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

doi:10.3760/cma.j.cn115909-20210202-00040

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Abstract Objective: To compare the changes and differences of accommodative and visual perceptual functions after small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomiluesis (FS-LASIK) for the correction of high myopia. Methods: This prospective, comparative clinical study included 60 patients (SMILE: n=35, FS-LASIK: n=25) who underwent SMILE or FS-LASIK surgery at the Eye Center of Xiangya Hospital, Central South University between November 2019 and July 2020. Accommodation (including negative/positive relative accommodation, amplitude of accommodation, accommodative response and facility of accommodation) and visual perceptual functions (including perceptual eye positon, fixation stability and fine stereopsis) were measured preoperatively and at week 1, month 1 and month 3 postoperatively. Using a t test, Wilcoxon test or λ2 test for comparison between the two groups, comparisons between the pre- and all three postoperative time-points were performed using repeated measures analysis of variance, LSD-t test, Kruskal-Wallis H or λ2 test. Results: In the SMILE group, the positive relative accommodations at month 1 and month 3 were higher than before surgery (all P<0.05). The monocular and binocular amplitudes of accommodation and facility of accommodation improved at month 1 and month 3 compared to week 1 (all P<0.05). The monocular amplitude of accommodation at month 3 was larger than the preoperative amplitude (P=0.028). The vertical eye position and 5 meters fine stereopsis at month 1 and month 3 were improved compared to preoperative levels (all P<0.05). In the FS-LASIK group, the positive relative accommodation at month 1 was larger than accommodation at week 1 (P=0.02), and improved at month 3 compared to preoperative and week 1 levels (P<0.05). The monocular and binocular amplitudes of accommodation at month 3 were improved compared to the earlier measurements (all P<0.05). The monocular and binocular facility of accommodation at week 1 was less than preoperative levels, but increased at month 1 and month 3 (all P<0.05), and at month 3 after surgery returned to the preoperative level. The 5 meters fine stereopsis was increased at month 3 compared to week 1 (P<0.05). When comparing the two groups, the preoperative binocular amplitude of accommodation (t=-2.067, P=0.043), the negative relative accommodation at month 1 (t=-3.181, P=0.03) and the monocular amplitude of accommodation at month 3 (t=-2.126, P=0.036) in the FS-LASIK group were higher than in the SMILE group. However, the positive relative accommodation (t=-2.249, P=0.028) and monocular facility of accommodation (t=3.013, P=0.003) at week 1 and binocular amplitude of accommodation at month 1 (t=3.031, P=0.004) in the FS-LASIK group were lower than in the SMILE group. The grades of 2.5 meters fine stereopsis in week 1 and month 1, and the 5 meters fine stereopsis in the three follow-ups after surgery in the FS-LASIK group were generally less than in the SMILE group (all P<0.05). Conclusions: Both SMILE and FS-LASIK have good results for correcting high myopia. The two operations cannot only improve the local accommodation functions of the eyes, but also improve the high-level visual perceptual function of the brain. The early postoperative visual perception function in the SMILE group recovers faster than that in the FS-LASIK group.

Key words： small incision lenticule extraction femtosecond laser-assisted laser in situ keratomiluesis high myopia accommodative functions visual perceptual functions

Received: 02 February 2021

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Fund: National Natural Science Foundation of China (82000937)

Corresponding Authors: Dan Wen, Eye Center of Xiangya Hospital, Central South University, Changsha 410000, China (Email: wendan@csu.edu.cn)

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https://www.cjoovs.com/EN/10.3760/cma.j.cn115909-20210202-00040 OR https://www.cjoovs.com/EN/Y2021/V23/I8/561

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