不同切削比全飞秒激光小切口角膜基质透镜取出术后早期角膜高阶像差的比较

目的观察不同切削比的全飞秒激光小切口角膜基质透镜取出术(small-incision lenticule extraction,SMILE)术后早期角膜高阶像差(higher-order aberrations,HOAs)的变化,探讨切削比对角膜HOAs的影响。方法选自2017年8月至2018年3月共58例(114眼)患者,所有患者均由同一位医师完成SMILE手术,按切削比(角膜切削深度/术前角膜厚度)将病例分为A组(切削比≤0.16)、B组(切削比>0.16~0.21)和C组(切削比>0.21),记录患者在术前及术后1 d、1周、1个月时测量的裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)、角膜HOAs等。结果术前及术后1 d、1周及1个月的UCVA、BCVA三组间差异均无统计学意义(均为P>0.05);A组术后1 d球差、总HOAs分别为(0.27±0.10)μm、(1.71±2.04)μm,B组分别为(0.32±0.18)μm、(2.43±2.06)μm,C组分别为(0.37±0.18)μm、(3.90±2.28)μm,A组的球差、总HOAs均明显低于C组(均为P<0.05),B组的总HOAs明显低于C组(P<0.05)。A组术后1周球差、总HOAs分别为:(0.27±0.13)μm、(1.74±1.95)μm,B组分别为(0.34±0.19)μm、(2.52±2.08)μm,C组分别为(0.43±0.18)μm、(3.93±2.29)μm,A组和B组的球差、总HOAs均明显低于C组(均为P<0.05);A组、B组、C组术后1个月球差分别为(0.26±0.10)μm、(0.32±0.14)μm、(0.45±0.15)μm,A组和B组的球差均明显低于C组(均为P<0.05)。术后球差、总HOAs与切削比均相关(均为P<0.05)。结论切削比越大的SMILE手术,术后早期角膜HOAs增加越明显,特别是角膜球差和总HOAs。因此,术前需考虑切削比对术后角膜HOAs的影响。

Comparison of early corneal higher-order aberrations after small-incision lenticule extraction with different cutting ratios

Objective　To observe the changes of corneal higher-order aberrations (HOAs) in the early stage after small-incision lenticule extraction (SMILE) with different cutting ratio and explore the effects of cutting ratio on corneal HOAs.Methods　Total fifty-eight patients (114 eyes) were selected,and they received the treatment of SMILE by the same doctor from August 2017 to March 2018 and were divided into 3 groups according to the cutting ratio (corneal cutting depth/preoperative corneal thickness):group A (cutting ratio ≤0.16),group B (cutting ratio >0.16-0.21) and group C (cutting ratio ＞0.21).The patients ’ uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),corneal HOAs,etc.measured before surgery and at postoperative 1 day,1 week and 1 month were recorded.Results　There was no significant difference in UCVA,BCVA between the three groups before surgery or at postoperative 1 day,1 week and 1 month (all P＞0.05);The spherical aberration and total HOAs at one day after surgery:(0.27±0.10)μm and (1.71±2.04)μm in group A;(0.32±0.18)μm and (2.43±2.06)μm in group B;(0.37±0.18)μm and (3.90±2.28)μm in group C;the spherical aberration and total HOAs of group A were both lower than that of group C significantly (all P＜0.05),the total HOAs of group B was lower than that of group C significantly (P＜0.05);the spherical aberration and total HOAs at one week after surgery:(0.27±0.13)μm and (1.74±1.95)μm in group A;(0.34±0.19)μm and (2.52±2.08)μm in group B;(0.43±0.18)μm and (3.93±2.29)μm in group C;the spherical aberration and total HOAs of group A and group B were both lower than that of group C significantly (all P＜0.05);the spherical aberration at one month after surgery:(0.26±0.10)μm in group A,(0.32±0.14)μm in group B,(0.45±0.15)μm in group C,the spherical aberration of group A and group B were both lower than that of group C significantly (all P＜0.05).The postoperative spherical aberration and total HOAs were both correlated with the cutting ratio(all P＜0.05).Conclusion　The postoperative corneal HOAs increase more obviously after SMILE with higher cutting ratio,especially corneal spherical aberration and total HOAs,so the influence of cutting ratio on postoperative corneal HOAs should be considered before surgery.