SMILE与ICL V4C植入术矫正高度近视的临床效果及对患者视网膜中央动脉血流动力学参数的影响

目的探究飞秒激光微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(ICL V4C)植入术矫正高度近视的临床效果及对患者视网膜中央动脉血流动力学参数的影响。方法选取80例高度近视患者的临床资料进行回顾性分析,根据治疗方案不同分为A组和B组,每组40例(80眼)。A组患者采用SMILE治疗,B组患者采用ICL V4C植入术治疗。随访3个月,统计对比两组手术前后(术前和术后1、3个月)裸眼视力、最佳矫正视力、等效球镜、对比敏感度、波前像差(高阶像差、垂直彗差、水平彗差、球差)、视网膜中央动脉血流动力学参数阻力指数(RI)、舒张末期血流速度(EDV)、收缩期峰值血流速度(PSV)]、国家眼科学会25项视觉功能问卷(NEI-VFQ-25)分值,并发症发生情况。结果术前和术后1、3个月,两组裸眼视力、最佳矫正视力、等效球镜组间对比差异均无统计学意义(P>0.05);术后1、3个月,两组裸眼视力、最佳矫正视力均较术前升高,等效球镜均较术前降低,差异具有统计学意义(P<0.05)。术前和术后1、3个月,两组干涉条纹视力(IVA)=0.05、0.2、0.4时的对比敏感度组间对比差异均无统计学意义(P>0.05);术后1、3个月,两组IVA=0.05、0.2、0.4时的对比敏感度均较术前降低,差异具有统计学意义(P<0.05)。术前,两组高阶像差、垂直彗差、水平彗差、球差对比差异均无统计学意义(P>0.05)。术后1、3个月,两组垂直彗差对比差异无统计学意义(P>0.05);但B组高阶像差、水平彗差、球差均低于A组,差异具有统计学意义(P<0.05)。术前,两组视网膜中央动脉RI、EDV、PSV对比差异均无统计学意义(P>0.05);术后1、3个月,两组RI均较术前降低,EDV、PSV均较术前升高,差异具有统计学意义(P<0.05);术后3个月,B组RI低于A组,EDV、PSV均高于A组,差异具有统计学意义(P<0.05)。术前,两组NEI-VFQ-25分值对比差异无统计学意义(P>0.05);术后1、3个月,两组NEI-VFQ-25分值均较术前升高,差异具有统计学意义(P<0.05);B组术后1个月NEI-VFQ-25分值(94.20±4.71)分略高于A组的(92.12±5.07)分,但差异无统计学意义(P>0.05);B组术后3个月NEI-VFQ-25分值(94.51±4.26)分高于A组的(92.25±4.82)分,差异具有统计学意义(P<0.05)。两组术后3个月内并发症发生率比较差异无统计学意义(P>0.05)。结论SMILE与ICL V4C植入术均为治疗高度近视的安全、有效方法,尤其是ICL V4C植入术,能进一步改善患者视网膜中央动脉血流动力学,提高视觉质量及生活质量。

Clinical effect of SMILE and ICL V4C implantation in correcting high myopia and its influence on hemodynamic parameters of central retinal artery in patients

Objective To investigate the effect of small incision lenticule extraction(SMILE)and implantable collamer lens V4 C(ICL V4 C)implantation in correcting high myopia and its influence on hemodynamic parameters of central retinal artery in patients.Methods A total of 80 patients with high myopia were divided into group A and group B according to different treatment regimens,with 40 cases(80 involved eyes)in each group.Group A was treated with SMILE,and group B was treated with ICL V4 C implantation.After 3 months of follow-up,the uncorrected vision,best corrected vision,spherical equivalent,contrast sensitivity,wavefront aberration(high-order aberration,vertical coma,horizontal coma,spherical aberration),hemodynamic parameters of central retinal arteryresistance index(RI),end diastolic velocity(EDV),peak systolic velocity(PSV)],national eye institute-visual function questionnaire-25(NEI-VFQ-25)before and after operation(before operation,1 and 3 months after operation),and occurrence of complications were compared between the two groups.Results Before operation,1 and 3 months after operation,there was no statistically significant difference in uncorrected vision,best corrected vision,spherical equivalent between the two groups(P>0.05);1 and 3 months after operation,the uncorrected vision and best corrected vision of the two groups were higher than those before operation,and spherical equivalent was lower than that before operation,and the difference was statistically significant(P<0.05).Before operation,1 and 3 months after operation,there was no statistically significant difference in the contrast sensitivity at interference fringe visual acuity(IVA)=0.05,0.2,0.4 between the two groups(P>0.05);1 and 3 months after operation,the contrast sensitivity of the two groups at IVA=0.05,0.2,0.4 was lower than that before operation,and the difference was statistically significant(P<0.05).Before operation,there was no statistically significant difference in high-order aberration,vertical coma,horizontal coma and spherical aberration between the two groups(P>0.05);1 and 3 months after operation,there was no statistically significant difference in vertical coma between the two groups(P>0.05),but the high-order aberration,horizontal coma and spherical aberration of group B were lower than those of group A,and the difference was statistically significant(P<0.05).Before operation,there was no statistically significant difference in RI,EDV,PSV of central retinal artery between the two groups(P>0.05).1 and 3 months after operation,the RI of the two group was lower than that before operation,and EDV and PSV were higher than those before operation,and the difference was statistically significant(P<0.05).3 months after operation,the RI of group B was lower than that of group A,and EDV and PSV were higher than those of group A,and the difference was statistically significant(P<0.05).Before operation,there was no statistically significant difference in NEI-VFQ-25 between the two groups(P>0.05).1 and 3 months after operation,the NEI-VFQ-25 of the two groups were higher than those before operation,and the difference was statistically significant(P<0.05).1 month after operation,the NEI-VFQ-25(94.20±4.71)points of group B was a little higher than(92.12±5.07)points of group A,but the difference was not statistically significant(P>0.05).3 months after operation,the NEI-VFQ-25(94.51±4.26)points of group B was higher than(92.25±4.82)points of group A,and the difference was statistically significant(P<0.05).There was no statistically significant difference in incidence of complications in 3 months after operation between the two groups(P>0.05).Conclusion SMILE and ICL V4 C implantation are safe and effective methods for treating high myopia,especially ICL V4 C implantation,it can further improve the hemodynamics of the central retinal artery of patients,improve their quality of vision and quality of life.