目的：探讨飞秒激光小切口角膜基质透镜取出术(SMILE)中不同激光能量参数对Ⅰ期不透明气泡层(OBL)及视觉质量的影响。

方法：回顾性分析2018-07/2019-12来本院接受SMILE手术的216例432眼患者临床资料。根据是否发生Ⅰ期OBL分为OBL组(42眼)和非OBL组(390眼)，比较两组年龄、视力参数、角膜参数、微透镜参数及能量参数，采用多因素回归分析能量设置差异与Ⅰ期OBL发生关联。比较130、135、140、145、150nJ能量参数患者术前、术后1mo的裸眼视力(UCVA)、最佳矫正视力(BCVA)、调制传递函数截止空间频率(MTF_cut-off)、斯特列尔比(SR)和眼内客观散射指数(OSI)。分析能量参数与Ⅰ期OBL、UCVA、BCVA、MTF_cut-off、SR、OSI的相关性。

结果：多因素回归分析显示，以5nJ为差异的能量设置未显现与Ⅰ期OBL的关联。不同能量参数组中，术后1mo UCVA(LogMAR)、MTF_cut-off、OSI均较术前改善(P<0.05)，组间有差异(F=75.712、15.304、26.293，均P<0.05)。SMILE术中能量参数与术后1mo UCVA(LogMAR)、MTF_cut-off、OSI呈负相关(r_s=-0.272、-0.132、-0.151，均P<0.05)。

结论：采用4.5μm的点间距时，常用能量范围内，越低能量的术后视觉质量更好，但不明显影响Ⅰ期OBL的发生。

METHODS: A retrospective analysis of the clinical data of 216 patients(432 eyes)who came to our hospital for SMILE surgery from July 2018 to December 2019. According to whether stage Ⅰ OBL occurred, they were divided into OBL group(42 eyes)and non-OBL group(390 eyes). The age, visual acuity parameters, corneal parameters, microlens parameters and energy parameters were compared between the two groups, and multivariate regression analysis was used to analyze the relationship between the difference in energy settings and the OBL of stage Ⅰ. The uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), and modulation transfer function cut-off spatial frequency(MTF_cut-off), Strehl Ratio(SR)and Objective Scattering Index(OSI)with energy parameters of 130, 135, 140, 145, and 150 nJ before and 1mo after surgery were compared. The correlation between energy parameters and stage Ⅰ OBL, UCVA, BCVA, MTF_cut-off, SR, OSI were analyzed.

RESULTS: Multivariate regression analysis showed that the energy setting with a difference of 5nJ did not show an association with stage Ⅰ OBL. In the different energy parameter groups, LogMAR UCVA, MTF_cut-off, and OSI at 1mo after surgery were improved compared with preoperatively(P<0.05), and the difference between the groups were statistically significant(F=75.712, 15.304, 26.293, all P<0.05). SMILE intraoperative energy parameters were negatively correlated with UCVA(r=-0.272), MTF_cut-off(r=-0.132), and OSI(r=-0.151)1mo after surgery(P<0.05).

CONCLUSION: When using a 4.5μm dot pitch, in the usual energy range, the lower the energy, the better the postoperative visual quality, but it does not significantly affect the incidence of stage Ⅰ OBL during SMILE surgery.