SMILE与FS-LASIK术后光学区特性比较

doi:10.3760/cma.j.cn115909-20190818-00229

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摘要目的：比较飞秒激光小切口角膜基质透镜取出术（SMILE）、SCHWIND Amaris1050平台和Wavelight EX500平台的飞秒激光制瓣的准分子激光原位角膜磨镶术（FS-LASIK）单纯近视矫正术后的实际光学区大小、非球面性和高阶像差。方法：回顾性病例对照研究。选取于2018年1月至2019年1月期间在广州爱尔眼科医院行近视手术矫正患者，根据手术方式和平台分为SMILE组、Amaris1050组和EX500组；收集患者术后1、3个月光学区直径、Q值、高阶像差等数据，利用Topolyzer术后切线曲率图（切线法）和Pentacam术前、术后切线曲率差异图（切线差异法）测量光学区直径。3组间光学区大小、Q值、高阶像差比较采用ANOVA单因素方差分析，多重比较采用Bonferroni法。2种方法间比较采用配对样本t检验。结果：共纳入91例（113眼），其中SMILE组42眼，Amaris1050组25眼， EX500组46眼。术后3个月，切线法和切线差异法所测光学区直径SMILE组大于Amaris1050组和 EX500组（均P<0.001），分别为（6.90±0.12）mm和（5.17±0.15）mm，（6.58±0.19）mm和（5.00±0.10） mm，（6.56±0.16）mm和（4.86±0.15）mm；Amaris1050 组切线差异法所测光学区大于EX500 组（P=0.003）。3组切线法光学区测量值大于切线差异法（t=64.836、34.146、63.927，均P<0.001）；角膜中央5、6 mm范围Q值，SMILE组小于Amaris1050组和EX500组（5 mm：P=0.017、0.013；6 mm： P=0.004、0.005），Amaris1050组和EX500组差异无统计学意义（P=1.000）；6 mm瞳孔直径下，SMILE 组球差小于Amaris1050组和EX500组（P=0.004、0.017），Amaris1050组和EX500组差异无统计学意义（P=0.793）。结论：SMILE术后实际光学区大于FS-LASIK，非球面形态优于FS-LASIK，引入球差更少；再者，SMILE和Amaris1050平台切削深度接近，大于EX500，消耗更多角膜组织。

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关键词 ：飞秒激光小切口角膜基质透镜取出术, 飞秒激光制瓣的准分子激光原位角膜磨镶术 , Amaris1050, EX500, 光学区, 非球面性, 像差

Abstract：Objective: To compare the actual diameter, asphericity and higher order aberrations (HOAs) of the optical zone after small incision lenticule extraction (SMILE) and femtosecond-assisted laser in situ keratomileusis (FS-LASIK) using the SCHWIND Amaris1050 and WaveLight EX500 excimer laser platforms for myopia. Methods: This was a retrospective study that included 91 patients (113 eyes) from January 2018 to January 2019 in the Refractive Surgery Center, Guangzhou Aier Eye Hospital. The patients were divided into a SMILE group (42 eyes), an Amaris1050 (25 eyes) and and an EX500 group (46 eyes). The postoperative optical zone was measured using two different maps. A tangential curvature map was generated with a placido corneal topographer (Topolyzer) and a tangential curvature difference map was generated with a Scheimplfag tomographer (Pentacam) for each eye 1 month and 3 months after surgery. The Q value and HOAs were also obtained with the Topolyzer. The postoperative optical zone, Q-value and HOAs among the three groups were analyzed with a one-way analysis of variance with Bonferroni-adjusted post hoc comparisons. The optical zones measured with the two maps were analyzed with a paired-samples t test. Results: The mean optical zones measured on the two maps were 6.90±0.12 mm and 5.17±0.15 mm with SMILE, 6.58±0.19 mm and 5.00±0.10 mm with Amaris1050, 6.56±0.16 mm and 4.86±0.15 mm with EX500 at 3 months postoperatively. The postoperative optical zones of SMILE were larger than Amaris1050 and EX500 in both maps (P<0.001), the optical zone of Amaris1050 was larger than EX500 in the tangential curvature difference map (P=0.003); the optical zone measured in the tangential curvature map was significantly larger than in the tangential curvature difference map (t=64.836, 34.146, 63.927, P<0.001). The postoperative Q-values of the cornea in the 5 mm and 6 mm areas of SMILE were both smaller than Amaris1050 and EX500 (5 mm: P=0.017, 0.013; 6 mm: P=0.004, 0.005). No significant difference was found between Amaris1050 and EX500 (P=1.000). As for the postoperative HOAs of the cornea in a 6 mm pupil diameter, the spherical aberrations of SMILE were larger than for both Amaris1050 and EX500 (P=0.004, 0.017). There was no significant difference between Amaris1050 and EX500 (P=0.793). Conclusions: When there is a same programmed optical zone, SMILE achieves a larger and a better aspheric shape of the optical zone than FS-LASIK, and induces fewer spherical aberrations after surgery. Whereas there was also a deeper ablation depth with SMILE and Amaris1050 than with EX500, thus consuming more corneal tissue.

Key words： small incision lenticule extraction femtosecond-assisted laser in situ keratomileusis Amaris1050 EX500 optical zone asphericity aberration

收稿日期: 2019-08-18

基金资助:湖南省卫计委科研计划（C2017057）；爱尔眼科集团科研项目（AM169D04）

通讯作者: 王铮（ORCID：0000-0002-7985-0811），Email：gzstwang@gmail.com

引用本文:

陈弯1 李莉1 刘胜旭2 胡一骏2 王铮1，2. SMILE与FS-LASIK术后光学区特性比较[J]. 中华眼视光学与视觉科学杂志, 2020, 22(5): 333-340. Wan Chen1,Li Li1,Shengxu Liu2,Yijun Hu2,Zheng Wang1, 2. Comparison of the Actual Optical Zones after SMILE and FS-LASIK for Myopia. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(5): 333-340. DOI: 10.3760/cma.j.cn115909-20190818-00229

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https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20190818-00229 或 https://www.cjoovs.com/CN/Y2020/V22/I5/333

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