摘要
目的观察散光标记器辅助小切口飞秒激光基质透镜取出术(SMILE)矫正高度近视散光的效果,并探讨其对术后稳定性、视觉质量的影响,为临床治疗提供指导。方法选取2023年2月至2024年3月郑州美视美康眼科医院眼科收治的86例(86眼)高度近视散光患者作为研究对象,按随机数表法分为观察组和对照组各43例(43眼)。对照组患者采取SMILE术治疗,观察组患者采取散光标记器辅助SMILE术治疗。比较两组患者术前及术后3个月的视力、等效球镜度、0°等效柱镜度,术后3个月的术后散光评价指标[散光矫正指数(CI)、矫正率(CR)、误差角度绝对值(|AofE|)、差异矢量绝对值(|DV|)],术前及术后3个月的角膜高阶像差,术前及术后1个月、3个月的角膜稳定性和泪膜稳定性[泪膜破裂时间(BUT)、泪液分泌功能检测(SIt)],统计两组患者术后并发症发生率。结果术后3个月,观察组患者的裸眼视力、矫正视力分别为(0.23±0.10)LogMAR、(0.12±0.05)LogMAR,明显优于对照组的(0.31±0.12)LogMAR、(0.18±0.08)LogMAR,差异均有统计学意义(P<0.05),但两组患者的等效球镜度、0°等效柱镜度比较差异均无统计学意义(P>0.05);术后3个月,观察组患者的|AofE|为0.64±0.76,明显低于对照组的4.87±0.92,差异有统计学意义(P<0.05),但两组患者的CI、CR、|DV|比较差异均无统计学意义(P>0.05);术后3个月,观察组患者的水平彗差、垂直彗差分别为0.21(0.09,0.34)μm、0.26(0.15,0.41)μm,明显低于对照组的0.34(0.1,0.48)μm、0.43(0.19,0.57)μm,差异均有统计学意义(P<0.05),但两组患者球差、三叶草比较差异均无统计学意义(P>0.05);术后1、3个月两组患者角膜最薄点高度、角膜后表面高度及BUT、SIt两组间比较差异均无统计学意义(P>0.05);观察组患者的术后并发症发生率为4.65%,与对照组的6.98%比较差异无统计学意义(P>0.05)。结论散光标记器辅助SMILE矫正高度近视散光安全、有效,可减小术后彗差,提高视觉质量,保障角膜、泪膜稳定性。
Objective To observe the effect of astigmatic marker-assisted smallincision lenticule extraction(SMILE)for correction of high myopic astigmatism,and to explore its effect on postoperative stability and visual quality,so as to provide guidance for clinical treatment.Methods A total of 86 patients(86 eyes)with high myopia and astigmatism admitted to the Department of Ophthalmology,Zhengzhou Meishi Meikang Eye Hospital from February 2023 to March 2024 were selected and divided into the observationgroup and control group according to the random number table,with 43 cases each group.Patients in the control group underwent SMILE surgery,while those in the observation group received astigmatism marker-assisted SMILE surgery.The visual acuity,equivalent spherical power,and 0°equivalent cylindrical power were compared between the two groups of patients before surgery and at 3 months after surgery,as well as the postoperative astigmatism evaluation indicators at 3 months after surgery(astigmatism correction index[CI],correction rate[CR],absolute value of error angle[|AofE|],and absolute value of difference vector[|DV|]),corneal higher-order aberrations before surgery and at 3 months after surgery,and corneal stability and tear film stability(tear break-up time[BUT]and SchirmerⅠtests[SIt])before surgery and at 1 month and 3 months after surgery.The incidence of postoperative complications in the two groups was statistically analyzed.Results At 3 months after surgery,the uncorrected visual acuity and corrected visual acuity of patients in the observation group were(0.23±0.10)LogMAR and(0.12±0.05)LogMAR,respectively,which were significantly better than the control group's(0.31±0.12)LogMAR and(0.18±0.08)LogMAR,with statistically significant difference(P<0.05).However,there was no statistically significant difference between the two groups in terms of equivalent spherical power and 0°equivalent cylindrical power(P>0.05).At 3 months after surgery,the|AofE|of patients in the observation group was 0.64±0.76,which was significantly lower than 4.87±0.92 of the control group(P<0.05);however,there were no significant differences in CI,CR,and|DV|between the two groups of patients(P>0.05).At 3 months after surgery,the horizontal coma and vertical coma of patients in the observation group were 0.21(0.09,0.34)μm and 0.26(0.15,0.41)μm,respectively,which were significantly lower the control group's 0.34(0.1,0.48)μm and 0.43(0.19,0.57)μm(P<0.05);however,there was no statistically significant difference between the two groups in terms of spherical aberration and trefoil comparison(P>0.05).There were no significant differences in the height of the thinnest point of the cornea,the height of the posterior surface of the cornea,BUT,and SIt between the two groups at 1 month and 3 months after surgery(P>0.05).The incidence of postoperative complications in the observation group was 4.65%,which did not significantly differ from that in the control group(6.98%),P>0.05.Conclusion The astigmatism marker-assisted SMILE correction of high myopia astigmatism is safe and effective,which can reduce postoperative coma,improve visual quality,and ensure corneal and tear film stability.
作者
田琦
庞辰久
耿英云
TIAN Qi;PANG Chen-jiu;GENG Ying-yun(Department of Ophthalmology,Zhengzhou Meishi Mekang Eye Hospital,Zhengzhou 450000,Henan,CHINA;Department of Refractive Surgery,Henan Provincial Eye Hospital,Zhengzhou 450000,Henan,CHINA)
出处
《海南医学》
2025年第2期211-216,共6页
Hainan Medical Journal
基金
2021年度河南省医学科技攻关计划联合共建项目(编号:LHGJ20211082)。
关键词
高度近视
散光
散光标记
小切口飞秒激光基质透镜取出术
角膜高阶像差
泪膜稳定性
High myopia
Astigmatism
Astigmatism markers
Small incision lenticule extraction(SMILE)
Corneal higher-order aberration
Lacrimal stability
