高度近视行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)和飞秒激光制瓣的准分子激光原位角膜磨镶术(FS-LASIK)矫正高度近视术后的视觉质量.方法 前瞻性非随机对照研究.收集四川大学华西医院眼科中心行近视矫正术的高度近视患者,按照其手术方式分为SMILE组21例(41眼)和FS-LASIK组19例(38眼).常规检查裸眼视力(UCVA)、最佳矫正视力(BCVA)、屈光度、眼压、对比敏感度(CS)、角膜高阶像差和屈光矫正对生活质量的影响问卷(QIRC)评分,于术后1 d、1周、1个月、3个月和6个月随访复查.采用独立样本t检验或Mann-Whitney U检验进行统计学分析.结果 FS-LASIK组和SMILE组的安全指数分别为1.00±0.23和1.00±0.12.术前SMILE组12.0 cpd的LogCS值高于FS-LASIK组(t=2.137,P=0.035),SMILE组3.0 cpd的LogCS值术后6个月与术前变化量高于FS-LASIK组(t=2.843,P=0.008),其余频率差异均无统计学意义.FS-LASIK组的总高阶像差、三阶彗差和四阶球差术后6个月与术前的变化量高于SMILE组,差异有统计学意义(t=-7.587,P<0.001;t=-4.127,P<0.001;t=10.068,P<0.001).2组之间术后3、6个月2个时间点QIRC量表评分与术前的变化量比较,差异无统计学意义.结论 SMILE和FS-LASIK均能安全地矫正高度近视.SMILE术后低频空间频率对比敏感度恢复情况优于FS-LASIK.SMILE与FS-LASIK均使角膜的高阶像差增加,后者引入了更多的彗差和球差.

Visual and refractive outcomes of SMILE and FS-LASIK for high myopia

Objective To compare the visual quality of small-incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) after correction for high myopia. Methods In this prospective non-randomized case-controlled study, patients were divided into a SMILE group (21 patients, 41 eyes) and a FS-LASIK group (19 patients, 38 eyes) based on the surgical method at the Department of Ophthalmology, West China Hospital. Routine ophthalmic examinations were performed.The patients were followed 6 months to monitor uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refractive error, intraocular pressure, contrast sensitivity, corneal higher order aberrations, and scores for Quality of Life Impact of Refractive Correction Questionnaire (QIRC). Statistical analyses were performed using an independent samples t-test or Mann-Whitney U test. Results The safety index was 1.00±0.23 in the FS-LASIK group and 1.00±0.12 in the SMILE group. Log contrast sensitivity (LogCS) of 12.0 cycles per degree (cpd) was significantly higher in the SMILE group compared to the FS-LASIK group before surgery (t=2.137, P=0.035). The change in LogCS for 3.0 cpd at six months after surgery was significantly greater in the SMILE group compared to the FS-LASIK group (t=2.843, P=0.008), but other differences were statistically insignificant. The changes in total higher order aberrations, the third order coma, and the fourth order spherical aberration were greater in the FS-LASIK group than in the SMILE group during the same period (t=-7.587, P<0.001; t=-4.127, P<0.001; t=10.068, P<0.001; respectively). There was no significant difference in the amount of change in the QIRC scores between the two groups at 3 and 6 months postoperation. Conclusion Both SMILE and FS-LASIK can safely correct high myopia. Spatial frequency contrast sensitivity recovers better after SMILE surgery compared to FS-LASIK. Both SMILE and FS-LASIK increase corneal higher-order aberrations, but the FS-LASIK procedure induces more coma and spherical aberrations than SMILE.