlated with OSI(P<0.05).

CONCLUSION:Both SMILE and FS-LASIK can effectively correct high myopia, and SMILE has a smaller increase in early postoperative corneal HOAs, and it is of great significance to relieve visual quality impairment.