SMILE与EVO-ICL植入术矫正中度近视的短期视觉质量观察

Short-term visual quality observation of femtosecond laser small incision lenticule extraction and evolution implantable collamer lens implantation in the correction of moderate myopia

摘要:

目的：探讨飞秒激光小切口角膜基质透镜取出术(SMILE)与中央孔型有晶状体眼后房型人工晶状体(EVO-ICL)植入术矫正中度近视术后短期视觉质量表现。

方法：前瞻性对照研究。选取2021-04/2022-02在潍坊眼科医院行SMILE和EVO-ICL植入术的中度近视患者51例51眼，根据手术方式分为SMILE组(30例30眼)和EVO-ICL组(21例21眼)。分别于术前、术后1wk，1、3mo观察两组患者视力\〖裸眼远视力(UDVA)、矫正远视力(CDVA)\〗、屈光度\〖等效球镜度(SE)\〗及双通道客观视觉质量分析系统(OQASⅡ)相关参数的变化，并填写视觉质量(QoV)调查问卷。

结果：术后3mo，SMILE组和EVO-ICL组安全性指数(术后CDVA/术前CDVA)分别为1.20(1.00，1.20)和1.20(1.00，1.38)，有效性指数(术后UDVA/术前CDVA)分别为1.00(1.00，1.20)和1.00(1.00，1.20)； SE在±0.50D以内的比例分别为87%和100%。SMILE组术后客观散射指数(OSI)值增加，术后1wk， 1mo调制传递函数截止频率(MTF cutoff)、对比度视力(VA)100%、VA20%及术后各时间点斯特列尔比(SR)、VA9%均较术前降低(均P<0.05)； EVO-ICL组术后各时间点OSI、MTF cutoff、SR、VA与术前相比均无差异(均P>0.05)。SMILE和EVO-ICL植入术后最常见的视觉症状分别为视觉朦胧和光晕。

结论：SMILE和EVO-ICL植入术矫正中度近视术后短期均有良好的安全性、有效性及可预测性，两种手术术后均有视觉症状的发生，但患者总体满意度高，且EVO-ICL植入术后具有更好的客观视觉质量表现。

Abstract:

AIM: To investigate the short-term visual quality outcomes after femtosecond laser small incision lenticule extraction(SMILE)and evolution implantable collamer lens(EVO-ICL)implantation for the correction of moderate myopia.

METHODS: Prospective control study. A total of 51 cases(51 eyes)with moderate myopia who underwent SMILE or EVO-ICL implantation surgery at Weifang Eye Hospital from April 2021 to February 2022 were selected. They were divided into SMILE group(30 patients, 30 eyes)and EVO-ICL group(21 patients, 21 eyes)according to the surgical methods. The changes of visual acuity \〖uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA)\〗, diopter \〖spherical equivalent(SE)\〗 and related parameters of optical quality analysis system(OQAS Ⅱ)were observed before surgery and at 1wk, 1 and 3mo after surgery, and the quality of vision(QoV)questionnaire was completed.

RESULTS: At 3mo after surgery, the safety index(postoperative CDVA/preoperative CDVA)of SMILE gruop and EVO-ICL group were 1.20(1.00, 1.20)and 1.20(1.00, 1.38), respectively, the efficacy index(postoperative UDVA/preoperative CDVA)were 1.00(1.00, 1.20)and 1.00(1.00, 1.20), respectively, and the percentage of SE within ±0.50D was 87% and 100%, respectively. In SMILE group, the objective scattering index(OSI)was increased after surgery, while modulation transfer function cutoff frequency(MTF cutoff), contrast visual acuity(VA)100%, and VA20% at 1wk and 1mo after surgery, and Strehl ratio(SR)and VA9% at each time point after surgery were all decreased compared with those before surgery(all P<0.05). The OSI, MTF cutoff, SR and VA of EVO-ICL group showed no difference at each time point after surgery compared with those before surgery(all P>0.05). The most common visual symptoms after SMILE and EVO-ICL implantation were visual haze and halos, respectively.

CONCLUSION: Both SMILE and EVO-ICL implantation have good safety, efficacy and predictability in the short term after the correction of moderate myopia. Both groups had visual symptoms after surgery, but the overall satisfaction of patients was high. Furthermore, EVO-ICL implantation has better objective visual quality performance.