飞秒激光小切口基质透镜切除术和准分子原位角膜磨镶术后的功能性光学区和中心定位：一项前瞻性、随机、对侧眼研究。

Functional Optical Zone and Centration Following SMILE and LASIK: A Prospective, Randomized, Contralateral Eye Study.

作者信息

Damgaard Iben B, Ang Marcus, Mahmoud Ashraf M, Farook Mohamed, Roberts Cynthia J, Mehta Jodhbir S

出版信息

J Refract Surg. 2019 Apr 1;35(4):230-237. doi: 10.3928/1081597X-20190313-01.

DOI:10.3928/1081597X-20190313-01

PMID:30984980

Abstract

PURPOSE

To compare centration and functional optical zone (FOZ) after small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (LASIK).

METHODS

In this prospective, randomized, single-masked, paired-eyed, clinical trial, 70 patients received SMILE in one eye and LASIK in the other eye for myopia and myopic astigmatism. FOZ was calculated using custom software on 3-month postoperative refractive power maps (Pentacam HR; Oculus Optikgeräte GmbH, Wetzlar, Germany). Programmed treatment area was defined as the total area of the programmed OZ plus the transition zone. Centration was evaluated by the linear distance between FOZ centroid and the pupil center and the corneal apex.

RESULTS

The average preoperative spherical equivalent (-5.38 ± 1.65 vs -5.45 ± 1.61 diopters [D]), postoperative spherical equivalent (0.05 ± 0.39 vs 0.06 ± 0.39 D), uncorrected distance visual acuity (0.01 ± 0.13 vs 0.00 ± 0.08 logMAR), and corrected distance visual acuity (-0.07 ± 0.10 vs -0.07 ± 0.10 logMAR) were comparable in SMILE- and LASIK-treated eyes of the 60 patients with complete datasets (P > .419). Postoperative increase in spherical aberration was lower in SMILE than in LASIK (0.08 ± 0.16 vs 0.17 ± 0.18 µm, P = .002). The FOZ area was significantly larger in SMILE than in LASIK (30.25 ± 3.60 vs 29.21 ± 3.72 mm), despite the smaller programmed OZ diameter (6.48 ± 0.08 vs 6.52 ± 0.11 mm) and smaller programmed treatment area (33.87 ± 0.81 vs 46.30 ± 2.61 mm, P < .037). Pupil centration (0.43 ± 0.21 vs 0.41 ± 0.22 mm) and apex centration (0.48 ± 0.24 vs 0.48 ± 0.22 mm) were comparable between SMILE and LASIK (P > .694).

CONCLUSIONS

SMILE created a larger FOZ than LASIK, despite the smaller programmed OZ. This may be due to a difference in the biomechanical response between the two procedures. Visual outcome and centration were comparable between SMILE and LASIK. [J Refract Surg. 2019;35(4):230-237.].

摘要

目的

比较小切口透镜切除术（SMILE）和飞秒激光原位角膜磨镶术（LASIK）后的中心定位和功能性光学区（FOZ）。

方法

在这项前瞻性、随机、单盲、双眼配对的临床试验中，70例近视和近视散光患者一只眼接受SMILE手术，另一只眼接受LASIK手术。使用定制软件在术后3个月的屈光力地形图（Pentacam HR；德国韦茨拉尔Oculus Optikgeräte GmbH公司）上计算FOZ。将编程治疗区域定义为编程光学区（OZ）的总面积加上过渡区。通过FOZ质心与瞳孔中心以及角膜顶点之间的线性距离评估中心定位。

结果

60例具有完整数据集的患者中，SMILE组和LASIK组患眼的术前平均等效球镜度数（-5.38±1.65对-5.45±1.61屈光度[D]）、术后等效球镜度数（0.05±0.39对0.06±0.39 D）、未矫正远视力（0.01±0.13对0.00±0.08 logMAR）和矫正远视力（-0.07±0.10对-0.07±0.10 logMAR）相当（P>.419）。SMILE术后球差的增加低于LASIK（0.08±0.16对0.17±0.18 µm，P =.002）。尽管编程的OZ直径较小（6.48±0.08对6.52±0.11 mm）且编程治疗区域较小（33.87±0.81对46.30±2.61 mm，P<.037），但SMILE组的FOZ面积明显大于LASIK组（30.25±3.60对29.21±3.72 mm）。SMILE和LASIK之间的瞳孔中心定位（0.43±0.21对0.41±0.22 mm）和顶点中心定位（0.48±0.24对0.48±0.22 mm）相当（P>.694）。