Primavera Laura, Canto-Cerdan Mario, Alio Jorge L, Alio Del Barrio Jorge L
Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain.
Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain.
Br J Ophthalmol. 2022 Mar;106(3):341-348. doi: 10.1136/bjophthalmol-2020-316865. Epub 2020 Nov 18.
To evaluate the influence of patient's age at the time of surgery on small incision lenticule extraction (SMILE) refractive outcomes.
This is a retrospective, consecutive, comparative study. We compared the refractive outcomes after myopic SMILE from two groups of patients divided by age (patients ≤35 and ≥40 years old). All eyes were evaluated preoperatively and at 1 and 6 months postoperatively. Main outcome measures were differences on efficacy, safety, predictability and astigmatic changes by vector analysis with ASSORT software between both study groups.
102 matched eyes of 53 patients were included. Preoperatively, we evidenced no differences in the mean SE or astigmatism between groups. However, 6 months postoperatively we observed a significantly worse mean astigmatism (p=0.019), while not regarding SE, in the older population, with a trend towards undercorrection of the refractive cylinder in the ≥40 group. We also observed a statistically significant difference in the efficacy (0.86-1 month and 0.97-6 months in ≥40group vs 0.97-1 month and 1.07-6 months in the ≤35 group; p=0.003) and safety indexes (0.93-1 month and 1.04-6 months in ≥40 group vs 1.0-1 month and 1.11-6 months in the ≤35 group; p=0.008) at 6 months among groups.
Post-SMILE refractive outcomes in those patients over 40 years of age, although acceptable, are not as good as those obtained in younger patients, showing a significantly lower efficacy and safety indexes, and poorer astigmatic outcomes, with a tendency towards undercorrection. We hypothetise that the increased corneal stroma stiffness in the aged group modifies the post-SMILE corneal stroma remodelling capacity, thus affecting the SMILE refractive and visual response.
评估手术时患者年龄对小切口透镜切除术（SMILE）屈光结果的影响。
这是一项回顾性、连续性、对比性研究。我们比较了两组按年龄划分的近视SMILE术后的屈光结果（年龄≤35岁和≥40岁的患者）。所有眼睛均在术前以及术后1个月和6个月进行评估。主要结局指标是通过ASSORT软件进行矢量分析，比较两组在有效性、安全性、可预测性和散光变化方面的差异。
纳入了53例患者的102只匹配眼。术前，两组之间的平均球镜等效度（SE）或散光无差异。然而，术后6个月，我们观察到老年人群的平均散光明显更差（p = 0.019），而SE方面无差异，≥40岁组的屈光柱镜有欠矫趋势。我们还观察到两组在术后6个月时的有效性（≥40岁组1个月时为0.86、6个月时为0.97，≤35岁组1个月时为0.97、6个月时为1.07；p = 0.003）和安全性指标（≥40岁组1个月时为0.93、6个月时为1.04，≤35岁组1个月时为1.0、6个月时为1.11；p = 0.008）存在统计学显著差异。
40岁以上患者的SMILE术后屈光结果虽然可以接受，但不如年轻患者，显示出明显更低的有效性和安全性指标，散光结果更差，有欠矫趋势。我们推测老年组角膜基质硬度增加会改变SMILE术后角膜基质的重塑能力，从而影响SMILE的屈光和视觉反应。
