SMILE与FS-LASIK治疗高度近视散光患者5年疗效对比

目的 比较飞秒激光小切口角膜基质透镜取出术(SMILE)与飞秒激光辅助准分子激光原位角膜磨镶术(FS-LASIK)治疗高度近视散光患者5年的临床疗效。方法 前瞻性非随机对照研究。根据所接受的手术方式不同患者被分为SMILE组和FS-LASIK组，术后随访5年，对比分析两组患者裸眼远视力(UDVA)、最佳矫正远视力(BCDVA)、等效球镜度(SE)、散光、总高阶像差(HOAs)、球差、彗差、泪液分泌功能、泪膜破裂时间(TBUT)和眼表疾病指数量表(OSDI)评分。采用重复测量资料的方差分析进行统计学分析，采用LSD-t检验进行两两比较，采用独立样本t检验进行组间分析。结果 2组患者相比，术后UDVA、SE、HOAs、球差、彗差、泪液分泌试验、TBUT、OSDI评分差异均有统计学意义(均为P<0.05),但BCDVA、散光的差异均无统计学意义(均为P>0.05)。SMILE组患者术后1个月的SE低于FS-LASIK组，而术后1～5年的SE均高于FS-LASIK组(均为P<0.05)。SMILE组患者术后3～6个月、3～5年的HOAs均较FS-LASIK组更低(均为P<...

Comparison of five-year clinical effects between the small incision lenticule extraction and femtosecond laser-assisted in situ keratomileusis in the treatment of high myopia with astigmatism

Objective　To compare the five-year clinical effects of small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) in treating high myopia with astigmatism. Methods　A prospective, non-randomized, controlled study was conducted. Patients were divided into the SMILE group and FS-LASIK group by the surgical procedure they received. The uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BCDVA), spherical equivalent (SE), astigmatism, higher-order aberrations (HOAs), spherical aberrations, coma aberrations, tear secretion function, tear break-up time (TBUT) and ocular surface disease index (OSDI) scores were analyzed and compared during the 5-year of follow-up. Variance analysis of repeated measurements was carried out, and the Least Significance Difference test was conducted for pairwise comparison. Furthermore, an independent sample t-test was used for intergroup analysis. Results　There were significant differences in postoperative UDVA, SE, HOAs, spherical aberrations, coma aberrations, tear secretion function, TBUT and OSDI scores (all P<0.05) between the two groups, but no differences in BCDVA and astigmatism between the two groups (both P>0.05). The SE in the SMILE group was lower than that of the FS-LASIK group at 1 month, but was higher than that of the FS-LASIK group from 1 to 5 years postoperatively (all P<0.05). The HOAs were lower in the SMILE group from 3 to 6 months and 3 to 5 years postoperatively (all P<0.05). The absolute values of spherical aberrations in the SMILE group were significantly lower than those in the FS-LASIK group from 3 to 5 years postoperatively (all P<0.05). However, the coma aberrations in the SMILE group were significantly higher than those in the FS-LASIK group at 1 month and 1 to 5 years postoperatively (all P<0.05). The TBUTs in the SMILE group were significantly longer than those in the FS-LASIK group from 1 to 6 months after the operation (all P<0.05). Conclusion　Both SMILE and FS-LASIK are safe and effective, but SMILE has advantages in long-term stability. SMILE introduces fewer HOAs and spherical aberrations but more coma aberrations. Furthermore, the duration of dry eye symptoms is shorter, and the recovery is faster after SMILE.