摘要
背景小切口角膜微透镜取出术（SMILE）术中无准分子激光虹膜跟踪技术，故矫正散光的效果存在争议，了解其矫正近视散光的效果将对临床有-定的指导意义。目的探讨SMILE与飞秒激光辅助的准分子激光角膜原位磨镶术（FS—LASIK）矫正低中度近视散光的临床效果。方法采用回顾性研究设计。纳入2013年12月至2014年7月在天津市眼科医院分别接受SMILE的患者51例95眼及同期接受FS—LASIK的低中度近视散光患者40例69眼，SMILE组与FS—LASIK组间术前球镜度、柱镜度和等效球镜度（sE）的差异均无统计学意义（均P〉0．05）。术眼于术前及术后1d、1周、1个月、3个月均检查裸眼视力（UCVA）、最佳矫正视力（BCVA），并进行显然验光、裂隙灯显微镜检查、眼压测量及角膜地形图测量。利用矢量分析法计算2种手术方式术前及术后残余散光的分布情况，并选取矫正指数（cI）、成功指数（IOS）、误差角（AofE）和变平指数（FI）等指标评价散光的矫正效果，以安全性指数、有效性指数作为评价视力恢复程度的指标，对2个组间疗效指标的差异进行比较，对术前Kappa角与各参数之间的关系进行分析。结果SMILE组术后球镜度、柱镜度和sE分别为（0．003±0．106）、（-0．063±0．126）和（-0．029±0．101）D，FS．LASIK组分别为（0．112±0．212）、（-0．091±0．142）和（0．067±0，198）D，SMILE组术后球镜度和SE均明显低于FS—LASIK组，差异均有统计学意义（Z=-4．328、-3．197，均P〈0．05）。矢量计算结果显示，SMILE组术后以顺规散光为主，而Fs．LASIK组术后则以斜轴散光为主，SMILE组术后cI和FI均明显低于FS—LASIK组，差异均有统计学意义（Z=-3．051、-3．126，均P〈0．05），SMILE组术后cI略低于1，而FS—LASIK组术后cI略高于1。SMILE组IOS和AofE小于FS—LASIK组，但差异均无统计学意义（Z=-1．557，P=0．119；Z=-1．923，P=0．054）。2个组中术眼术后的安全性指数和有效性指数差异均无统计学意义（均P〉0．05）。SMILE组安全性指数和有效性指数与术前Kappa角的偏移量均呈负相关（r=-0．258、-0．257，均P〈0．05）。结论SMILE和FS-LASIK均能有效矫正低中度近视散光，术后均能达到预期视力。SMILE手术切口的愈合反应轻于FS—LASIK，故术后残余散光轴向偏差小。SMILE术后散光呈欠矫趋势，术者可根据经验适当增加散光矫正度。
Background Small incision lenticule extraction （SMILE） is lack of eye-tracking system and there is controversy in the treatment of astigmatism. It is very important to understand its correction effctiveness for myopic astigmatism. Objective This study was to evaluate the clinical outcomes in the correction of myopic astigmatism between SMILE and femtosecond laser assisted laser in situ keratomileusis （FS-LASIK）. Methods In this retrospective study, 95 eyes of 51 patients and 69 eyes of 40 patients with myopic astigmatism underwent the SMILE surgery and FS-LASIK surgery respectively in Tianjin Eye Hospital from December 2013 to July 2014 under the informed consent. No significant differences were found in spherical power, astigmatic power and spherical equivalent （SE） between the SMILE group and FS-LASIK group before surgery （all at P〉0.05 ）. The uncorrected visual acuity （UCVA）, best corrected visual acuity （BCVA）, manifest refraction, slit-lamp microscopy, intraocular pressure and corneal topography were measured before surgery and 1 day, 1 week, I month,3 months after surgery. Vector analysis was used to calculate the components of astigmatism before and after surgery. Correction index （CI） , index of success （IOS） , angle of error （AofE） and flattening index （FI） were used to evaluate the correctioneffectiveness of astigmatism. Safety index and efficacy index were used to evaluate the recovery status of visual acuity. The corrected effectiveness was compared between the two groups, and the correlations of kappa angle with measured parameter were assessed by Spearman rank correlation analysis. Results The mean spherical power, astigmatic power and SE were （0. 003±0. 106）, （-0. 063 ± 0. 126） and （-0. 029 ± 0. 101 ）D in the SMILE group,which were significantly lower than （0. 112 ±0. 212）, （-0. 091 ± 0. 142） and （0. 067 ± 0. 198 ）D in the FS-LASIK group （Z = -4. 328, -3. 197, both at P〈0. 05）. Vector analysis showed the postoperative with-the-rule astigmatism in the SMILE group and oblique astigmatism in the FS-LASIK group respectively, and the CI and FI in the SMILE group were significantly lower than those in the FS-LASIK group （Z =- 3. 051,-3. 126, both at P〈0. 05 ）. The insignificant reduce in IOS and AofE were seen in the SMILE group compared with the FS-LASIK group （Z= -1. 557 ,P=0. 119; Z=- 1. 923,P = 0. 054）. In addition, the safety index and efficacy index were not significantly different between the two groups （both at P 〉 0. 05 ）. Negative correlations were found between safety index or efficacy index and preoperative kappa angle in the SMILE group （r =-0. 258,-0. 257,both at P〈0.05）. Conclusions Both SMILE and FS-LASIK surgeries are effective and safe in correcting myopic astigmatism with good postoperative visual acuity. SMILE surgery shows less axis rotation and higher accuracy than FS-LASIK because of small incision and flapless procedure. The correction of cylinder can adjust based on experience of surgeon.
出处
《中华实验眼科杂志》
CAS
CSCD
北大核心
2016年第5期432-437,共6页
Chinese Journal Of Experimental Ophthalmology
基金
国家自然科学基金项目（81470658）
