Wang Li-Xiang, Wang Xiao-Li, Tang Jing, Ma Ke, Yin Hong-Bo, Deng Ying-Ping
Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Department of Ophthalmology, the People's Hospital of Jianyang City, Chengdu 641400, Sichuan Province, China.
Int J Ophthalmol. 2023 Apr 18;16(4):608-615. doi: 10.18240/ijo.2023.04.15. eCollection 2023.
To compare the subjective and objective visual quality between small incision lenticule extraction (SMILE) and transepithelial photorefractive keratectomy (tPRK) in patients with low and moderate myopia.
Patients undertaking SMILE or tPRK for the correction of low and moderate myopia were consecutively recruited in this prospective cohort study with a 3-month follow-up period. Objective evaluation [visual acuity test, manifest refraction, wavefront aberrations, the total cut-off value of the total modulation transfer function (MTF), and Strehl ratio (SR)] and subjective evaluation of visual quality (quality-of-life questionnaire) were conducted before surgery and at days 1, 7, 30, and 90 after surgery.
A total of 47 patients (94 eyes) with SMILE and 22 patients (22 eyes) with tPRK were enrolled. The uncorrected visual acuity (UCVA) was better in SMILE patients on day 7 after surgery (1.13±0.13 0.99±0.17, =4.85, <0.001) but was comparable at days 30 and 90. At day 90, the SMILE group had a lower spherical equivalent (SE) than the tPRK group (0.04±0.31 0.19±0.43, =2.08, =0.042). Total higher order aberrations (HOAs) were induced in both surgical types, which were more evident in the tPRK group with 3-mm pupil diameter (0.16±0.07 0.11±0.05, =4.27, <0.001) and 5-mm pupil diameter (0.39±0.17 0.36±0.11, =2.33, =0.022). The MTF and SR showed a trend of improvement in both SMILE and tPRK patients but were statistically better in the SMILE group with both pupil diameters. There was a significant improvement of contrast sensitivity (CS) over baseline levels at the spatial frequency of 18 cycles/degree (c/d) in the SMILE group (=2.72, =0.033) and at 3 c/d (=3.03, =0.031), 12 c/d (=3.72, =0.013), and 18 c/d (=4.62, =0.004) in the tPRK group. The subjective quality of life questionnaire showed a steady improvement in the SMILE group (=8.31, <0.001) but not the tPRK group.
SMILE and tPRK are both safe and effective ways to correct low and moderate myopia. A generally better and quicker recovery of visual quality favors the application of SMILE in qualified patients.
比较小切口透镜切除术（SMILE）和经上皮准分子激光角膜切削术（tPRK）在中低度近视患者中的主观和客观视觉质量。
在这项前瞻性队列研究中，连续招募接受SMILE或tPRK矫正中低度近视的患者，并进行为期3个月的随访。在手术前以及手术后第1天、第7天、第30天和第90天进行客观评估[视力测试、显验光、波前像差、总调制传递函数（MTF）的总截止值和斯特列尔比（SR）]以及视觉质量的主观评估（生活质量问卷）。
共纳入47例（94只眼）接受SMILE手术的患者和22例（22只眼）接受tPRK手术的患者。SMILE组患者术后第7天的裸眼视力（UCVA）更好（1.13±0.13 0.99±0.17，=4.85，<0.001），但在第30天和第90天相当。在第90天，SMILE组的等效球镜度（SE）低于tPRK组（0.04±0.31 0.19±0.43，=2.08，=0.042）。两种手术方式均会诱发总的高阶像差（HOAs），在瞳孔直径为3 mm时，tPRK组更明显（0.16±0.07 0.11±0.05，=4.27，<0.001），在瞳孔直径为5 mm时也是如此（0.39±0.17 0.36±0.11，=2.33，=0.022）。MTF和SR在SMILE和tPRK患者中均呈改善趋势，但在两种瞳孔直径下，SMILE组在统计学上均更好。在SMILE组中，在空间频率为18周/度（c/d）时对比敏感度（CS）较基线水平有显著改善（=2.72，=0.033），在tPRK组中，在3 c/d（=3.03，=0.031）、12 c/d（=3.72，=0.013）和18 c/d（=4.62，=0.004）时对比敏感度较基线水平有显著改善。主观生活质量问卷显示SMILE组有稳步改善（=8.31，<0.001），而tPRK组则没有。
SMILE和tPRK都是矫正中低度近视的安全有效方法。视觉质量总体上更好、恢复更快有利于在符合条件的患者中应用SMILE。
