SMILE术后屈光状态偏差原因分析

doi:10.3760/cma.j.cn115909-20201111-00433

Abstract
Figure/Table
References (13)
Related Citation (15)

Download: PDF (739 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS) Supporting Info

Guide

Abstract Objective: To observe refractive status after femtosecond laser small incision lenticule extraction (SMILE); to explore the causes of postoperative spherical equivalent deviation. Methods: Retrospective case series study. A total of 200 patients (400 eyes) who had undergone SMILE surgery in Peking University Shenzhen Hospital from January 2019 to April 2020 were observed at the 3-month follow-up. Parameters like age, preoperative spherical equivalent (SE), preoperative mean keratometry (Km) and postoperative SE at 1 week, 1 month, 3 months were collected. Patients were divided into 3 groups according to preoperative SE: Low myopia group (≥-3.00 D), moderate myopia group (>-6.00-<-3.00 D), high myopia group (≤-6.00 D), and divided into three groups according to preoperative Km: Low curvature group (≤42 D), moderate curvature group (>42-<45 D), high curvature group (≥45 D). At 1 week, 1 month, and 3 months postoperatively, a Kruskal Wallis test or ANOVA was used to compare the postoperative SE in each group. A Wilcoxon test or paired-samples t test was used to compare the postoperative SE among the two groups divided according to the dominant eye and right/left eyes. The parameters from dominant eyes were analyzed by Spearman correlation coefficient and multiple linear regression. Results: The postoperative SE was negatively correlated with Km, nomogram values and preoperative SE at 1 week postoperatively (r=-0.155, P=0.029; r=-0.174, P=0.014; r=-0.170, P=0.016), and negatively correlated with nomogram values, age and preoperative SE at 1 month postoperatively (r=-0.225, P=0.002; r=-0.148, P=0.046; r=-0.203, P=0.006). The nomogram value (r=-0.338, P=0.002) and preoperative SE (r=-0.336, P=0.002) were negatively correlated with SE 3 months postoperatively. Regression analysis showed that Km (B=-0.033, P=0.047) and preoperative SE (B=-0.037, P=0.017) are the influence factors of postoperative SE at 1 week. Age (B=-0.013, P=0.022) and nomogram value (B=-0.564, P=0.001) are the influence factors of postoperative SE at 1 month. Preoperative SE is the influence factor of postoperative SE at 3 months (B=-0.070, P=0.001). Comparison of the SE between the low, moderate and high myopia groups 1 week (H=6.007, P=0.05), 1 month (H=6.236, P=0.044) and 3 months (H=6.051, P=0.004) postoperatively showed statistically significant differences. The difference in postoperative SE between the right and left eyes was statistically significant at 1 week (Z=-3.327, P=0.001) and 1 month (Z=-3.130, P=0.002) postoperatively but not statistically significant at 3 months. Conclusions: The older and high myopia patients' postoperative refractive status tends to be myopic, meaning undercorrection. The younger and low myopia patients' postoperative refractive status tends to be hyperopic, meaning overcorrection. Postoperative refractive status is influenced by age and preoperative SE. Nomogram is characteristically set according to the influence factors to achieve the maximum surgical effect.

Key words： nomogram small incision lenticule extraction refractive error refractive diopter deviation corneal surgery

Received: 11 November 2020

PACS:

Fund: Science, Technology and Innovation Commission of Shenzhen Municipality (JCYJ20190809100405621)

Corresponding Authors: Jinying Li, Peking University Shenzhen Hospital, Beijing 518036, China (Email: ljyszbdyy@126.com)

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors

Cite this article:

URL:

https://www.cjoovs.com/EN/10.3760/cma.j.cn115909-20201111-00433 OR https://www.cjoovs.com/EN/Y2021/V23/I6/434

[1]	Liang G, Chen X, Zha X, et al. A nomogram to improve predictability of small-incision lenticule extraction surgery. Med Sci Monit, 2017, 23(1): 5168-5175. DOI: 10.12659/msm.904598.
[2]	Ivarsen A, Asp S, Hjortdal J. Safety and complications of more than 1 500 small-incision lenticule extraction procedures. Ophthalmology, 2014, 121(4): 822-828. DOI: 10.1016/ j.ophtha.2013.11.006.
[3]	张丰菊. SMILE角膜屈光手术专家共识的临床解读. 中华眼视光学与视觉科学杂志, 2017, 19(3): 129-130. DOI: 10.3760/ cma.j.issn.1674-845X.2017.03.001.
[4]	杜凯旋, 吴小影, 文丹, 等. 近视患者SMILE术后双眼视觉功能变化. 中华眼视光学与视觉科学杂志, 2019, 21(7): 521-526. DOI: 10.3760/cma.j.issn.1674-845X.2019.07.007.
[5]	陈露, 吴小影, 文丹, 等. SMILE矫正高度近视的临床疗效及角膜后表面高度改变. 中华眼视光学与视觉科学杂志, 2019, 21(10): 776-782. DOI: 10.3760/cma.j.issn.1674-845X.2019. 10.009.
[6]	Ganesh S, Brar S, Arra RR. Refractive lenticule extraction small incision lenticule extraction: A new refractive surgery paradigm. Indian J Ophthalmol, 2018, 66(1): 10-19. DOI: 10.4103/ijo. IJO_761_17.
[7]	Fernandez J, Valero A, Martinez J, et al. Short-term outcomes of small-incision lenticule extraction (smile) for low, medium, and high myopia. Eur J Ophthalmol, 2017, 27(2): 153-159. DOI: 10.5301/ejo.5000849.
[8]	黄云丽, 王雁, 窦瑞, 等. SMILE术后角膜形变与角膜生物力学变化的研究. 中华眼科杂志, 2017, 53(1): 11-17. DOI: 10.3760/cma.j.issn.0412-4081.2017.01.004.
[9]	Moshirfar M, Desautels JD, Walker BD, et al. Mechanisms of optical regression following corneal laser refractive surgery: Epithelial and stromal responses. Med Hypothesis Discov Innov Ophthalmol, 2018, 7(1): 1-9.
[10]	丁萱, 付单, 汪琳, 等. 不同屈光度近视SMILE术后1个月角膜屈光力分布及角膜高阶像差研究. 中国眼耳鼻喉科杂志, 2019, 19(6): 388-394. DOI: 10.14166/j.issn.1671-2420.2019.06. 007.
[11]	Hjortdal JO, Vestergaard AH, Ivarsen A, et al. Predictors for the outcome of small-incision lenticule extraction for myopia. J Refract Surg, 2012, 28(12): 865-871. DOI: 10.3928/1081597X- 20121115-01.
[12]	刘莛, 余婷, 潘娇, 等. 角膜曲率对飞秒激光小切口角膜基质透镜取出术后患者屈光状态影响的临床研究. 中华眼科杂志, 2018, 54(1): 48-54. DOI: 10.3760/cma.j.issn.0412-4081.2018. 01.009.
[13]	Cui T, Wang Y, Ji S, et al. Applying machine learning techniques in nomogram prediction and analysis for smile treatment. Am J Ophthalmol, 2020, 210: 71-77. DOI: 10.1016/j.ajo.2019.10.015.

[1]	. [J]. Chinese Journal of Optometry Ophthalmology and Visual science, 2023, 25(8): 0-.