中高度近视患者飞秒激光微小切口角膜基质透镜取出术后视觉质量变化

目的：：比较分析VisuMax飞秒激光微小切口角膜基质透镜取出术( small incision lenticule extraction,SMILE)和准分子激光原位角膜磨镶术( laser in situ keratomileusis,LASIK)治疗中高度近视及近视散光患者(等效球镜-3.00~-9.00D)术后的视觉质量。方法：采用前瞻性病例对照研究,选取我院行角膜屈光手术的近视及近视散光患者共84例168眼分为两组：Ⅰ组为接受SMILE手术的患者42例84眼；Ⅱ组为接受准分子激光LASIK手术的患者42例84眼。两组患者术前近视度数在-3.00~-8.00D,散光-0.25~-2.00D。术后跟踪随访6mo,分别对术前、术后1、3、6mo 的裸眼视力( uncorrected visual acuity, UCVA )、等效球镜( spherical equivalent, SE)、高阶像差( higher order aberration, HOA)、对比敏感度( contrast sensitivity, CS)进行比较并作统计学分析。结果：全部患者手术进行顺利,术中和术后均无危害视力的并发症发生。术后Ⅰ组UCVA好于Ⅱ组,且SE低于Ⅱ组(P<0.05)。两组患者术后高阶像差均较术前增加,Ⅱ组球差高于Ⅰ组(P<0.05)。术后两组患者低、中、高频率空间点对比敏感度较术前相比均下降(P<0.05)；3、6mo对比敏感度均有所恢复。结论：SMILE 手术能够有效矫正中高度近视和散光,与LASIK手术相比术后视力较好、屈光度更稳定、球差增加较少、在对比敏感度的恢复及提高视觉质量方面优于LASIK手术,但需加大样本量及延长随访时间做远期观察。

Clinical study on the visual quality in patients with moderate or high myopia after small incision lenticule extraction

AIM: To compare the visuaI quaIity between patients with moderate or high myopia and myopic astigmatism (SE-3. 00~-9. 00D)after femtosecond Iaser smaII incision IenticuIe extraction ( SMILE ) and Iaser in situ keratomiIeusis( LASIK) . METHODS: The prospective study was appIied. Eighty four patients (168 eyes) were divided into two groups:42 patients ( 84 eyes ) with myopia underwent SMILE was group I, 42 patients (84 eyes) with myopia underwent LASIK was groupⅡ. The myopia degree of the patients was -3. 00~-8. 00D and astigmatism was -0. 25~-2. 00D before treatments and they were foIIowed for 6mo. Uncorrected visuaI acuity ( UCVA ) , sphericaI equivaIent ( SE) , high order aberration ( HOA ) , contrast sensitivity ( CS ) were compared and statisticaIIy anaIyzed at preoperativeIy, 1,3 and 6mo postoperativeIy. RESULTS: AII operations were successfuI without serious compIications that damaged vision. The UCVA in group Iwas higher than that in groupⅡ, and the SE was Iower than that in group Ⅱ postoperativeIy(P<0. 05). The HOA in both groups increased compared with those preoperative ( P< 0. 05 ), but the increase of sphericaI aberration( SA) in groupⅡ were significantIy higher than that in group I ( P < 0. 05 ). The CS at each spatiaI frequency in both groups decreased compared with those preoperative(P<0. 05). At 3 and 6mo postoperativeIy, the CS in both groups was improved. CONCLUSION: Moderate or high myopia and astigmatism can be effectiveIy corrected by SMILE. Better visuaI acuity, more stabIe refractive state, Iess increase on SA, the recovery of CS and the improvement on visuaI quaIity, are the advantage of SMILE, but investigation with Iarger sampIe size and Iong term observation are needed.