FS-LASIK、WF-LASIK与SMILE术后视觉质量比较的研究

目的探讨飞秒激光制瓣的LASIK(FS-LASIK)、波前像差引导的LASIK(WF-LASIK)和飞秒激光小切口角膜基质透镜取出术(SMILE)矫正近视散光后的视觉质量及高阶像差。方法病例对照研究。本研究纳入2014年9月至2016年9月来北京同仁医院屈光中心手术的108例(212只眼)单纯近视或复性近视散光患者进行研究,其中男性34例(66只眼),女性74例(146只眼);年龄27(24,32)岁。按术式将患者分为3个组,其中FS-LASIK组37例(71只眼),WF-LASIK组35例(69只眼),SMILE组36例(72只眼)。术前及术后12个月记录患者的屈光度、角膜参数、高阶像差值以及对比敏感度值,并进行秩和检验比较不同时间的差异。结果术后12个月时,FS-LASIK组、WF-LASIK组和SMILE组分别有69(97.18%)、67(97.10%)和69只眼(95.83%)裸眼视力≥1.0,3个组分别有59(83.10%)、60(86.96%)和61只眼(84.72%)术后裸眼视力好于术前最佳矫正视力。WF-LASIK组角膜表面规则指数(SRI)从0.11(0.07,0.28)降低为0.07(0.06,0.20)(Z=-2.662,P=0.008),低于FS-LASIK组和SMILE组(Z=-3.236,-3.118;P=0.001,0.000),角膜表面不对称指数(SAI)从0.34(0.25,0.43)增加为0.38(0.30,0.52)(Z=-2.140,P=0.032),均低于FS-LASIK组和SMILE组(Z=-2.910,-3.779;P=0.004,0.000)。FS-LASIK组总高阶像差均方根值从0.32(0.27,0.41)增加为0.53(0.40,0.65)(Z=-6.228,P=0.000),高于WF-LASIK组和SMILE组(Z=-3.595,-4.086;P=0.000,0.000),WF-LASIK组彗差从0.16(0.11,0.24)增加为0.26(0.15,0.37)(Z=-3.816,P=0.000),低于FS-LASIK组(Z=-3.528,P=0.000),FS-LASIK组和WF-LASIK组分别球差从0.10(0.05,0.21)和0.08(0.04,0.12)增加到0.24(0.13,0.34)和0.15(0.09,0.26)(Z=-5.141,-4.864;P=0.000,0.000),高于SMILE组(Z=-2.549,-4.682;P=0.011,0.000)。术后12个月时,WF-LASIK组在12.0周/度空间频率下暗环境对比敏感度从1.34(1.18,1.48)增加为1.48(1.34,1.63)(Z=-2.985,P=0.003),高于FS-LASIK组和SMILE组(Z=-3.194,-2.977;P=0.001,0.003),有眩光对比敏感度在12.0周/度空间频率下从1.26(1.18,1.34)增加为1.34(1.34,1.63)(Z=-3.608,P=0.000),高于FS-LASIK组和SMILE组(Z=-4.033,-2.913;P=0.000,0.004)。结论FS-LASIK、WF-LASIK及SMILE术后12个月均可获得理想的视力,其中WF-LASIK术后角膜对称性最好,高阶像差增加最少,视觉质量最好。

Comparison of the visual quality at 1 year following femtosecond laser-assisted LASIK,wavefront-guided femtosecond LASIK and small incision lenticule extraction for myopia and astigmatism

Objective To investigate mesopic contrast sensitivity(CS)and high-order aberrations after femtosecond laser-assisted LASIK(FS-LASIK),wavefront-guided femtosecond LASIK(WF-LASIK)and small incision lenticule extraction(SMILE)for myopia and astigmatism.Methods In this case-control study,212 eyes of 108 patients with myopia and astigmatism from September 2014 to September 2016 were treated by refractive surgery.There were 34 males(66 eyes)and 74 females(146=eyes),aged 27(24,32)years.They were divided into 3 groups,with 37 patients(71 eyes),35 patients(69 eyes)and 36 patients(72 eyes)treated by FS-LASIK,WF-LASIK and SMILE,respectively.Refraction diopters,corneal tomography,wavefront aberrations and contrast sensitivity were evaluated before and at 12 months after surgery.The results of different groups were compared by rank sum test.Results At 12=months of follow-up,69 eyes(97.18%)treated by FS-LASIK,67 eyes(97.10%)by WF-LASIK and 69 eyes(95.83%)by SMILE had the uncorrected distance visual acuity of 20/20 or better.Fifty-nine eyes(83.10%)treated by FS-LASIK,60 eyes(86.96%)by WF-LASIK and 61 eyes(84.72%)by SMILE had better postoperative uncorrected distance visual acuity than preoperative corrected distance visual acuity.Surface regularity index of the WF-LASIK group decreased from 0.11(0.07,0.28)to 0.07(0.06,0.20)(Z=-2.662,P=0.008),which was less than that of the FS-LASIK and SMILE groups(Z=-3.236,-3.118,P=0.001,0.000).Surface asymmetry index of the WF-LASIK group increased from 0.34(0.25,0.43)to 0.38(0.30,0.52)(Z=-2.140,P=0.032),which was less than that of the FS-LASIK and SMILE groups(Z=-2.910,-3.779,P=0.004,0.000).The root mean square of high-order of the FS-LASIK group increased from 0.32(0.27,0.41)to 0.53(0.40,0.65)(Z=-6.228,P=0.000),which was more than that of the WF-LASIK and SMILE groups(Z=-3.595,-4.806,P=0.000,0.000).Coma of the WF-LASIK group increased from 0.16(0.11,0.24)to 0.26(0.15,0.37)(Z=-3.816,P=0.000),which was less than that of the FS-LASIK group(Z=-3.528,P=0.000).Spherical aberration of the FS-LASIK and WF-LASIK groups increased from 0.10(0.05,0.21)and 0.08(0.04,0.12)to 0.24(0.13,0.34)and 0.15(0.09,0.26),respectively(Z=-5.141,-4.864,P=0.000,0.000),which were more than that of the SMILE group(Z=-2.549,-4.682,P=0.011,0.000).CS of the WF-LASIK group at 12 cycles per degree(c/d)increased from 1.34(1.18,1.48)to 1.48(1.34,1.63)(Z=-2.985,P=0.003),which was more than that of the FS-LASIK and SMILE groups(Z=-3.194,-2.977,P=0.001,0.003).CS with glare of the WF-LASIK group at 12.0 c/d increased from 1.26(1.18,1.34)to 1.34(1.34,1.63)(Z=-3.608,P=0.000),which was more than that of the FS-LASIK and SMILE groups(Z=-4.033,-2.913,P=0.000,0.004).Conclusions FS-LASIK,WF-LASIK and SMILE achieved ideal visual outcomes at 12 months postoperatively.WF-LASIK treated eyes showed the best corneal symmetry,the least increase of high-order aberrations and the best visual quality among three kinds of surgeries.