不同切口SMILE对近视散光矫正影响的矢量分析

doi:10.3760/cma.j.cn115909-20221008-00384

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摘要目的：探讨不同切口大小飞秒激光小切口角膜基质透镜取出术（SMILE）对近视散光矫正影响的矢量分析。方法：回顾性系列病例研究。连续纳入2021年2—12月在天津市眼科医院屈光手术中心行SMILE的近视散光患者349例（349眼），均选取右眼进行研究。其中行2 mm切口SMILE的患者129 例（129眼）作为2 mm切口组，行3 mm切口SMILE的患者220例（220眼）作为3 mm切口组。按柱镜度分组：柱镜度<1.50 D为低度散光组，柱镜度≥1.50 D为高度散光组，再将柱镜度按照切口不同进行亚分组。按球镜度分组：-3.00~0 D为低度球镜组，-6.00~-3.25 D为中度球镜组，<-6.00 D为高度球镜组，再将球镜度按照切口不同进行亚分组。于术前及术后3个月对术眼进行视力、屈光度以及角膜地形图检查。利用矢量分析法分析散光的矫正效果，观察指标包括目标矫正散光（TIA）、手术实际矫正散光（SIA）、差异向量（DV）、矫正指数（CI）、成功指数（IOS）、误差角度（AOE）、误差角度绝对值（|AOE|）、误差幅度（ME）、平坦效果（FE）和平坦指数（FI）等。不同切口组间术前基线参数的差异比较采用独立样本t检验，术后屈光度、TIA、SIA、CI、IOS、AOE、|AOE|、FI、FE、ME 的差异比较采用Mann-Whitney检验。结果：不同切口组患者术后3个月的球镜度、柱镜度和SE差异均无统计学意义（均P>0.05）。2 mm切口组术后3个月裸眼远视力（UDVA）≥20/20的眼数比例为96%，3 mm切口组术后3个月UDVA≥20/20的眼数比例为95%。矢量分析结果显示，3 mm切口组的IOS低于2 mm切口组，差异有统计学意义（Z=-2.27，P=0.023）。低度散光组中，3 mm切口组的IOS、CI小于2 mm切口组，差异有统计学意义（Z=-2.17，P=0.030；Z=-2.84，P=0.005），3 mm切口组的FI和ME大于2 mm切口组，差异有统计学意义（Z=-2.42，P=0.016；Z=-2.02，P=0.043）。中度球镜组中3 mm切口组的IOS和FI小于2 mm切口组，差异有统计学意义（Z=-3.33，P=0.001；Z=-2.39，P=0.017）。高度球镜组中，3 mm切口组的CI小于2 mm切口组，差异有统计学意义（Z=-2.24，P=0.025）。余指标组间差异均无统计学意义（均P>0.05）。结论：不同切口大小的SMILE手术均能达到良好的散光矫正效果，虽然2 mm切口微创，但是矢量分析显示3 mm切口在低度散光的矫正方面呈现一定的优势。

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	田彩霞
	王雁
	张佳媚

Abstract：Objective: To analyze the effect of different incision sizes of small incision lenticule extraction (SMILE) on the correction of myopic astigmatism. Methods: This was a retrospective series case study. Three hundred and forty-nine patients (349 eyes) with myopic astigmatism who underwent SMILE surgery in the Refractive Surgery Center of Tianjin Eye Hospital from February to December 2021 were consecutively included in this study. Data from the right eyes of each patient were analyzed. The patients were divided into two groups: 129 patients (129 eyes) who received SMILE with 2 mm incision as the 2 mm incision group, and 220 patients (220 eyes) with 3 mm incision as the 3 mm incision group. The patients were grouped according to their cylinder diopter, with those less than 1.50 D being assigned to the low astigmatism group and those with 1.50 D or greater assigned to the high astigmatism group. Subsequently, the degree of cylinder was further sub-grouped according to the incision. Additionally, patients were grouped according to the degree of spherical diopter: the patients with spherical of -3.00-0 D were in the low sphere group, those with a spherical diopter between -6.00 and -3.25 D were assigned to the moderate sphere group, and the patients with spherical diopter less than -6.00 D were defined as the high sphere group, after which the degree of spherical was sub-grouped according to the incision. The visual acuity, diopter, and corneal topography were performed on the operated eyes before and 3 months after surgery. The vector analysis method was used to analyze the correction effect of astigmatism. The observation indicators included target induced astigmatism (TIA), surgically induced astigmatism (SIA), difference vector (DV), correction index (CI), index of success (IOS), angle of error (AOE), absolute value of error angle (|AOE|), magnitude of error (ME), flatten effect (FE), and flattening index (FI). Independent sample t-test was used to analyse the differences in baseline parameters between different incision groups, and Mann-Whitney test was used to compare the differences for postoperative diopter, TIA, SIA, CI, IOS, AOE, | AOE |, FI, FE, ME after surgery. Results: There was no signifcant difference in spherical, cylindrical and SE values between the different incision groups at 3 months after operation (all P>0.05). The percentage of eyes with the uncorrected visual acuity≥20/20 at 3 months after surgery was 96% in the 2 mm incision group, and 95% in the 3 mm incision group. The vector analysis showed that the IOS of the 3 mm incision group was lower than that of the 2 mm group, with a statistically significant difference (Z=-2.27, P=0.023). In the low astigmatism group, the IOS and CI of the 3 mm incision group were less than that of the 2 mm incision group, with statistical difference (Z=-2.17, P=0.030; Z=-2.84, P=0.005). The FI and ME of the 3 mm incision group were greater than that of the 2mm incision group, with statistical differences (Z=-2.42, P=0.016; Z=-2.02, P=0.043). In the moderate sphere group, the IOS and FI of the 3 mm incision group was less than that of the 2 mm incision group, with statistical differences (Z=-3.33, P=0.001; Z=-2.39, P=0.017). The CI of the 3 mm incision group in the high sphere group was less than that of the 2 mm incision group, showing a statistical difference between the two groups (Z=-2.24, P=0.025). There was no significant difference for other indexes between the two groups. Conclusions: The SMILE procedure with different sizes of incisions achieves excellent correction of astigmatism. Although the 2 mm incision is minimally invasive, the 3 mm incision also shows several advantages in the correction of low-grade astigmatism from vector analysis.

收稿日期: 2022-10-08

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基金资助:国家自然科学基金（81873684）

通讯作者: 王雁（ORCID：0000-0002-1257-6635），Email：wangyan7143@vip.sina.com

引用本文:

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. Caixia Tian1, Yan Wang2, Jiamei Zhang2. Vector Analysis of the Effect of Different Incision Sizes of SMILE on MyopicAstigmatism Correction. Chinese Journal of Optometry Ophthalmology and Visual science, 2023, 25(5): 347-353. DOI: 10.3760/cma.j.cn115909-20221008-00384

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https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20221008-00384 或 https://www.cjoovs.com/CN/Y2023/V25/I5/347