2.0mm小切口飞秒激光角膜基质透镜取出术与飞秒激光辅助的LASIK矫正近视的疗效比较

目的　比较２．０ｍｍ微切口飞秒激光角膜基质透镜取出术（２．０ｍｍｓｍａｌｌｉｎｃｉｓｉｏｎｌｅｎｔｉｃｕｌｅｅｘｔｒａｃｔｉｏｎ，２．０ｍｍＳＭＩＬＥ）与飞秒激光辅助的ＬＡＳＩＫ（ｌａｓｅｒｉｎｓｉｔｕｋｅｒａｔｏｍｉｌｅｕｓｉｓｗｉｔｈｆｅｍｔｏｓｅｃｏｎｄｌａｓｅｒ，ＦＳ-ＬＡＳＩＫ）矫正近视的疗效。方法　研究纳入行２．０ｍｍＳＭＩＬＥ的近视患者４８例（９６眼），同期行ＦＳ-ＬＡＳＫ者５０例（１００眼），记录并比较两组术前及术后１ｄ、１周、１个月、３个月及６个月的裸眼视力（ｕｎｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ，ＵＣＶＡ）、最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ，ＢＣＶＡ）、屈光度、生活质量量表（ｑｕａｌｉｔｙｏｆｌｉｆｅ，ＱＯＬ）得分及手术满意度量表评分。结果　在术后１周以后ＳＭＩＬＥ组视力高于ＦＳ-ＬＡＳＩＫ组，且状态较ＦＳ-ＬＡＳＩＫ组更为稳定。术后１个月、３个月、６个月ＳＭＩＬＥ组ＵＣＶＡ≥术前ＢＣＶＡ的比例高于ＦＳ-ＬＡＳＩＫ组，差异均有统计学意义（均为Ｐ＜０．０５）。术后早期（术后１周）ＳＭＩＬＥ组存在１例过矫，而ＦＳ-ＬＡＳＩＫ组存在１例欠矫，但在术后１个月、３个月、６个月两组手术患者均在±１．００Ｄ范围内。术后平均角膜前表面形态变异指数及垂直不对称指数在各时间点均为ＦＳ-ＬＡＳＩＫ组大于ＳＭＩＬＥ组，差异均有统计学意义（均为Ｐ＜０．０５）。两组术前及术后６个月ＱＯＬ得分组间比较，差异均无统计学意义（均为Ｐ＞０．０５），术后６个月ＱＯＬ得分均较术前有所增加，且差异均有统计学意义（ＳＭＩＬＥ:ｔ＝－１３．８５，Ｐ＝０．００；ＦＳ-ＬＡＳＩＫ:ｔ＝－１３．２１，Ｐ＝０．００），而两组术后６个月ＱＯＬ得分比较，差异无统计学意义（Ｐ＞０．０５）。两组均有较高的再次手术选择率及手术推荐率，并且未发生严重的并发症。结论　２．０ｍｍＳＭＩＬＥ与ＦＳ-ＬＡＳＩＫ均具有良好的有效性、稳定性以及可预测性，术后都可获得良好的视力及良好的生活质量，前者更好地保持了角膜前表面的形态。

Comparison of 2.0 mm small incision lenticule extraction and femtosecond laser LASIK for myopia

Objective To compare and evaluate the postoperative outcomes of 2. 0 mm small incision lenticule extraction (2. 0 mm SMILE) and laser in situ keratomileusis with femtosecond laser ( FS-LASIK) for myopia. Methods Forty-eight patients (96 eyes) with myopia were selected for 2. 0 mm SMILE and another 50 patients ( 100 eyes) were selected for FS-LASIK at the same time. Uncorrected visual acuity ( UCVA) , best corrected visual acuity ( BCVA) , spherical equivalent ( SE ) and quality of life (QOL) were measured preoperatively and l day,7 days,l month,3 months and 6 months postoperatively. Results The average visual acuity of SMILE group were higher than those of FS-LASIK group at l week,l month,3 months and 6 months postoperatively,and visual acuity state of the SMILE group was more stable. The rates to get postoperative BCVA less than preoperative BCVA at l month,3 months,6 months after operation in SMILE group were higher than those in FS-LASIK group,and the differences were statistically significant ( all P < 0. 05 ). 1 eye was overcorrected in SMILE group and 1 eye was undercorrected at l week postoperatively. SE were within + 1. 00 D of the attempted correction at l month,3 months,6 months postoperatively of two groups. The index of surface variance and vertical asymmetry of SMILE group was higher than those of FS-LASIK group at each follow-up time after surgery,the difference were statistically significant( all P < 0. 05 ). There was no significant difference in the score of QOL before surgery and 6 months after surgery between two groups ( all P > 0. 05 ) The postoperative average QOL scores of two groups were lugher than before surgery,and the difference were statistically sigruficant ( SMILE : t = - 13. 85 ,P = 0. 00 ; FS-LASIK: t = - 13. 21 , P = 0. 00). Two groups had a high degree of satisfaction and rate of recommended surgery to others.ln the two groups,no serious complication was occurred. Conclusion 2. 0 mm SMILE and FS-LASIK are effective,stable and predictable to treat refractive errors. Sigruficant visual acuity and QOL improvements are found in the two surgery patients. The anterior corneal surface of 2. 0 mm SMILE is better stable than FS-LASIK.