One-year clinical efficacy evaluation of selective corneal wavefront aberration-guided FS-LASIK correction in patients with high myopia

AIM: To evaluate the effectiveness, safety, predictability, precision and changes of higher-order aberrations (HOAs) on corneal front surface of selective corneal wavefront aberration-guided femtosecond laser-assisted in situ keratomileusis (CW-FS-LASIK) in patients with high myopia 1-year postoperatively. METHODS: Totally 74 eyes of 37 patients with high myopia or myopic astigmatism in both the eyes who underwent the CW-FS-LASIK procedure in Xi’an Gaoxin Hospital from January 2021 to June 2021 were included. The changes of uncorrected distance visual acuity (UDVA), best corrected visual acuity (BCVA), spherical equivalent refraction (SER), astigmatism, HOAs and Strehl ratio (SR) on the anterior surface of the cornea after 1y of the surgery were analyzed. RESULTS: At postoperative 1y, the UDVA (logMAR) of 74 eyes (100%) reached 0 or better, including 0 in 8 eyes (10.81%), -0.1 in 45 eyes (60.81%), and -0.2 in 21 eyes (28.38%). The effectiveness index was 1.29±0.134. There was no decrease in postoperative BCVA compared with preoperative BCVA in all patients. Postoperative BCVA was the same in 44 eyes (59.46%) as preoperative BCVA, increased by 1 line in 23 eyes (31.08%) and increased by 2 lines in 7 eyes (9.46%) compared with preoperative BCVA. The safety index was 1.11±0.159. The estimated corrected SER before surgery was (-7.76±1.21) D, and the actual corrected SER was (-7.83±1.25) D (Y=0.9811X+0.2156, R2=0.9084). There was a high correlation between the estimated corrected SER and the actual corrected SER. The postoperative SER in 74 eyes (100%) was within ±0.75 D. The postoperative astigmatism of all was within -0.75 D to 0. Root mean square (RMS) HOAs of spherical aberration and SR within 5 mm of the corneal front surface were all increased compared with those before operation (P<0.01). The total coma, horizontal coma and vertical coma were all decreased compared with those before operation (P<0.01). There was no statistically significant difference in horizontal trefoil and vertical trefoil compared with preoperative ones (P>0.05). CONCLUSION: Selective CW-FS-LASIK for correction of high myopia is effective, safe, predictive, and accurate. For patients with preoperative RMS HOAs over 0.25 defocus equivalent, postoperative coma aberration can be significantly reduced, and SR value can be increased, thus corneal imaging quality can be improved.     

角膜地形图引导的FS-LASIK与TICL植入术矫正近视合并中高度散光的疗效

目的：探讨角膜地形图引导的飞秒激光制瓣的准分子激光原位角膜磨镶术(FS-LASIK)与有晶状体眼后房型环曲面人工晶状体(TICL)植入术矫正近视合并中高度散光的临床疗效。

方法：选取2019-06/2021-06在河源爱尔眼科医院屈光中心就诊的近视合并中高度散光患者60例115眼,按手术方式分组,接受角膜地形图引导的FS-LASIK患者32例62眼纳入A组; 接受TICL植入术的患者28例53眼纳入B组。记录术前、术后3mo的裸眼视力(UCVA)、最佳矫正视力(BCVA)、球镜度、残余散光度,评估手术安全性和有效性,并利用Alpins矢量分析方法评估散光的矫正效果。

结果：术后3mo,两组患者安全性指数(1.163±0.167 vs 1.136±0.194)和有效性指数(1.145±0.159 vs 1.123±0.196)均无差异(P>0.05),但散光矢量分析显示两组患者成功指数\〖0.125(0.091,0.200)vs 0.200(0.167,0.250)\〗、矫正指数\〖1.000(0.902,1.066)vs 0.834(0.783,0.869)\〗、变平指数\〖1.000(0.922,1.079)vs 0.835(0.795,0.870)\〗均有差异(P<0.01)。

结论：角膜地形图引导的FS-LASIK与TICL植入术均能安全、有效地矫正近视散光,角膜地形图引导的FS-LASIK手术矫正散光的效果优于TICL植入术。     

FS-LASIK Xtra治疗中高度近视患者术后2a的矫正效果

目的:评估FS-LASIK Xtra治疗中高度近视患者术后2 a的矫正效果及角膜形态的稳定性。方法:回顾性病例对照研究。纳入2019-08/2020-08在我院拟行屈光手术的中高度近视合并散光患者30例58眼,根据术前角膜地形图中圆锥角膜筛查相关指数行不同手术方式,分为FS-LASIK Xtra组15例29眼,FS-LASIK组15例29眼。术前,术后3 mo, 1、2 a观察裸眼视力(UCVA)、最佳矫正视力(BCVA)、等效球镜度(SE)及Sirius三维角膜地形图仪测量的不同直径区域(3、5、7 mm)前后表面角膜曲率。结果:两组患者术后不同时间点UCVA均较术前明显提高(均P<0.01),两组间UCVA和SE比较均无差异(P>0.05)。术后2 a, FS-LASIK Xtra组25眼(86%),FS-LASIK组24眼(83%)残余散光为-0.25-0 D。两组实际矫正SE与预矫正SE均呈正相关(均P<0.05)。两组患者术后3 mo, 1、2 a不同直径区域(3、5、7 mm)前后表面角膜曲率均较术前有差异(均P<0.05),术后1、2 a FS-L...     

Comparative study of objective visual quality between FS-LASIK and SMART in myopia

AIM: To compare the changes in the objective visual quality of patients with low and moderate myopia postoperatively after transepithelial photorefractive keratectomy using the smart pulse technology (SMART) and femtosecond laser in situ keratomileusis (FS-LASIK). METHODS: Corneal higher-order aberrations (HOAs), horizontal coma, vertical coma and spherical aberration were measured using Pentacam, and cutoff for modulation transfer function (MTF cutoff), objective scatter index (OSI) and Strehl ratio (SR) was measured using an optical quality analysis system (OQAS-II), before and after operation at 1, 3, and 6mo, and data were analyzed by repeated measurement two-way analysis of variance. RESULTS: The difference in uncorrected distance visual acuity between SMART and FS-LASIK was statistically significant only 1wk postoperatively. Approximately 86.36% and 80.69% of patients with spherical equivalent (SE) in ±0.50 D were observed in the SMART and FS-LASIK groups, respectively. No significant difference was observed in SE between the two groups (P=0.509). The HOAs increased postoperatively compared with those before surgery in both groups (P<0.05). No significant difference in HOA, corneal horizontal coma, spherical aberration, ΔHOA, Δhorizontal coma, and Δspherical aberration were observed between the two group (P>0.05). Corneal vertical coma and Δcorneal vertical coma in the FS-LASIK group were higher than those in the SMART group (P<0.05). The OSI of both groups at 1mo after surgery was higher than that before surgery (P<0.05). At 3 and 6mo postoperatively, the OSI in the FS-LASIK group was slightly higher than that in the SMART group (P=0.040 and 0.047, respectively). At 6mo after surgery, the MTF cutoff was statistically significant different between the two groups (P=0.026). No significant difference in SR between the FS-LASIK and SMART groups was observed at 1, 3, and 6mo postoperatively (P>0.05). CONCLUSION: The HOAs increase and visual quality is delayed in both groups postoperatively, and the long-term objective visual quality after SMART is slightly better than that after FS-LASIK.     

FS-LASIK与SMILE手术前后视网膜周边屈光状态及像差的变化

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<...     

中低度近视FS-LASIK、SMILE及ICL植入术的效果比较

目的:比较飞秒激光制瓣准分子激光原位角膜磨镶术(FS-LASIK)、全飞秒激光小切口角膜基质透镜取出术(SMILE)和有晶状体眼后房型人工晶状体(ICL V4c)植入术三者矫正中低度近视的效果。方法:采用回顾性研究。以惠州爱尔眼科医院2019年6月至2020年4月矫正中低度近视120例(120眼)作为研究对象,受术者分...     

【In Press】 Femtosecond laser corneal refractive surgery for the correction of high myopic anisometropic amblyopia in juveniles

AIM: To evaluate the effects of femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small-incision lenticule extraction (SMILE) to correct high myopic anisometropic amblyopia in juvenile patients. METHODS: From November 2013 to January 2015, 33 amblyopic patients with high myopic anisometropic amblyopia were studied. FS-LASIK (30 eyes) or SMILE (3 eyes) was performed in the amblyopic eyes. Visual acuity, refraction, contrast sensitivity, stereoacuity and complications were evaluated. Patients completed follow-up examinations at 3d, 1mo, 3mo and the last follow-up time (mean 8.17±3.23mo) after surgery. RESULTS: The mean age at surgery was 9.04±3.04y (range 6-16). The mean spherical equivalent in the amblyopic eyes was significantly decreased from -10.00±2.39 D preoperatively to -0.06±1.06 D at 1mo, -0.19±1.33 D at 3mo and -0.60±1.43 D at approximately 8mo postoperatively (P<0.05 for all). The mean myopic anisometropia was significantly decreased from -9.45±2.33 D preoperatively to +0.37±1.48 D at 1mo, -0.46±1.47 D at 3mo and -0.09±1.83 D at approximately 8mo (P<0.05 for all). The logarithm of the minimum angle of resolution (logMAR) for uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively) of the amblyopic eye improved from 1.74±0.35 and 0.98±0.63 preoperatively to 0.45±0.31 and 0.41±0.33 at approximately 8mo after surgery, respectively. The LogMAR CDVA at 3d, 1, 3 and 8mo postoperatively improved by means of 1.42, 2.22, 2.96, and 4.39 lines, and a gain of more than two lines accounted for 45%, 50%, 74% and 86% of all patients, respectively. The contrast sensitivity of both amblyopic eyes and dominant eyes at 0.5, 2, 8 cycles per degree (cpd) was significantly improved postoperatively (P<0.05 for all). Of the 33 pediatric patients, no patients had near stereopsis preoperatively and seven patients (21.2%) recovered near stereopsis (400″ to 60″) at approximately 8 months after surgery. No intraoperative or postoperative complications occurred in any patients. CONCLUSION: FS-LASIK or SMILE can be promising alternative methods to correct high myopic anisometropic amblyopia in juvenile patients who have failed with traditional approaches.     

Trans-PRK、FS-LASIK和SMILE矫正近视散光的对比观察

目的 探讨Trans-PRK、FS-LASIK和SMILE矫正近视散光的临床效果。方法 选择Trans-PRK组54眼、FS-LASIK组55眼和SMILE组56眼进行回顾性病例研究,随访6个月,比较三组的术前术后各个时间点的视力、屈光度、高阶像差,评估三种不同术式的安全性、有效性。结果 (1)三组术前基线数据差异无统计学意义(P=0.148, 0.148, 0.31, 0.285, 0.283, 0.901);(2)术后1、3、6个月三组之间的UCVA差异无统计学意义(P=0.902),组内比较时Trans-PRK组术后6个月视力高于术后1个月差异具有统计学意义(χ²=0.571,P=0.014);(3)三组间只有在术后1个月柱镜度数差异具有统计学意义(χ²=9.411,P=0.009),两两比较时FS-LASIK组柱镜度数小于SMILE组差异具有统计学意义(χ²=24.400,P=0.004),在术后3、6个月三组之间的柱镜度数差异无统计学意义(P=0.159, 0.106);(4)术后1、3、6个月三组之间的SE差...     

SMILE与FS-LASIK术后角膜光密度的变化研究

目的:比较飞秒激光小切口角膜基质透镜取出术(SMILE)与飞秒激光辅助制瓣的准分子激光角膜原位磨镶术(FS-LASIK)术后角膜光密度的变化,探讨SMILE术后角膜界面混浊对视觉的影响。方法:前瞻性队列研究。选取2020-05/2021-10在南通大学附属医院眼科屈光手术中心拟行角膜屈光手术的患者93例186眼,其中SMILE组48例96眼,FS-LASIK组45例90眼,观察两组患者术前和术后1d, 1wk, 1、3、6mo时角膜光密度、等效球镜、裸眼视力(UCVA)的变化。结果:纳入93例患者均顺利完成手术,术中及术后均未出现相关并发症,无失访病例。FS-LASIK组在术后1d, 1wk UCVA分别为0.044±0.064和-0.001±0.065优于SMILE组(0.102±0.077和0.023±0.064)(均P<0.05)。两组间术后各随访时间的等效球镜均无差异(P>0.05)。FS-LASIK组术后1d在距角膜顶点0～2、2～6mm的角膜光密度及总角膜光密度分别为18.0(17.5,18.6)、16.2(15.6,16.7)、16.7(16.1,17.3),...     

飞秒激光术中角膜基质不透明气泡层的研究进展

飞秒激光辅助的准分子激光原位角膜磨镶术(FS-LASIK)和飞秒激光小切口角膜基质透镜取出术(SMILE)是目前主流的角膜屈光手术方式。虽然临床研究显示其具有很高的安全性、有效性和可预测性,但制作角膜瓣或透镜时需要依赖飞秒激光,不可避免地会发生飞秒激光相关并发症,如负压失吸、不透明气泡层(OBL)等。OBL是飞秒激光在角膜组织中发生光爆破作用时产生的二氧化碳和水蒸气聚集体在角膜基质中无法及时排出而形成,是飞秒激光手术特有的并发症。气泡可能会干扰术中操作和影响术后视觉质量。本文就OBL形成的机制、分级和分类、影响因素及其对术中操作和术后效果的影响进行综述,以期为进一步临床工作提供参考和依据。