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）矫正近视及近视散光术后视觉质量的差异。方法前瞻性非随机对照研究。选取2015年1-6月于武汉爱尔眼科汉口医院屈光手术中心行SMILE的近视患者41例（41眼）作为SMILE组，行FS-LASIK的近视患者37例（37眼）作为FS-LASIK组。所有患者于术前，术后1 d、1个月及3个月行裸眼视力（UCVA）、综合验光检查，并于术前、术后3个月行角膜像差检查。应用重复测量的方差分析、配对样本t检验、独立样本t检验、卡方检验对数据进行分析。结果2组患者UCVA及等效球镜度（SE）在术后1 d、1个月和3个月差异均无统计学意义。术后3个月，FS-LASIK组95%患者SE在±0.50 D范围内，SMILE组98%患者SE在±0.50 D范围内，差异无统计学意义。术后不同时间点2组间UCVA达到5.0及更好的百分比差异均无统计学意义。在6 mm瞳孔直径下，SMILE组患者术后3个月时的角膜总高阶像差、彗差及球差分别为（0.54±0.13）µm、（0.29±0.14）µm、（0.32±0.12）µm，均显著低于FS-LASIK组分别为（0.71±0.45）µm、（0.48±0.42）µm、（0.47±0.38）µm]，差异有统计学意义（t=1.60、2.00、1.66，P＜0.05）。结论SMILE与FS-LASIK矫正近视及近视散光均有良好的安全性和有效性，且SMILE术后高阶像差的改变比FS-LASIK小，术后视觉质量更佳。

Comparison of visual quality after SMILE and FS-LASIK

Objective To compare the clinical outcomes and aberrations of small incision lenticule extraction (SMILE) and femtosecond laser-assisted LASIK (FS-LASIK) for correction of myopia and myopic astigmatism. Methods This prospective, non-randomized, controlled study enrolled 41 patients (41 eyes) who had SMILE surgery and 37 patients (37 eyes) who had FS-LASIK. Uncorrected distance visual acuity and manifest refraction were measured preoperatively and at 1 day, 1 month, and 3 months postoperatively. Corneal aberrations were measured preoperatively and postoperatively at 3 months. Repeated measures analysis of variance, independent t-tests, paired t-tests, and Chi-square tests were used to analyze and compare the collected data for the two surgical groups. Results There was no significant differences in uncorrected distance visual acuity or spherical equivalent between the SMILE and FS-LASIK groups at 1 day, 1 month, or 3 months postoperatively. For the FS-LASIK and SMILE groups, 95% and 98% of the treated eyes were within ±0.50 diopter (D) of spherical equivalent, and there were no significant differences between the two groups. There was also no significant difference between the two groups in the percentage of the uncorrected visual acuity (=5-LogMAR) which was 5.0 or better at any of the time points after operations. Three months after surgery, the high order aberrations, coma, and spherical aberration of cornea in the 6-mm pupil diameter of the SMILE group were 0.54±0.13 μm, 0.29±0.14 μm, and 0.32±0.12 μm, respectively. These values were significantly lower than in the FS-LASIK group, 0.71±0.45 μm, 0.48±0.42 μm, and 0.47±0.38 μm respectively (t=1.60, 2.00, 1.66, all P<0.05). Conclusion Both SMILE and FS-LASIK resulted in good visual outcomes in the correction of myopia and myopic astigmatism. The SMILE procedure had a lower aberration induction rate.