SMILE与FS-LASIK术后视觉质量比较

目的：比较飞秒激光小切口角膜基质透镜取出术（SMILE）与飞秒激光制瓣准分子激光原位角膜磨镶术（FS-LASIK）矫正近视及散光术后的视觉质量。方法：前瞻性非随机对照研究。选取2015 年11 月至2016 年2 月在长沙爱尔眼科医院屈光中心接受飞秒激光屈光手术的近视散光患者162 例（324 眼），按患者选择的手术方式不同分为SMILE组78例（156眼）和FS-LASIK组84例（168眼）。术后随访6个月，分别比较2组患者术后1 d、1个月、6个月的裸眼视力（UCVA）、等效球镜度（SE）以及术后3个月的角膜像差及切削中心偏移量。在术后1、6 个月时对2 组患者进行视觉质量问卷调查，调查问卷为简化后的视觉质量量表。采用重复测量方差分析、单因素方差分析、卡方检验、秩和检验对数据进行统计分析。结果：SMILE组术后1 d的UCVA低于FS-LASIK组（t=4.555，P < 0.001），术后1、6 个月2组间UCVA差异无统计学意义。术后1 d SMILE组SE大于FS-LASIK组（t=-2.952，P=0.003），术后1、6个月2组间差异无统计学意义。2组术后3个月角膜总高阶像差、球差、彗差、三叶草差均较术前增加（均P < 0.05），SMILE组术后3个月球差、三叶草差大于FS-LASIK组，差异有统计学意义（t= 5.633，P < 0.001；t=2.586，P=0.010）。SMILE组术后3个月切削中心偏移量为（0.17 ± 0.09）mm，FS-LASIK组为（0.18 ± 0.10）mm，组间差异无统计学意义。与术后1 个月相比，SMILE组术后6 个月光晕发生比例明显减轻（χ2=5.547，P=0.019），程度明显减轻（Z=-2.283，P=0.022），而FS-LASIK组各项症状发生比例差异无统计学意义。术后1、6 个月2 组间各项症状发生眼数及得分差异均无统计学意义。结论：与FS-LASIK手术相比，SMILE术后早期视力恢复较慢，球差和三叶草差增加更多，偏中心切削和不良视觉症状的发生无明显差异。

Comparison of Visual Quality after SMILE and FS-LASIK

Objective: To compare the visual quality between small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) in treating myopia and astigmatism. Methods: In this prospective non-randomized study, we selected 162 patients (324 eyes) with myopia and astigmatism who wanted refractive surgery in Changsha Aier Hospital from November, 2015 to February, 2016. The patients were allocated to either of two groups according to each person's request. The SMILE group had 78 patients (156 eyes) and the FS-LASIK group had 84 patients (168 eyes). All patients were followed up for 6 months. Uncorrected visual acuity (UCVA) and spherical equivalent (SE) were measured 1 day, 1 month, and 6 months after surgery. Corneal higher-order aberrations (HOAs) and decentration were measured 3 months after surgery. A vision quality questionnaire, based on a simplified version of Quality of Vision (QoV) Questionnaire to assess negative symptoms, was administered at 1 month and 6 months after surgery. Repeated measures ANOVA, ANOVA, chi-square test, and the rank-sum test were used to analyze and compare the data for the two groups. Results: One day after surgery, UCVA in the FS-LASIK group was better than in the SMILE group (t=4.555, P<0.001), but there were no significant differences between the two groups in the later periods. The SE in the SMILE group at 1 day after surgery were higher than in the FS-LASIK group (t=-2.952, P=0.003), but at 1 month and 6 months after surgery, there was no significant difference between them. HOA, spherical, coma, and trefoil aberrations were significantly increased in both groups at 3 months after surgery compared with the preoperative values (P<0.05). SMILE induced more spherical and trefoil aberrations compared with FS-LASIK (t=5.633, P<0.001; t=2.586, P=0.010). The cutting decentration with SMILE (0.17±0.09 mm) was similar to FS-LASIK (0.18±0.10 mm) (t=0.594, P=0.553). For SMILE patients, the rates and degrees of haloes at 6 months had declined compared with 1 month (χ2=5.547, P=0.019; Z=-2.283, P=0.022). For FS-LASIK patients, there were no significant changes in postoperative negative visual symptoms between 1 month and 6 months after surgery. There were also no significant differences between the two groups at 1 and 6 months. Conclusions: Vision recovery was slower with SMILE, and it induced more spherical and trefoil aberrations than FS-LASIK. Cutting decentration and the occurrence of negative visual symptoms were similar in both procedures.