SMILE术后视觉质量分析

目的 根据SMILE术矫正近视的初期临床结果,评估其对视力、高阶像差及对比敏感度的影响,分析术前屈光度与术后高阶像差的关系.方法 回顾性病例研究.选择在南京军区南京总医院眼科进行SMILE术的40例近视患者（76眼）.利用iTrace视觉分析仪测量并计算出术前,术后1d、1周、1个月、3个月在小瞳孔（3 mm）及中等瞳孔（5 mm）时的角膜总高阶像差、球差、彗差、三叶草的均方根值（RMS）,并检测屈光度、UCVA、调制传递函数（MTF）值、对比敏感度.对结果数据进行方差分析和直线相关分析.结果 手术后,5 mm瞳孔直径和3 mm瞳孔直径下高阶像差均轻微增高.5 mm瞳孔下,术后1个月总高阶像差、球差RMS值较术前明显增加（P＜0.05）,术后3个月球差RMS值有所增加（P＜0.05）;3 mm瞳孔下,术后1个月球差RMS值与术前相比,差异无统计学意义,术后3个月球差RMS值较1个月时明显增加（P＜0.05）.无论瞳孔大小,术后总高阶像差、彗差、三叶草RMS值与术前屈光度存呈正相关.5、10、15、20、25、30 c/d空间频率下,术后1 d MTF值较术前明显增加,差异有统计学意义（P＜0.01）,术后1周较术后1d有所减少（P＜0.05）.在3、6、12、18 c/d下术后对比敏感度随着随访时间的增加而增加.术中、术后没有发现严重的并发症.结论 SMILE术能有效矫正近视,提高UCVA,但是高阶像差有所增加,尤以球差最明显.术前屈光度越高,手术所导致的高阶像差也越大.

An analysis of visual quality after SMILE surgery

Objective To evaluate the changes in higher order aberration （HOA） in myopic patients after small incision lenticular extraction （SMILE）; to compare the relationship between spherical equivalent refractive error （SE） and aberrations.Methods This was a retrospective study.Forty patients （76 eyes） with myopia underwent small-incision lenticular extraction using the Visumax femtosecond laser.Postoperative changes in corneal HOA,uncorrected visual acuity （UCVA） and SE were analyzed during a 3 months follow-up period.The main outcome measures of HOA,UCVA and SE before and after the surgery were evaluated.Data were analyzed using ANOVA and pearson correlation.Results Corneal HOAs for 3 mm and 5 mm corneal diameters increased slightly.For the 5 mm corneal diameter,significant increases in corneal HOA and spherical aberrations （SA） were measured 1 month after surgery （P＜0.05）.Three months after surgery,SA also increased compared to measurements 1 month after surgery （P＜0.05）,for the 3 mm corneal diameter,SA also increased compared to 1 month after surgery （P＜0.05）.Significant correlations were found between preoperative SE and total HOA,coma aberrations,or trefoil aberrations.At spatial frequencies of 5,10,15,20,25,and 30 c/d,modulation transfer function （MTF） 1 day after surgery increased significantly compared to preoperative measurements （P＜0.01）,and then decreased 1 week after surgery （P＜0.05）.At 3,6,12,18 c/d,contrast sensitivity （CS） slightly increased over time.There were no serious intraoperative or postoperative complications in this study.Conclusion Significant improvement in UCVA and was observed after surgery,but there was also an increase in HOA,especially SA.More HOA were induced after surgery with a larger preoperative SE.