经上皮准分子激光角膜切削术与小切口微透镜取出术治疗近视及近视散光的对比。

Comparison between aberration-free transepithelial photorefractive keratectomy and small incision lenticule extraction for correction of myopia and myopic astigmatism.

机构信息

Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, 515041, China.

Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

出版信息

Int Ophthalmol. 2021 Jan;41(1):303-314. doi: 10.1007/s10792-020-01582-3. Epub 2020 Sep 8.

DOI:10.1007/s10792-020-01582-3

PMID:32901403

Abstract

PURPOSE

To evaluate the clinical outcomes of small incision lenticule extraction (SMILE) and aberration-free transepithelial photorefractive keratectomy (AF t-PRK) in patients with low to moderate myopic astigmatism, including visual acuity, refractive outcomes, astigmatic vector analysis and corneal aberrometric changes.

METHOD

This retrospective comparative case series study involved 110 right eyes of 110 patients who underwent either SMILE (55 eyes) or AF t-PRK (55 eyes). Visual acuity, manifest refractive error and corneal higher-order aberrations (HOAs) were measured and analyzed at baseline, 1 month and 3 months after operation. The safety and efficacy indices, and vector parameters were also compared.

RESULT

1 month postoperatively, the mean uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) and spherical equivalent refraction (SE) were better after SMILE than AF t-PRK (logMAR UDVA, - 0.03 ± 0.07 and - 0.006 ± 0.07, P = 0.050; logMAR CDVA, - 0.06 ± 0.07 and - 0.03 ± 0.07, P = 0.043; SE, - 0.04 ± 0.25 and 0.15 ± 0.26, P < 0.001). However, these parameters were comparable between the groups at 3 months after surgery. Residual astigmatism ≤ 0.25 diopters was observed in 74.5% and 90.9% (P = 0.023) of the eyes at one month and in 87.3% and 85.5% (P = 0.781) of the eyes at 3 months after SMILE and AF t-PRK, respectively. There were no significant differences between the groups in any of the vector parameters at 1 month or 3 months after surgery. Coma and total HOAs after SMILE were significantly higher than AF t-PRK (1 month coma, 0.49 ± 0.23 and 0.29 ± 0.15, P < 0.001; 1 month total RMS HOAs, 0.65 ± 0.20 and 0.54 ± 0.14, P = 0.001; 3 months coma, 0.50 ± 0.22 and 0.30 ± 0.17, P < 0.001; 3 months total RMS HOAs, 0.68 ± 0.20 and 0.55 ± 0.17, P < 0.001).

CONCLUSION

In this study, both SMILE and AF t-PRK were effective and comparable for correction of low to moderate myopic astigmatism. AF t-PRK group induced less coma and total HOAs than SMILE.

摘要

目的

评估小切口透镜切除术（SMILE）和无像差经上皮准分子激光角膜切削术（AF t-PRK）治疗低中度近视散光患者的临床疗效，包括视力、屈光结果、散光矢量分析和角膜像差变化。

方法

本回顾性病例对照系列研究纳入了 110 例（110 只眼）患者，其中 55 只眼接受 SMILE 手术，55 只眼接受 AF t-PRK 手术。分别在基线、术后 1 个月和 3 个月测量并分析视力、显性屈光误差和角膜高阶像差（HOAs）。还比较了安全性和有效性指标以及矢量参数。

结果

术后 1 个月，SMILE 组的未矫正距离视力（UDVA）、矫正距离视力（CDVA）和等效球镜（SE）优于 AF t-PRK 组（logMAR UDVA，-0.03±0.07 和-0.006±0.07，P=0.050；logMAR CDVA，-0.06±0.07 和-0.03±0.07，P=0.043；SE，-0.04±0.25 和 0.15±0.26，P<0.001）。然而，术后 3 个月两组间这些参数相当。SMILE 和 AF t-PRK 术后 1 个月和 3 个月的残留散光均≤0.25 屈光度的眼分别为 74.5%和 90.9%（P=0.023）和 87.3%和 85.5%（P=0.781）。术后 1 个月和 3 个月，两组间各矢量参数均无显著差异。SMILE 术后彗差和总 HOAs 明显高于 AF t-PRK（1 个月彗差，0.49±0.23 和 0.29±0.15，P<0.001；1 个月总 RMS HOAs，0.65±0.20 和 0.54±0.14，P=0.001；3 个月彗差，0.50±0.22 和 0.30±0.17，P<0.001；3 个月总 RMS HOAs，0.68±0.20 和 0.55±0.17，P<0.001）。