小切口角膜基质透镜取出术与飞秒激光辅助准分子原位角膜磨镶术对角膜生物力学特性影响的对比分析

目的　比较小切口角膜基质透镜取出术（small-incision lenticule extraction，SMILE）与飞秒激光辅助准分子原位角膜磨镶术（femtosecond laser-assisted laser in situ keratomileusis，FS-LASIK）治疗近视对患者角膜生物力学特性的影响。方法　选取在我院行SMILE和FS-LASIK手术的近视患者共67例134眼。根据手术方式及等效球镜度数（spherical equivalent，SE）的不同将患者分为4组:中度近视SMILE组15例30眼和中度近视FS-LASIK组16例32眼（-3.00 D≤SE＜-6.00 D）；高度近视SMILE组18例36眼和高度近视FS-LASIK组18例36眼（6.00 D≤SE＜-9.00 D）。分别于术前及术后3 d 、10 d、1个月、3个月使用眼反应分析仪ORA测量4组患者角膜滞后量（corneal hysteresis，CH）和角膜阻力因子（corneal resistance factor，CRF）。计算4组患者术后各时间点的CH和CRF改变量，并分别比较中度近视SMILE组和中度近视FS-LASIK组、高度近视SMILE组和高度近视FS-LASIK组CH和CRF改变量的差异。结果　中度近视SMILE组患者△CH在术后3 d（P=0.030）和术后3个月（P=0.030）时均小于中度近视FS-LASIK组。中度近视SMILE组患者△CRF在术后3 d（P=0.000）、10 d（P=0.008）、1个月（P=0.011）、3个月（P=0.001）时均小于中度近视FS-LASIK组。高度近视SMILE组△CH和△CRF在术后3 d、10 d、1个月、3个月时均小于高度近视FS-LASIK组（均为P=0.000）。结论　SMILE与FS-LASIK手术都会引起角膜生物力学稳定性的降低，但SMILE对角膜生物力学变化的影响更小。

Comparison of changes in corneal biomechanical properties after small-incision lenticule extraction and femtosecond laser-assisted laser in situ keratomileusis

Objective　To compare the effect of corneal biomechanical properties of myopic patients after small-incision lenticule extraction （SMILE） and femtosecond laser-assisted laser in situ keratomileusis （FS-LASIK）.Methods　Together 67 patients （134 eyes） with myopia received SMILE and FS-LASIK were selected.According to the different operation methods and spherical equivalent （SE），all patients were divided into four groups:moderate myopia SMILE group with 15 patients （30 eyes） and moderate myopia FS-LASIK group with 16 patients （32 eyes），SE -3.00 to -6.00 D；high myopia SMILE group with 18 patients （36 eyes） and high myopia FS-LASIK group with 18 patients （36 eyes），SE -6.00 to -9.00 D.Corneal hysteresis （CH） and corneal resistance factor （CRF） in the four groups were examined by ocular response analyzer （ORA） before operation and 3 days，10 days，1 month，3 months after operation.The change quantity of CH and CRF at each time point after operation were calculated and compared respectively in moderate myopia and high myopia between SMILE group and FS-LASIK group.Results　The change quantity of CH in moderate myopia SMILE group at 3 days（P=0.030）and 3 months（P=0.030）after operation were less than those in moderate myopia FS-LASIK group，and the change quantity of CRF at 3 days（P=0.000），10 days（P=0.008），1 month（P=0.011） and 3 months（P=0.001）after operation were less than those in moderate myopia FS-LASIK group.The change quantity of CH and CRF in high myopia SMILE group at 3 days，10 days，1 month，3 months after operation were less than those in high myopia FS-LASIK group （all P=0.000）.Conclusion　Both SMILE and FS-LASIK can decrease the corneal biomechanical stability，but the effect of SMILE on the corneal biomechanics is less than FS-LASIK.