[关键词]
[摘要]
随着屈光手术技术的快速发展，飞秒激光小切口角膜基质透镜取出术(SMILE)因其在保留角膜前弹力层和上皮层完整性方面具有优势，逐渐成为主流术式。然而，术后角膜基质组织的削减和应力分布的改变仍可能导致角膜生物力学性能下降，对术后角膜的稳定性与视觉质量产生不利影响。文章立足于角膜生物力学特性变化的机制，综合分析近年来关于SMILE术后角膜厚度减少、机械强度降低及应力重构的研究。探讨术后角膜扩张风险、高阶像差(HOAs)增加和视觉质量波动的潜在机制，并分析其个体差异，同时归纳当前研究中的争议问题及对临床决策的影响。此外，文章结合角膜交联(CXL)等术后干预策略的最新研究进展，分析这些干预措施在增强角膜生物力学性能、降低术后并发症发生率及改善视觉质量方面的临床应用前景与局限性。最后，对CXL的最佳应用时机、生物力学评估指标的临床阈值以及个体化术前评估与术后干预方案的未来发展方向进行了展望，以期为提高SMILE术后安全性与视觉质量提供理论依据和临床参考。
[Key word]
[Abstract]
With the rapid advancement of refractive surgery, small incision lenticule extraction(SMILE)has become a mainstream procedure due to its biomechanical advantage in preserving the integrity of the anterior elastic layer and epithelium. However,postoperative stromal tissue removal and stress redistribution may still compromise corneal biomechanical stability, potentially affecting long-term corneal stability and visual quality. This review focuses on the mechanisms underlying biomechanical changes after SMILE, summarizing recent findings on corneal thinning, reduced mechanical strength, and stress remodeling, and their impact on corneal morphology and visual quality. It further explores potential contributors to postoperative ectasia, increased higher-order aberrations(HOAs), and visual fluctuations, highlighting individual variability and current controversies in the literature. Moreover, current evidence on adjunctive strategies such as corneal cross-linking(CXL)in enhancing biomechanical strength, reducing complications, and improving optical quality was analyzed. Finally, optimal timing for CXL, threshold values of biomechanical metrics, and the role of individualized preoperative assessment and postoperative management was discussed, aiming to provide a theoretical and clinical basis for improving safety and visual outcomes following SMILE.
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[基金项目]
甘肃省青年科技基金计划项目(No.22JR11RA001); 甘肃省自然科学基金项目(No.23JRRA537, 24JRRA003)
