眼内散光对SMILE矫正近视散光术后视觉质量的影响

doi:10.3760/cma.j.cn115909-20191225-00349

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摘要目的：应用矢量分析法计算眼内散光（ORA），并分析ORA对近视散光患者飞秒激光小切口角膜基质透镜取出术（SMILE）后视觉质量的影响。方法：前瞻性队列研究。收集2019年1─8月在中国医科大学附属盛京医院行SMILE的患者60例（115眼）。应用矢量分析法分析计算出ORA，根据ORA大小分为高眼内散光组（ORA≥1.00 D）42眼和低眼内散光组（ORA<1.00 D）73眼。随访时间3个月，比较2组术后裸眼视力（UCVA）、毕达哥斯拉长度、总高阶像差（tHOAs）、垂直三叶草差（Z9）、垂直彗差（Z7）、水平彗差（Z8）、斜三叶草差（Z10）、斜四叶草差（Z15）、斜二次散光（Z13）、球差（Z11）、垂直二次散光（Z12）、垂直四叶草差（Z14）以及85 cd/m2和3 cd/m2 下的对比敏感度，同时矢量分析比较2组术后显然验光散光结果的矢量误差、大小误差、角度误差、矫正指数和成功指数。通过t检验及 Mann-Whitney U检验分析比较2组间差异。结果：术后3个月，高眼内散光组术后残余散光度数大于低眼内散光组，差异有统计学意义（t=3.293，P=0.001）。对2组术后3个月残余散光进行矢量分析，高眼内散光组矢量误差、角度误差绝对值、成功指数均大于低眼内散光组，差异均有统计学意义（t=-3.235，P=0.001；t=-2.326，P=0.020；t=-2.587，P=0.010）。SMILE术后，所有患者均获得了理想的视力[高眼内散光组（LogMAR）：-0.15±0.05，低眼内散光组（LogMAR）：-0.15±0.05]，高眼内散光组与低眼内散光组间手术前后总高阶像差及3、4阶各像差差异无统计学意义，2组间术前最佳矫正视力（BCVA）、术后UCVA差异无统计学意义，85 cd/m2下18 c/d空间频率下低眼内散光组对比敏感度高于高眼内散光组（t=-2.877，P=0.005），2组患者术后毕达哥斯拉长度差异无统计学意义。结论：眼内散光的存在会造成SMILE对近视散光矫正的误差，使高眼内散光患者术后残余散光更大，且降低术后亮环境下高空间频率对比敏感度，但并未对视力及高阶像差造成影响。

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飞秒激光小切口角膜基质透镜取出术')" href="#">">飞秒激光小切口角膜基质透镜取出术, 眼内散光')" href="#">">眼内散光, 视觉质量')" href="#">">视觉质量, 矢量分析

')" href="#">">矢量分析

Abstract： Objective: To calculate ocular residual astigmatism (ORA) by vector analysis and to evaluate the impact of ocular residual astigmatism on refractive and visual outcomes after correction of myopic astigmatism by small incision lenticule extraction (SMILE). Methods: In this prospective case-series study, 115 eyes with myopic astigmatism were treated with SMILE from Jauary 2019 to August 2019 at Refractive Center of Ophthalmology Department, Shengjing Hospital, China Medical University. ORA was calculated by vector analysis and patients were divided into two groups according to the magnitude of ORA: high ORA group (ORA≥1.00 D) with 42 eyes and low ORA group (ORA<1.00 D) with 73 eyes. The follow-up period was 3 months after the operation. Uncorrected visual acuity (UCVA) and pythagorean length were measured and compared after the operation. The following measurements were compared: refractive outcomes, total higher order aberrations (tHOAs), vertical trefoil, vertical coma, horizontal coma, oblique trefoil, oblique quadrafoil, oblique secondary astigmatism, spherical aberration, vertical secondary astigmatism, and vertical quadrafoil. Contrast sensitivity was compared between the high and low ORA groups under either 85 cd/m2 or 3 cd/m2 illumination from 1.5 c/d to 18 c/d. The data were analyzed by an independent-samples t test and Mann-Whitney U test to compare the differences between the two groups. Results: Three months postoperatively, refractive outcomes showed that postoperative residual astigmatism in the high ORA group was significantly higher than in the low ORA group (t=3.293, P=0.001). Vector analysis showed that the error vector (EV), absolute error of angle (absolute EA) and index of success (SI) were higher in the high ORA group (t=-3.235, P=0.001; t=-2.326, P=0.020; t=-2.587, P=0.010). After SMILE，all cases had achieved a desirable visual acuity: high ORA group: -0.15±0.05, low ORA group: -0.15±0.05. There were no statistically significant differences in visual acuity, pythagorean length, tHOAs, vertical trefoil, vertical coma, horizontal coma, oblique trefoil, oblique quadrafoil, oblique secondary astigmatism, spherical aberration, vertical secondary astigmatism, or vertical quadrafoil between the two groups. An obvious difference was found in contrast sensitivity, which showed a higher contrast sensitivity at a spatial frequency of 18 c/d with 85 cd/m2 in the low ORA group than in the high ORA group (t=-2.877, P=0.005), but this tendency was not present at 3 cd/m2 . Conclusions: Ocular residual astigmatism impacts the precision of SMILE in correcting myopic astigmatism. This leads to a tendency of more residual astigmatism in refractive outcomes, and reduces contrast sensitivity at high spatial frequencies. However, it does not affect the outcome of obtaining good visual quality in both visual acuity and higher order aberrations.

Key words： small incision lenticule extraction ocular residual astigmatism visual outcomes vector analysis

收稿日期: 2019-12-25

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通讯作者: 夏丽坤（ORCID：0000-0001-6269-339X），Email：xialk@sj-hospital.org

引用本文:

卢玥浩　夏丽坤　于泳　刘璐　陈苓　张桂新. 眼内散光对SMILE矫正近视散光术后视觉质量的影响[J]. 中华眼视光学与视觉科学杂志, 2020, 22(10): 728-737. Yuehao Lu, Likun Xia, Yong Yu, Lu Liu, Ling Chen, Guixin Zhang. Impact of Ocular Residual Astigmatism on Visual Outcomes of Myopic Astigmatism Correction after Small Incision Lenticule Extraction. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(10): 728-737. DOI: 10.3760/cma.j.cn115909-20191225-00349

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https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20191225-00349 或 https://www.cjoovs.com/CN/Y2020/V22/I10/728

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