FS-LASIK与SMILE手术前后视网膜周边屈光状态及像差的变化

Changes in retinal peripheral refractive status and aberrations before and after femtosecond laser-assisted laser in situ keratomileusis and small incision lenticule extraction

摘要:

目的：观察比较飞秒激光制瓣准分子激光原位角膜磨镶术(FS-LASIK)与飞秒激光小切口角膜基质透镜取出术(SMILE)矫正近视术后视网膜周边屈光和像差的改变。

方法：选取2022-10/2023-04来院行FS-LASIK的近视患者71例71眼作为FS-LASIK组，行SMILE的近视患者80例80眼作为SMILE组。所有患者于术前，术后3mo均行角膜像差检查和多光谱地形图检查，检查黄斑周围0°～10°、10°～20°、20°～30°、30°～40°、40°～53°环形视网膜相对离焦值(RDV)，并记录为RDV-(0°～10°)、RDV-(10°～20°)、RDV-(20°～30°)、RDV-(30°～40°)、RDV-(40°～53°)。对两组患者检查结果进行比较。

结果：术后3mo，两组患者RDV-(0°～10°)、RDV-(10°～20°)、RDV-(20°～30°)、RDV-(30°～40°)、RDV-(40°～53°)比较均无差异(均P>0.05)。两组术后3mo的RDV-(20°～30°)、RDV-(30°～40°)、RDV-(40°～53°)均显著低于术前(均P<0.05)。SMILE组患者术后3mo时的彗差(水平)及球差(SA)分别为0.106(0.056，0.171)、0.115(0.081，0.182)μm，均显著低于FS-LASIK组\〖0.206(0.104，0.355)、0.197(0.128，0.254)μm\〗(Z=-4.170、-5.016，均P<0.05)。术后SA与术后RDV-(10°～53°)呈负相关(r_s=-0.205、-0.181、-0.226、-0.244，均P<0.05)。

结论：FS-LASIK与SMILE均能减少黄斑周围20°～53°离心率范围的视网膜远视离焦，且SMILE术后彗差(水平)和SA的改变比FS-LASIK小。术后SA与术后的周边视网膜离焦存在一定的相关性。

Abstract:

AIM: To observe and compare the changes in retinal peripheral refraction and aberrations after femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)versus small incision lenticule extraction(SMILE)for myopia correction.

METHODS: A total of 71 patients(71 eyes)with myopia who underwent FS-LASIK from October 2022 to April 2023 in our hospital were selected as the FS-LASIK group, and 80 patients(80 eyes)with myopia who underwent SMILE were selected as the SMILE group. All patients underwent corneal wavefront aberration measurement and multispectral refractive topography preoperatively and 3mo postoperatively, as well as refraction difference value(RDV)in the range of 0°～10°, 10°～20°, 20°～30°, 30°～40°, and 40°～53° in the annulus of the retina, which were recorded as RDV-(0°～10°), RDV-(10°～20°), RDV-(20°～30°), RDV-(30°～40°), and RDV-(40°～53°). The results of two groups of patients were compared.

RESULTS: No significant differences were observed in RDV-(0°～10°), RDV-(10°～20°), RDV-(20°～30°), RDV-(30°～40°), RDV-(40°～53°)between the two groups at 3mo post-operation(all P>0.05). Furthermore, the RDV-(20°～30°), RDV-(30°～40°)and RDV-(40°～53°)of the two groups at 3mo postoperatively were all significantly lower than those preoperatively(all P<0.05). The changes in coma(horizontal)and spherical aberration(SA)at 3mo postoperatively were smaller in the SMILE group \〖0.106(0.056, 0.171)and 0.115(0.081, 0.182)μm\〗 than in the FS-LASIK group \〖0.206(0.104, 0.355)and 0.197(0.128, 0.254)μm\〗(Z=-4.170, -5.016, all P<0.05). A negative correlation was found between postoperative SA and postoperative RDV-(10°～53°)(r_s=-0.205, -0.181, -0.226, -0.244, all P<0.05).

CONCLUSION: Both FS-LASIK and SMILE reduced retinal hyperopic defocus in the peripapillary macular range of 20°～53° eccentricity, and the postoperative changes in coma(horizontal)and SA were smaller with SMILE than with FS-LASIK. There was a certain correlation between postoperative SA and postoperative retinal peripheral defocus.