小切口透镜切除术与波前引导飞秒激光原位角膜磨镶术矫正高度近视和近视散光的三年结果
Three-year results of small incision lenticule extraction and wavefront-guided femtosecond laser-assisted laser keratomileusis for correction of high myopia and myopic astigmatism.
作者信息
Xia Li-Kun, Ma Jing, Liu He-Nan, Shi Ce, Huang Qing
机构信息
Department of Ophthalmology, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China.
Department of Ophthalmology, the General Hospital of Shenyang Military, Shenyang 110016, Liaoning Province, China.
出版信息
Int J Ophthalmol. 2018 Mar 18;11(3):470-477. doi: 10.18240/ijo.2018.03.18. eCollection 2018.
AIM
To compare and calculate the 3-year refractive results, higher-order aberrations (HOAs), contrast sensitivity (CS) and dry eye parameters after small incision lenticule extraction (SMILE) and wavefront-guided femtosecond laser-assisted laser keratomileusis (FS-LASIK) for correction of high myopia and myopic astigmatism.
METHODS
In this prospective, non-randomized comparative study, 78 eyes with spherical equivalent (SE) of -8.11±1.09 diopters (D) received a SMILE surgery, and 65 eyes with SE of -8.05±1.12 D received a wavefront-guided FS-LASIK surgery with the VisuMax femtosecond laser (Carl Zeiss Meditec, Jena, Germany) for flap cutting. Visual acuity, manifest refraction, CS, HOAs, ocular surface disease index (OSDI) and tear break-up time (TBUT) were evaluated during a 3-year follow-up.
RESULTS
The difference of uncorrected distance visual acuity (UDVA) postoperatively was achieved at 1mo and at 3mo, whereas the difference of the mean UDVA between two groups at 3y were not statistically significant (=-1.59, =0.13). The postoperative change of SE was 0.89 D in the FS-LASIK group (=5.76, =0.00), and 0.14 D in the SMILE group (=0.54, =0.59) from 1mo to 3y after surgery. At 3-year postoperatively, both HOAs and spherical aberrations in the SMILE group were obviously less than those in the FS-LASIK group (=0.00), but the coma root mean square (RMS) was higher in the SMILE group (0.59±0.26) than in the FS-LASIK group (0.29±0.14, =0.00). The mesopic CS values between two groups were not statistically significant at 3y postoperatively. Compared with the FS-LASIK group, lower OSDI scores and longer TBUT values were found in the SMILE group at 1mo and 3mo postoperatively. With regard to safety, no eye lost any line of CDVA in both groups at 3y after surgery.
CONCLUSION
Both SMILE and wavefront-guided FS-LASIK procedures provide good visual outcomes. Both procedures are effective and safe, but SMILE surgery achieve more stable long-term refractive outcome and better control of early postoperative dry eye as compared to FS-LASIK.
目的
比较并计算小切口透镜切除术（SMILE）和波前引导飞秒激光原位角膜磨镶术（FS-LASIK）矫正高度近视和近视散光后的3年屈光结果、高阶像差（HOA）、对比敏感度（CS）和干眼参数。
方法
在这项前瞻性、非随机对照研究中，78只等效球镜度（SE）为-8.11±1.09屈光度（D）的眼睛接受了SMILE手术，65只SE为-8.05±1.12 D的眼睛接受了使用VisuMax飞秒激光（德国耶拿卡尔蔡司医疗技术公司）制作角膜瓣的波前引导FS-LASIK手术。在3年的随访期间评估视力、显验光、CS、HOA、眼表疾病指数（OSDI）和泪膜破裂时间（TBUT）。
结果
术后1个月和3个月时，两组的未矫正远视力（UDVA）差异显著，而两组在3年时的平均UDVA差异无统计学意义（=-1.59，=0.13）。术后1个月至3年，FS-LASIK组的SE变化为0.89 D（=5.76，=0.00），SMILE组为0.14 D（=0.54，=0.59）。术后3年时，SMILE组的HOA和球差均明显低于FS-LASIK组（=0.00），但SMILE组的彗差均方根（RMS）高于FS-LASIK组（0.59±0.26对比0.29±0.14，=0.00）。两组在术后3年时的中间视觉CS值无统计学差异。与FS-LASIK组相比，SMILE组在术后1个月和3个月时的OSDI评分更低，TBUT值更长。在安全性方面，两组在术后3年时均未出现任何最佳矫正远视力（CDVA）下降。
结论
SMILE和波前引导FS-LASIK手术均能提供良好的视觉效果。两种手术均有效且安全，但与FS-LASIK相比，SMILE手术能获得更稳定的长期屈光结果，并能更好地控制术后早期干眼。
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