飞秒激光小切口基质透镜切除术（SMILE）后准分子原位角膜磨镶术（LASIK）再次治疗的效果

Outcomes of Re-treatment by LASIK After SMILE.

作者信息

Reinstein Dan Z, Carp Glenn I, Archer Timothy J, Vida Ryan S

出版信息

J Refract Surg. 2018 Sep 1;34(9):578-588. doi: 10.3928/1081597X-20180717-02.

DOI:10.3928/1081597X-20180717-02

PMID:30199561

Abstract

PURPOSE

To report the outcomes of LASIK re-treatments after small incision lenticule extraction (SMILE).

METHODS

Retrospective review of all eyes to have undergone a re-treatment by LASIK after primary SMILE between September 2013 and January 2016. Thin-flap LASIK was used in most cases as long as sufficient tissue was available for safe flap creation between the maximum epithelial thickness and minimum cap thickness. Otherwise, the SMILE interface was converted into a LASIK flap by the Circle technique or side cut only. The multivariate nomogram for LASIK re-treatments was used, including sphere, cylinder, age, and primary spherical equivalent (SEQ) as variables. Patients were observed for 1 year after surgery and standard outcomes analysis was performed.

RESULTS

A total of 116 LASIK re-treatments were performed in a population of 2,643 consecutive SMILE procedures, indicating a re-treatment rate of 4.39%. Mean attempted SEQ was -0.05 ± 0.99 diopters (D) (range: -1.88 to +1.50 D). Mean cylinder was -0.70 ± 0.55 D (range: 0.00 to -2.25 D). Postoperative uncorrected distance visual acuity was 20/20 or better in 81% of eyes, for a population with corrected distance visual acuity (CDVA) of 20/20 or better in 95% before re-treatment. Mean postoperative SEQ relative to the target was +0.19 ± 0.49 D (range: -0.88 to +2.13 D), with 74% within ±0.50 D. Mean postoperative cylinder was -0.29 ± 0.24 D (range: 0.00 to -1.25 D). There was one line loss of CDVA in 15% of eyes, but no eyes lost two or more lines. There was a small increase in contrast sensitivity (P < .05). Overcorrection was identified in myopic re-treatments (n = 20) of -1.00 D or more; mean postoperative SEQ was +0.59 ± 0.64 D (range: -0.63 to +2.13 D).

CONCLUSIONS

Re-treatment after SMILE by LASIK achieved excellent visual and refractive outcomes, although these results indicate that myopic LASIK retreatment after primary myopic SMILE requires a different nomogram than for myopic LASIK re-treatment after primary myopic LASIK. [J Refract Surg. 2018;34(9):578-588.].

摘要

目的

报告小切口透镜切除术（SMILE）后准分子激光原位角膜磨镶术（LASIK）再次治疗的结果。

方法

回顾性分析2013年9月至2016年1月期间所有在初次SMILE术后接受LASIK再次治疗的眼睛。多数情况下采用薄瓣LASIK，前提是在最大上皮厚度和最小瓣帽厚度之间有足够的组织用于安全制作瓣。否则，通过环形技术或仅做侧切口将SMILE界面转换为LASIK瓣。使用LASIK再次治疗的多变量列线图，将球镜、柱镜、年龄和初次等效球镜度（SEQ）作为变量。术后观察患者1年并进行标准结果分析。

结果

在连续2643例SMILE手术患者中，共进行了116次LASIK再次治疗，再次治疗率为4.39%。平均目标SEQ为-0.05±0.99屈光度（D）（范围：-1.88至+1.50 D）。平均柱镜为-0.70±0.55 D（范围：0.00至-2.25 D）。术后裸眼远视力在81%的眼睛中达到20/20或更好，再次治疗前矫正远视力（CDVA）在95%的患者中为20/20或更好。相对于目标的平均术后SEQ为+0.19±0.49 D（范围：-0.88至+

2.13 D），74%在±0.50 D范围内。平均术后柱镜为-0.29±0.24 D（范围：0.00至-1.25 D）。15%的眼睛CDVA下降一行，但没有眼睛下降两行或更多行。对比敏感度有小幅增加（P <.05）。在近视再次治疗（n = 20）中，过矫1.00 D或更高；平均术后SEQ为+0.59±0.64 D（范围：-0.63至+2.13 D）。