不同切割深度对SMILE术后治疗效果的影响
韩惠萍,陆勤康,查桂平,张元钧,王惠云,童奇湖,赖晓明
325035 温州医科大学(韩惠萍、陆勤康);315100 宁波市鄞州人民医院眼科(查桂平、张元钧、王惠云、童奇湖、赖晓明)
Comparison of the Curative Effect after Small Incision Lenticule Extraction Surgery at Different Ablation Depths
Huiping Han, Qinkang Lu, Guiping Zha, Yuanjun Zhang, Huiyun Wang,Qihu Tong, Xiaomin Lai
1Wenzhou Medical University, Wenzhou 325035, China
2Ningbo Yinzhou People's Hospital, Ningbo 315100, China
摘要 目的:评估不同切割深度对飞秒激光小切口角膜基质透镜取出术(SMILE)后治疗效果的影响,并初步探讨切割深度可预测性的影响因素。方法:回顾性研究。选择2016 年4 月至2017 年7 月在宁波市鄞州人民医院行SMILE的近视屈光参差患者58 例(116 眼)。以预期切割深度较深眼为A组,对侧眼为B组。分别统计患者术前及术后1 d、1周、1个月、6个月裸眼视力(UCVA)、最佳矫正视力(BCVA)、等效球镜度(SE)、角膜高阶像差等。记录患者术前平均角膜曲率、眼轴长度、矫正眼压、预期切割深度,并计算实际切割深度。采用重复测量方差分析、配对t检验、Pearson相关分析、多元线性回归分析对数据进行统计分析。结果:术后6个月2组的有效性指数、安全性指数均大于1.0。术后1个月,A组角膜总高阶像差(t=3.747,P=0.001)、球差(t=3.308,P=0.002)、垂直彗差(t=3.507,P=0.001)的增加量较B组大。A、B组分别发生2 眼和3 眼一级弥漫层间角膜炎,经治疗后均痊愈。A组预期与实际切割深度的差值较B组大(t=4.250,P<0.001)。预期与实际切割深度的差值与预期切割深度(r=0.397,P<0.001)、眼轴长度(r=0.350,P=0.002)、SE(r=-0.308,P=0.007)均有相关性,通过多元线性回归得到公式:预期与实际切割深度的差值=0.171×预期切割深度-8.201。结论:SMILE适应证范围内,不同切割深度不会影响手术的安全性、稳定性及有效性。预期切割深度较深眼引入的角膜总高阶像差、球差和垂直彗差较大,预期切割深度越深可预测性越差。另外,预期切割深度的可预测性与预期切割深度、眼轴长度、术前SE等呈弱相关性。
关键词 :
飞秒激光小切口角膜基质透镜取出术 ,
切割深度 ,
高阶像差 ,
治疗结果
Abstract :Objective: To determine the effect of different ablation depths on the curative effect after small incision lenticule extraction (SMILE). Methods: A total of 116 eyes (58 patients with anisometropia) that underwent SMILE were included in this retrospective study from April 2016 to July 2017 in Ningbo Yinzhou People's Hospital. The deeper ablated eye in each patient was assigned to Group A, while the contralateral eye was assigned to Group B. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical equivalent (SE), higher-order aberrations (HOA), and other parameters were recorded preoperatively and at 1 day, 1 week, 1 month, and 6 months postoperatively. The average preoperative corneal curvature, axial length, corrected intraocular pressure, and expected ablation depth were recorded, while the actual ablation depths were calculated. The data were analyzed by repeated measurement ANOVA, paired samples t-tests, Pearson correlation analysis, and linear regression analysis. Results: The mean safety index and the mean effective index were greater than 1.0 in both groups 6 months postoperatively. Mean postoperative SEs were both within the range of ±0.5 diopter (D). The increases of corneal total higher-order aberrations
(t=3.747, P=0.001), spherical aberration (t=3.308, P=0.002), and vertical coma (t=3.507, P=0.001) in Group A were all higher than in Group B at 1 month postoperatively. Two cases of diffuse lamellar keratitis occurred in Group A while three occurred in Group B. All were cured by glucocorticoid treatment. The
deviations between the expected and actual ablation depths in Group A were greater than that in Group B (t=4.250, P<0.001). The deviation between the expected and actual ablation depths was correlated with the expected ablation depth (r=0.397, P<0.001), axial length (r=0.350, P=0.002), and SE (r=-0.308, P=0.007).
Using multiple linear regression, the following relationship was determined: D=0.171×expected ablation depth -8.201, where D was the deviation between the expected and actual ablation depths. Conclusions:Within the range of indications, ablation depth did not affect the safety, stability, or effectiveness of SMILE
surgery. However, the deeper the expected ablation depth was, the more corneal total HOA, spherical aberration, and vertical coma were introduced after surgery, and the worse the predictability of ablation depth was. The predictability of ablation depth was weakly correlated with expected ablation depth axial
length, and preoperative SE.
Key words :
small incision lenticule extraction
ablation depth
high-order aberrations
treatment outcomes
收稿日期: 2018-02-02
通讯作者:
陆勤康(ORCID:0000-0002-0648-2499),Email:lqktyyx@163.com
引用本文:
韩惠萍,陆勤康,查桂平,张元钧,王惠云,童奇湖,赖晓明. 不同切割深度对SMILE术后治疗效果的影响[J]. 中华眼视光学与视觉科学杂志, 2018, 20(7): 420-425,432.
Huiping Han, Qinkang Lu, Guiping Zha, Yuanjun Zhang, Huiyun Wang,Qihu Tong, Xiaomin Lai. Comparison of the Curative Effect after Small Incision Lenticule Extraction Surgery at Different Ablation Depths. Chinese Journal of Optometry Ophthalmology and Visual science, 2018, 20(7): 420-425,432. DOI: 10.3760/cma.j.issn.1674-845X.2018.07.006.
链接本文:
https://www.cjoovs.com/CN/10.3760/cma.j.issn.1674-845X.2018.07.006. 或 https://www.cjoovs.com/CN/Y2018/V20/I7/420
[1]
Han T, Zheng K, Chen Y, et al. Four-year observation of
[1]
Han T, Zheng K, Chen Y, et al. Four-year observation of
predictability and stability of small incision lenticule extraction.
BMC Ophthalmol, 2016, 16(1): 149. DOI: 10.1186/s12886-016-
predictability and stability of small incision lenticule extraction.
BMC Ophthalmol, 2016, 16(1): 149. DOI: 10.1186/s12886-016-
03
31-0.
03
31-0.
[2]
Hansen RS, Lyhne N, Grauslund J, et al. Small-incision lenticule
[2]
Hansen RS, Lyhne N, Grauslund J, et al. Small-incision lenticule
extraction (SMILE): outcomes of 722 eyes treated for myopia
extraction (SMILE): outcomes of 722 eyes treated for myopia
and myopic astigmatism. Graefes Arch Clin Exp Ophthalmol,
20
16, 254(2): 399-405. DOI: 10.1007/s00417-015-3226-5.
and myopic astigmatism. Graefes Arch Clin Exp Ophthalmol,
20
16, 254(2): 399-405. DOI: 10.1007/s00417-015-3226-5.
[3]
陈跃国. 应重视准分子激光角膜屈光手术对角膜生物力学结
构完整性的影响. 中华眼科杂志 , 2011 , 47 (7): 577-579. DOI:
[3]
陈跃国. 应重视准分子激光角膜屈光手术对角膜生物力学结
构完整性的影响. 中华眼科杂志 , 2011 , 47 (7): 577-579. DOI:
10
3760/cma.j.issn.0412-4081.2011.07.001.
10
3760/cma.j.issn.0412-4081.2011.07.001.
[4]
Wu W, Wang Y, Zhang H, et al. One-year visual outcome of
[4]
Wu W, Wang Y, Zhang H, et al. One-year visual outcome of
small incision lenticule extraction (SMILE) surgery in high
small incision lenticule extraction (SMILE) surgery in high
myopic eyes: retrospective cohort study. BMJ Open, 2016, 6(9):
e010993. DOI: 10.1136/bmjopen-2015-010993.
myopic eyes: retrospective cohort study. BMJ Open, 2016, 6(9):
e010993. DOI: 10.1136/bmjopen-2015-010993.
[5]
Wu W, Wang Y. The correlation analysis between corneal
[5]
Wu W, Wang Y. The correlation analysis between corneal
biomechanical properties and the surgically induced corneal
biomechanical properties and the surgically induced corneal
high-order aberrations after small incision lenticule extraction
high-order aberrations after small incision lenticule extraction
and femtosecond laser in situ keratomileusis. J Ophthalmol,
20
15, 2015: 758196. DOI: 10.1155/2015/758196.
and femtosecond laser in situ keratomileusis. J Ophthalmol,
20
15, 2015: 758196. DOI: 10.1155/2015/758196.
[6]
Chen M, Yu M, Dai J. Comparison of biomechanical effects
[6]
Chen M, Yu M, Dai J. Comparison of biomechanical effects
of small incision lenticule extraction and laser-assisted
of small incision lenticule extraction and laser-assisted
subepithelial keratomileusis. Acta Ophthalmologica, 2016,
94
(7): e586-e591. DOI: 10.1111/aos.13035.
subepithelial keratomileusis. Acta Ophthalmologica, 2016,
94
(7): e586-e591. DOI: 10.1111/aos.13035.
[7]
窦瑞,王雁,吴文静, 等. 飞秒激光小切口角膜基质透镜取出
[7]
窦瑞,王雁,吴文静, 等. 飞秒激光小切口角膜基质透镜取出
术术后角膜生物力学的影响因素分析. 中华实验眼科杂志,
20
16, 34(5): 448-455. DOI: 10.3760/cma.j.issn.2095-0160.
术术后角膜生物力学的影响因素分析. 中华实验眼科杂志,
20
16, 34(5): 448-455. DOI: 10.3760/cma.j.issn.2095-0160.
20
16.05.013.
20
16.05.013.
[8]
Zhang L, Wang Y, Yang X. Ablation depth and its effects on
[8]
Zhang L, Wang Y, Yang X. Ablation depth and its effects on
corneal biomechanical changes in laser in situ keratomileusisand epipolis laser in situ keratomileusis. Int Ophthalmol, 2014,
34
(2): 157-164. DOI: 10.1007/s10792-013-9798-3.
corneal biomechanical changes in laser in situ keratomileusisand epipolis laser in situ keratomileusis. Int Ophthalmol, 2014,
34
(2): 157-164. DOI: 10.1007/s10792-013-9798-3.
[9]
Miao H, Tian M, Xu Y, et al. Visual outcomes and optical quality
[9]
Miao H, Tian M, Xu Y, et al. Visual outcomes and optical quality
after femtosecond laser small incision lenticule extraction: An
after femtosecond laser small incision lenticule extraction: An
18
-month prospective study. J Refract Surg, 2015, 31(11): 726-
73
1. DOI: 10.3928/1081597X-20151021-01.
18
-month prospective study. J Refract Surg, 2015, 31(11): 726-
73
1. DOI: 10.3928/1081597X-20151021-01.
[10]
Blum M, Täubig K, Gruhn C, et al. Five-year results of small
[10]
Blum M, Täubig K, Gruhn C, et al. Five-year results of small
incision lenticule extraction (ReLEx SMILE). Br J Ophthalmol,
20
16, 100(9): 1192-1195. DOI: 10.1136/bjophthalmol-2015-
30
6822.
incision lenticule extraction (ReLEx SMILE). Br J Ophthalmol,
20
16, 100(9): 1192-1195. DOI: 10.1136/bjophthalmol-2015-
[11]
Kamiya K, Shimizu K, Igarashi A, et al. Visual and refractive
30
6822.
[11]
Kamiya K, Shimizu K, Igarashi A, et al. Visual and refractive
outcomes of small incision lenticule extraction for the correction
of myopia: 1-year follow-up. BMJ Open, 2015, 5(11): e008268.
DOI: 10.1136/bmjopen-2015-008268.
outcomes of small incision lenticule extraction for the correction
[12]
樊容, 邱岩, 邸玉兰, 等. LASIK术后出现视觉不良症状者的
of myopia: 1-year follow-up. BMJ Open, 2015, 5(11): e008268.
DOI: 10.1136/bmjopen-2015-008268.
高阶像差分析. 中华眼视光学与视觉科学杂志, 2012, 14(1):
16
-21. DOI: 10.3760/cma.j.issn.1674-845X.2012.01.005.
[12]
樊容, 邱岩, 邸玉兰, 等. LASIK术后出现视觉不良症状者的
[13]
Sekundo W, Gertnere J, Bertelmann T, et al. One-year refractive
高阶像差分析. 中华眼视光学与视觉科学杂志, 2012, 14(1):
16
-21. DOI: 10.3760/cma.j.issn.1674-845X.2012.01.005.
results, contrast sensitivity, high-order aberrations and
[13]
Sekundo W, Gertnere J, Bertelmann T, et al. One-year refractive
results, contrast sensitivity, high-order aberrations and
complications after myopic small-incision lenticule extraction
(ReLEx SMILE). Graefes Arch Clin Exp Ophthalmol, 2014,
complications after myopic small-incision lenticule extraction
25
2(5): 837-843. DOI: 10.1007/s00417-014-2608-4.
(ReLEx SMILE). Graefes Arch Clin Exp Ophthalmol, 2014,
[14]
A?ca A, Demirok A, Cankaya K?, et al. Comparison of
25
2(5): 837-843. DOI: 10.1007/s00417-014-2608-4.
[14]
A?ca A, Demirok A, Cankaya K?, et al. Comparison of
visual acuity and higher-order aberrations after femtosecond
visual acuity and higher-order aberrations after femtosecond
lenticule extraction and small-incision lenticule extraction.
Cont Lens Anterior Eye, 2014, 37(4): 292-296. DOI: 10.1016/
j.clae.2014.03.001.
lenticule extraction and small-incision lenticule extraction.
Cont Lens Anterior Eye, 2014, 37(4): 292-296. DOI: 10.1016/
[15]
Jin HY, Wan T, Wu F, et al. Comparison of visual results and
j.clae.2014.03.001.
higher-order aberrations after small incision lenticule extraction
[15]
Jin HY, Wan T, Wu F, et al. Comparison of visual results and
higher-order aberrations after small incision lenticule extraction
(SMILE): high myopia vs. mild to moderate myopia. BMC
Ophthalmol, 2017, 17(1): 118. DOI: 10.1186/s12886-017-0507-
2.
(SMILE): high myopia vs. mild to moderate myopia. BMC
Ophthalmol, 2017, 17(1): 118. DOI: 10.1186/s12886-017-0507-
2.
[16]
Jin HY, Wan T, Wu F, et al. Comparison of visual results and
higher-order aberrations after small incision lenticule extraction
[16]
Jin HY, Wan T, Wu F, et al. Comparison of visual results and
(SMILE): high myopia vs. mild to moderate myopia. BMC
Ophthalmol, 2017, 17(1): 118. DOI: 10.1186/s12886-017-0507-2.
higher-order aberrations after small incision lenticule extraction
(SMILE): high myopia vs. mild to moderate myopia. BMC
[17]
胡亮, 余野, 吴江秀, 等. 近视LASIK术后人眼波前像差与中
Ophthalmol, 2017, 17(1): 118. DOI: 10.1186/s12886-017-0507-2.
[17]
胡亮, 余野, 吴江秀, 等. 近视LASIK术后人眼波前像差与中
央角膜厚度、切削深度的相关性研究. 中华眼视光学与视
觉科学杂志, 2010, 12(5): 357-362. DOI: 10.3760/cma.j.issn.
央角膜厚度、切削深度的相关性研究. 中华眼视光学与视
觉科学杂志, 2010, 12(5): 357-362. DOI: 10.3760/cma.j.issn.
16
74-845X.2010.05.009.
16
74-845X.2010.05.009.
[18]
徐雯, 周跃华, 张丽, 等. SMILE与FS-LASIK对近视眼角膜
[18]
徐雯, 周跃华, 张丽, 等. SMILE与FS-LASIK对近视眼角膜
基质切削深度可预测性的比较. 中华实验眼科杂志, 2017,
35
(6): 532-536. DOI: 10.3760/cma.j.issn.2095-0160.2017.06.
010.
基质切削深度可预测性的比较. 中华实验眼科杂志, 2017,
35
(6): 532-536. DOI: 10.3760/cma.j.issn.2095-0160.2017.06.
010.
[1]
刘嘉, 钟定娟, 陈蛟, 等. 轻度干眼患者SMILE与FS-LASIK术后眼表和干眼严重程度变化比较 [J]. 中华眼视光学与视觉科学杂志, 2023, 25(5): 354-360.
[2]
田彩霞, 王雁, 张佳媚. 不同切口SMILE对近视散光矫正影响的矢量分析 [J]. 中华眼视光学与视觉科学杂志, 2023, 25(5): 347-353.
[3]
杨哲, 夏丽坤. SMILE矫正高度近视及散光术后功能性光学区的变化 [J]. 中华眼视光学与视觉科学杂志, 2023, 25(3): 188-194.
[4]
何笑英, 韩伟. 角膜屈光手术中影响高阶像差的因素 [J]. 中华眼视光学与视觉科学杂志, 2023, 25(3): 235-240.
[5]
任雪文, 夏丽坤. SMILE术后不同效价激素治疗对角膜光密度值和角膜上皮厚度的影响 [J]. 中华眼视光学与视觉科学杂志, 2023, 25(2): 96-103.
[6]
王 子 辰,程 新 梁,俞 莹 .. SMILE术后增效手术的研究进展 [J]. 中华眼视光学与视觉科学杂志, 2022, 24(8): 635-640.
[7]
李康寯, 王姗姗, 李青云, 等.. SMILE手术前后全眼高阶像差与角膜生物力学变化 [J]. 中华眼视光学与视觉科学杂志, 2022, 24(5): 351-357.
[8]
李娜, 刘明娜, 高华, 等.. 高度近视SMILE、FS-LASIK及LASEK 术后角膜后表面高度变化的比较 [J]. 中华眼视光学与视觉科学杂志, 2022, 24(5): 343-350.
[9]
杨哲,夏丽坤. SMILE矫正近视术后功能性光学区与角膜上皮重塑的相关性 [J]. 中华眼视光学与视觉科学杂志, 2022, 24(12): 902-909.
[10]
刘思源,靳光明,郑丹莹. 先天性晶状体脱位患者角膜曲率与像差特征 [J]. 中华眼视光学与视觉科学杂志, 2022, 24(11): 806-811.
[11]
高奕晨, 杨军, 蒋元丰, 等. 不同像差分析设备对白内障患者角膜高阶像差测量的比较 [J]. 中华眼视光学与视觉科学杂志, 2022, 24(10): 752-.
[12]
向爱群 杜凯旋 吴小影 尹叶薇 傅艳燕 卢颖 傅秋满 胡涂 李元君 文丹. 高度近视SMILE和FS-LASIK术后早期局部调节和中枢视感知觉功能变化 [J]. 中华眼视光学与视觉科学杂志, 2021, 23(8): 561-569.
[13]
陈嘉宝1 江春霞2 黄钦颖1,2 林晓璇1,2 李金瑛1. SMILE术后屈光状态偏差原因分析 [J]. 中华眼视光学与视觉科学杂志, 2021, 23(6): 434-440.
[14]
侯湘涛1,2 吴小影1,2 杜凯旋1,2 文丹1,2 胡生发1,2 胡涂1,2 李晨玲1,2 唐艳辉1,2. SMILE术后不同瞳孔直径下视觉质量的比较 [J]. 中华眼视光学与视觉科学杂志, 2021, 23(5): 336-342.
[15]
刘云川 侯臻 王洪娟 周萍. 8 600眼SMILE术中术后并发症观察 [J]. 中华眼视光学与视觉科学杂志, 2021, 23(5): 343-347.