Chan Tommy C Y, Ng Alex L K, Cheng George P M, Woo Victor C P, Zhang Jiamei, Wang Yan, Jhanji Vishal
*Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; †Department of Ophthalmology, The University of Hong Kong, Hong Kong, China; ‡Hong Kong Laser Eye Center, Hong Kong, China; §Tianjin Eye Hospital and Eye Institute, Tianjin, China; and ¶University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA.
Cornea. 2017 Sep;36(9):1044-1050. doi: 10.1097/ICO.0000000000001246.
To investigate the effect of the learning curve for small-incision lenticule extraction during the first 2 years of experience.
Small-incision lenticule extraction was performed using the 500-kHz VisuMax femtosecond laser (Carl Zeiss Meditec) by the same surgeon. The initial 100 patients since the surgeon started operating independently were considered as group 1; the recent 100 patients were considered as group 2. The same laser settings and technique were used. The visual and refractive outcomes were compared between groups at postoperative 1 week and 6 months. Vector analysis was performed for eyes with astigmatic correction.
Two hundred right eyes of 200 patients were included. Age, preoperative corrected visual acuity, manifest refraction, and central corneal thickness were similar between groups (P ≤ 0.154). Postoperatively, the efficacy index at 1 week was better in group 2 (group 1: 0.85 ± 0.16 vs. group 2: 0.91 ± 0.10, P = 0.019) but was similar between groups at 6 months (group 1: 0.91 ± 0.14 vs. group 2: 0.94 ± 0.08, P = 0.181). The safety index was higher in group 2 at 1 week (group 1: 0.93 ± 0.10 vs. group 2: 0.95 ± 0.08, P = 0.045) and 6 months postoperatively (group 1: 0.97 ± 0.07 vs. group 2: 0.99 ± 0.03, P = 0.011). Vector analysis showed that postoperative residual astigmatism and misalignment of astigmatic correction were lower in group 2 than in group 1 (P ≤ 0.039) at 1 week and 6 months. The duration of docking and that of lenticule extraction was shorter in group 2 (P ≤ 0.034).
Our study showed that faster visual recovery, better safety profile, and more accurate astigmatic correction could be attained with increasing surgical experience.
探讨小切口透镜切除术在最初2年手术经验中的学习曲线效应。
由同一位外科医生使用500kHz的VisuMax飞秒激光（卡尔蔡司医疗技术公司）进行小切口透镜切除术。自外科医生开始独立手术以来的最初100例患者被视为第1组；最近的100例患者被视为第2组。使用相同的激光参数和技术。比较两组患者术后1周和6个月时的视力和屈光结果。对散光矫正的眼睛进行矢量分析。
纳入200例患者的200只右眼。两组患者的年龄、术前矫正视力、显验光和中央角膜厚度相似（P≤0.154）。术后，第2组在1周时的疗效指数更好（第1组：0.85±0.16 vs.第2组：0.91±0.10，P = 0.019），但在6个月时两组相似（第1组：0.91±0.14 vs.第2组：0.94±0.08，P = 0.181）。第2组在术后1周（第1组：0.93±0.10 vs.第2组：0.95±0.08，P = 0.045）和6个月时（第1组：0.97±0.07 vs.第2组：0.99±0.03，P = 0.011）的安全指数更高。矢量分析显示，术后1周和6个月时，第2组的残余散光和散光矫正偏差低于第1组（P≤0.039）。第2组的对接时间和透镜切除时间更短（P≤0.034）。
我们的研究表明，随着手术经验的增加，可以实现更快的视力恢复、更好的安全性和更准确的散光矫正。
