近视眼中可植入角膜胶原晶状体植入术与小切口透镜切除术的术后疗效、安全性、可预测性及视觉质量：一项Meta分析。
Postoperative efficacy, safety, predictability, and visual quality of implantable collamer lens implantation versus small incision lenticule extraction in myopic eyes: a Meta-analysis.
作者信息
Li Hong-Yu, Ye Zi, Li Zhao-Hui
机构信息
Medical School of Chinese PLA, Beijing 100853, China.
Senior Department of Ophthalmology, the Third Medical Center of PLA General Hospital, Beijing 100853, China.
出版信息
Int J Ophthalmol. 2023 Mar 18;16(3):442-452. doi: 10.18240/ijo.2023.03.16. eCollection 2023.
AIM
To compare the postoperative efficacy, safety, predictability, and visual quality of implantable collamer lens (ICL) implantation versus small incision lenticule extraction (SMILE) in myopia eyes.
METHODS
PubMed, EMBASE, Web of Science, Cochrane Library and several Chinese databases were searched at May 2021 to select relevant studies in comparison of clinical outcomes between ICL implantation and SMILE for myopia. The primary outcomes were efficacy, safety, and predictability. And the secondary outcomes were postoperative higher-order ocular aberrations (HOAs), modulation transfer function cutoff frequency (MTF), objective scatter index (OSI), contrast sensitivity and a quality of vision (QoV) questionnaire.
RESULTS
A total of 1036 eyes from 10 studies, of which 503 eyes underwent ICL implantation and 533 eyes underwent SMILE, were enrolled in this Meta-analysis. Pooled results revealed that ICL group had a better safety index and post-corrected distance visual acuity (CDVA) (=0.007, <0.00001, respectively), and a lower percentage of eyes with a postoperative CDVA lost 1 line (=0.007) than the SMILE group. No significant differences were found in comparison of the other primary outcomes. In the long-term follow-up (>6mo), ICL group had a lower total HOA, coma, and spherical aberration than SMILE group (=0.003, <0.00001, 0.04). Yet higher trefoil was found in ICL group at 6mo after surgery (=0.003). Additionally, ICL group also had a higher MTF value (=0.02), and a higher contrast sensitivity score for spatial frequencies of 1.5, 6, and 12 cpds (=0.02, 0.005, 0.02, respectively). And it also had a lower score of bothersome in QoV questionnaire than SMILE group (=0.003).
CONCLUSION
ICL implantation and SMILE have similar and comparable outcomes in term of the efficacy and predictability for correcting high myopia. However, ICL group is relatively safer and also has better visual quality in comparison of SMILE group.
目的
比较植入式角膜胶原晶状体（ICL）植入术与小切口基质透镜切除术（SMILE）治疗近视的术后疗效、安全性、可预测性和视觉质量。
方法
于2021年5月检索PubMed、EMBASE、Web of Science、Cochrane图书馆及多个中文数据库，以选取比较ICL植入术与SMILE治疗近视临床结局的相关研究。主要结局为疗效、安全性和可预测性。次要结局为术后高阶像差（HOAs）、调制传递函数截止频率（MTF）、客观散射指数（OSI）、对比敏感度及视觉质量（QoV）问卷。
结果
本Meta分析共纳入10项研究的1036只眼，其中503只眼接受ICL植入术，533只眼接受SMILE手术。汇总结果显示，ICL组的安全指数和矫正后远视力（CDVA）更好（分别为=0.007，<0.00001），术后CDVA下降1行的眼的比例低于SMILE组（=0.007）。在其他主要结局的比较中未发现显著差异。在长期随访（>6个月）中，ICL组的总高阶像差、彗差和球差低于SMILE组（=0.003，<0.00001，0.04）。然而，术后6个月时ICL组的三叶像差更高（=0.003）。此外，ICL组的MTF值也更高（=0.02），在空间频率为1.5、6和12周/度时的对比敏感度得分也更高（分别为=0.02、0.005、0.02）。并且其在QoV问卷中的困扰得分也低于SMILE组（=0.003）。
结论
ICL植入术和SMILE在矫正高度近视的疗效和可预测性方面具有相似且可比的结果。然而，与SMILE组相比，ICL组相对更安全，视觉质量也更好。
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