Cui Ge, Di Yu, Yang Shan, Chen Di, Li Ying
Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Front Med (Lausanne). 2023 Jan 19;9:1100241. doi: 10.3389/fmed.2022.1100241. eCollection 2022.
This study aimed to evaluate the efficacy of small-incision lenticule extraction (SMILE) in improving vision and visual quality and correcting astigmatism for the treatment of high astigmatism.
Eligible studies and studies comparing the efficacy of SMILE with femtosecond laser-assisted laser keratomileusis (FS-LASIK) or transepithelial photorefractive keratectomy (T-PRK) for high astigmatism (≥2.00 D) were identified in PubMed, Embase, and the Cochrane Central Register of Controlled Trials, searched from their inception to 29 May 2022. The references of all searched studies were checked as supplements. The risk of bias was evaluated for each eligible study. The literature was screened according to the inclusion and exclusion criteria, and relative data were extracted. Data were extracted and analyzed by ReviewManager 5.4. The primary outcome was post-operative uncorrected distance visual acuity (UDVA). The secondary outcomes included corneal aberrations and vector parameters. The weight mean difference (WMD) and their 95% confidence intervals (95% CI) were used to assess the strength of the association.
A total of six studies including 380 astigmatism eyes were involved, with 211 high-astigmatism eyes and 31 low-astigmatism eyes undergoing SMILE surgery, 94 high-astigmatism eyes undergoing FS-LASIK surgery, and 44 high-astigmatism eyes undergoing T-PRK surgery. Compared with non-SMILE, SMILE induced more astigmatism (weighted mean difference [WMD] = -0.07, 95% CI [-0.12 to -0.02], = 0.005) and fewer sphere aberrations (WMD = -0.12, 95% CI [-0.17 to -0.08], < 0.00001). The post-operative UDVA, sphere, spherical equivalent (SE), and higher order aberrations in different surgeries were likewise equivalent. The difference vector and index of success were significantly higher, and the surgically induced astigmatism vector, correction index, and magnitude of error were significantly lower in SMILE.
This meta-analysis suggests that SMILE, FS-LASIK, and T-PRK show excellent efficacy, predictability, and safety for myopia. SMILE exhibited less astigmatism refraction predictability and less surgically induced spherical aberrations. There may be more under-correction in SMILE. More randomized, prospective, and large sample-sized studies are needed to confirm these conclusions in the long term.
本研究旨在评估小切口透镜切除术（SMILE）在改善视力和视觉质量以及矫正散光以治疗高度散光方面的疗效。
在PubMed、Embase和Cochrane对照试验中央登记库中检索从建库至2022年5月29日符合条件的研究以及比较SMILE与飞秒激光制瓣准分子原位角膜磨镶术（FS-LASIK）或经上皮准分子激光角膜切削术（T-PRK）治疗高度散光（≥2.00 D）疗效的研究。所有检索到的研究的参考文献作为补充进行检查。对每项符合条件的研究评估偏倚风险。根据纳入和排除标准筛选文献，并提取相关数据。采用ReviewManager 5.4软件进行数据提取和分析。主要结局指标为术后裸眼远视力（UDVA）。次要结局指标包括角膜像差和矢量参数。采用加权均数差（WMD）及其95%置信区间（95%CI）评估关联强度。
共纳入6项研究，涉及380只散光眼，其中211只高度散光眼和31只低度散光眼接受了SMILE手术，94只高度散光眼接受了FS-LASIK手术，44只高度散光眼接受了T-PRK手术。与非SMILE手术相比，SMILE手术导致更多的散光（加权均数差[WMD]=-0.07，95%CI[-0.12至-0.02]，P=0.005）和更少的球差（WMD=-0.12，95%CI[-0.17至-0.08]，P<0.00001）。不同手术方式术后的UDVA、球镜、等效球镜（SE）和高阶像差同样相当。SMILE手术的差异矢量和成功指数显著更高，而手术诱导散光矢量、矫正指数和误差大小显著更低。
这项荟萃分析表明，SMILE、FS-LASIK和T-PRK在治疗近视方面均显示出优异的疗效、可预测性和安全性。SMILE手术的散光屈光预测性较差，手术诱导的球差较少。SMILE手术可能存在更多欠矫情况。需要更多随机、前瞻性和大样本量的研究来长期证实这些结论。
