小切口基质内透镜取出术及飞秒激光LASIK治疗高度近视的临床对比研究

目的　对比研究小切口基质内透镜取出术（ｓｍａｌｌｉｎｃｉｓｉｏｎｌｅｎｔｉｃｕｌｅｅｘｔｒａｃｔｉｏｎ，ＳＭＩＬＥ）及飞秒激光ＬＡＳＩＫ（ｆｅｍｔｏｓｅｃｏｎｄｌａｓｅｒｉｎｓｉｔｕｋｅｒａｔｏｍｉｌｅｕｓｉｓ，ＦＳ-ＬＡＳＩＫ）治疗高度近视患者的手术疗效。方法　４０例８０眼高度近视患者（等效球镜度数为－７．００～－１０．５０Ｄ）根据手术方式不同分为２组，其中ＳＭＩＬＥ组２０例４０眼行ＳＭＩＬＥ，ＦＳ-ＬＡＳＩＫ组２０例４０眼行ＶｉｓｕＭａｘＦＳ-ＬＡＳＩＫ，观察时间点为术后１ｄ、１周、１个月、３个月、６个月。分别观察两组术后裸眼视力、等效球镜度数、最佳矫正视力、角膜地形图形态等。结果　安全性:术后３个月ＳＭＩＬＥ组和ＦＳ-ＬＡＳＩＫ组最佳矫正视力达到术前最佳矫正视力的比例分别为９７．５％（３９／４０）、９５．０％（３８／４０）（Ｐ＞０．０５），术后最佳矫正视力／术前最佳矫正视力分别为１．１５±０．１２、１．０９±０．１４（Ｐ＞０．０５）。有效性:术后３个月ＳＭＩＬＥ组和ＦＳ-ＬＡＳＩＫ组裸眼视力达到术前最佳矫正视力的比例分别为９５．０％（３８／４０）、８０．０％（３２／４０）（Ｐ＜０．０５），术后裸眼视力／术前最佳矫正视力分别为１．１１±０．１３、０．９８±０．１４（Ｐ＜０．０５）。可预测性（精确性）:术后３个月ＳＭＩＬＥ组和ＦＳ-ＬＡＳＩＫ组等效球镜在±０．５０Ｄ的比例分别为９５．０％（３８／４０）、７０．０％（２８／４０）（Ｐ＜０．０５）；等效球镜在±０．７５Ｄ的比例分别为９７．５％（３９／４０）、８２．５％（３３／４０）（Ｐ＜０．０５）。稳定性:与术后１周相比，术后１个月、３个月及６个月各时间点ＳＭＩＬＥ组和ＦＳ-ＬＡＳＩＫ组等效球镜度数的差异均无统计学意义（Ｐ＞０．０５）。角膜地形图形态:ＳＭＩＬＥ组和ＦＳ-ＬＡＳＩＫ组角膜地形图都以平滑型最多，分别占８２．５％（３３／４０）、６０．０％（２４／４０），两组比较差异有统计学意义（Ｐ＜０．０５）。结论　ＳＭＩＬＥ及ＦＳ-ＬＡＳＩＫ治疗高度近视均安全、稳定，而ＳＭＩＬＥ有效性、可预测性、精确性、术后角膜形态均稍好于ＦＳ-ＬＡＳＩＫ，矫正高度近视更值得临床应用。

Clinical comparative study of small incision lenticule extraction and femtosecond laser-assisted LASIK for high myopia

Objective To compare the clinical surgical results of small incision lenticule extraction ( SMILE) and femtosecond laser LASIK ( FS-LASIK) for high myopia. Methods Eighty eyes of 40 consecutive patients were enrolled in this retrospective study and divided int0 2 groups according to the operation method :FS-LASIK group (40 eyes ,20 cases) and SMILE group (40 eyes ,20 cases) , the spherical refraction was from -7. 00 D to - 10. 50 D. The results were observed at postoperative I day,l week,l month , 3 months and 6 months. Postoperative best corrected visual acuity , spherical equivalent refraction.uncorrected visual acuity , corneal topography were observed. Results Security index; After 3 months , the ratio of postoperative best corrected visual acuity reach to the preoperative best corrected visual acuity in SMILE group and FSLASIK group were 97. 5 % ( 39/40 ) and 95 . 0% ( 38/40 ) , respectively ( P > 0. 05 ) , the postoperative best corrected visual acuity /preoperative best corrected visual acuity were l. 15 + 0. 12 . 1. 09 + 0. 14 , respectively ( P > 0. 05 ) . Effective index : The ratio of postoperative uncorrected visual acuity reach to the preoperative best corrected visual acuity in SMILE group and FS-LASIK group were 95. 0% ( 38/40) and 80. 0% ( 32/40) (P < 0. 05 ) , the uncorrected visual acuity/preoperative best corrected visual acuity were l. 11 +0. 13 and 0. 98 + 0. 14 ( P < 0. 05 ) . Predictability : After 3 months . the rate of spherical equivalent refraction within + 0. 50 D were 95. 0% ( 38/40 ) and 70. 0% ( 28/40) (P < 0. 05 ) , within +0. 75 D were 97. 5% ( 39/40) and 82. 5% ( 33/40 ) (P < 0. 05 ) . Stability : Compared with postoperative I week. there was no statistical difference in spherical equivalent refraction of FS-LASIK group and SMILE group at postoperative l month .3 months and 6 months (P > 0. 05 ) . After surgery , the corneal topography of two groups were mainly smooth . the rates were 82. 5% ( 33/40 ) and 60. 0% ( 24/40 ) , respectively , the difference was statistically significant ( P < 0. 05 ) . Conclusion Both FS-LASIK and SMILE for high myopia is safe and stable. and SMILE is