SMILE与ICL V4c植入术矫正高度近视的临床效果及视觉质量对比分析

目的探讨飞秒激光小切口角膜基质透镜取出术(small incision lenticule extraction,SMILE)和中央孔型有晶体眼后房型人工晶状体(implantable collamer lens，ICL)V4c植入术矫正高度近视的临床效果及高阶像差的变化特点。 方法收集于行近视矫正手术的高度近视患者（近视大于-6.0 D），根据手术方式不同分为SMILE组（30例，58眼)及ICL组（30例，59眼），观察2组术前及术后裸眼视力(uncorrected visual acuity，UCVA)、最佳矫正视力(best corrected visual acuity，BCVA)、屈光度、等效球镜度、眼压、角膜高阶像差等数据，随访时间1年并进行统计分析。 结果安全性：术后1年2组所有术眼BCVA均达到 20/20以上，无一眼发生BCVA 1行以上丢失。有效性：2组术后1年UCVA达到20/20以上者分别为53眼（91.38%）及56眼（94.91%），20/25以上者分别为58眼（100%）及59眼（100%）。可预测性：术后1年2组等效球镜度在±1.0 D的比例均为100%。SMILE组术后等效球镜度高于ICL组，2组间差异有统计学意义。高阶像差：SMILE组术后总高阶像差、球差、垂直慧差增加， ICL组术后斜向三叶草增加，水平慧差减少。在2组中，Spearman相关性分析均未发现2组各像差成分变化值与术前球镜、柱镜、等效球镜及术后等效球镜存在相关性。 结论SMILE及ICL矫正高度近视均具有良好的安全性、有效性，对于高度近视ICL预测性强，且较少引入高阶像差。

Comparative analysis of clinical effect and visual quality of SMILE and ICL V4c implantation in the correction of high myopia

ObjectiveTo explore the clinical effects and the variation features of higher-order aberrations(HOAs) of femtosecond laser small incision lenticule extraction（SMILE）and implantable collamer lens （ICL） V4cafter the correction surgery of high myopia.MethodsThe patients with -6.00 D plus high myopia who underwent myopic surgery were enrolled. In accordance with the surgical methods, they were divided into two groups, SMILE group(30 cases, 58 eyes) and ICL group(30 cases, 59 eyes), and a series of data before and after surgery, including uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), refraction, spherical equivalent(SE), intra-ocular tension and HOAs of corneas, were observed. All patients were followed up for 1 year and analyzed statistically.ResultsAs for security, the BCVA of both groups reached 20/20 plus. None eyes experienced the loss of more than one line at BCVA. As for effectiveness, at one year after the surgery, 53 eyes （91.38%） and 32 eyes （94.91%） reached 20/20 plus at UCVA in two groups respectively, and 58 eyes （100%） and 59 eyes （100%） reached 20/25 plus respectively. In terms of predictability, at one year after the surgery, the proportion of SE at ±1.0 D was 100% in both groups. The residual refractive error in SMILE group was higher than that in ICL group, and the difference between two groups was statistically significant. As for HOAs, total higher-order aberration, spherical aberration and vertical comatic aberration were increased in SMILE group after surgery. As for ICL group, the oblique trefoil was increased whilst horizonal comatic aberration was decreased. Spearman correlation analysis revealed no correlation between the aberration variation value and the preoperative spherical equivalent, cylindrical equivalent, SE, as well as the postoperative residual SE in two groups.ConclusionBoth SMILE and ICL have advantages of security and effectiveness for correction surgery of high myopia. ICL possessed stronger predictability for high myopia, and HOAs were not much generated.