Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, Beijing, China.
BMC Ophthalmol. 2024 Sep 5;24(1):396. doi: 10.1186/s12886-024-03661-w.
This study aimed to observe corneal and retinal thicknesses at 5 years after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) for myopia, investigate the effect of epithelial remodeling on refractive status and visual quality, and compare retinal thicknesses among fundus tessellation grades.
Patients who received FS-LASIK or SMILE 5 years before were enrolled in this cross-sectional study. After 1:1 propensity score matching, each surgical group obtained 177 patients (177 eyes). Examinations including visual acuity, refraction, corneal and retinal thicknesses, corneal higher-order aberrations (HOAs), and fundus photography were performed in this visit at 5 years after surgery. The Quality of Vision (QoV) questionnaire was used to assess visual symptoms and overall satisfaction. Corneal and retinal thicknesses between groups were compared, contributing factors were analyzed, and correlations with postoperative refractive status, HOAs, QoV scores and overall satisfaction were evaluated.
The discrepancy of epithelial thickness between central and pericentral zones in FS-LASIK group was larger than that in SMILE group, which was negatively correlated with postoperative spherical equivalent (SE), positively correlated with spherical aberration (all P < 0.05), but not correlated with QoV scores and overall satisfaction (all P > 0.05) in both surgical groups. There was no statistical difference in stromal thickness and total corneal thickness (all P > 0.05). Most annuluses of epithelial and stromal thicknesse were linearly related to preoperative SE (all P < 0.05). The macular thickness, ganglion cell complex thickness, and retinal nerve fiber layer thickness exhibited comparable values between two surgical groups and four fundus tessellation grades, with no significant association observed with postoperative SE (all P > 0.05).
The tendency that epithelial thickness in central zone was thicker than peripheral zone was more obvious at 5 years after FS-LASIK compared to SMILE. This uneven distribution of epithelial thickness might play a role in myopic regression and the changes in HOAs, especially in patients with high myopia, but it had little effect on patients' subjective visual quality and satisfaction. Retinal thicknesses were not affected by these two surgical methods, and they did not appear to be the clinical indicators for myopic regression or fundus tessellation progression.
本研究旨在观察近视患者接受飞秒激光辅助原位角膜磨镶术（FS-LASIK）和小切口微透镜提取（SMILE）后 5 年的角膜和视网膜厚度，探讨上皮重塑对屈光状态和视觉质量的影响，并比较不同眼底镶嵌分级的视网膜厚度。
本横断面研究纳入了 5 年前接受 FS-LASIK 或 SMILE 的患者。通过 1:1 倾向评分匹配，每组手术均获得 177 例患者（177 只眼）。在术后 5 年的这次就诊中，进行了视力、屈光度、角膜和视网膜厚度、角膜高阶像差（HOAs）以及眼底照相检查。使用视觉质量（QoV）问卷评估视觉症状和总体满意度。比较两组间的角膜和视网膜厚度，分析影响因素，并评估与术后屈光状态、HOAs、QoV 评分和总体满意度的相关性。
FS-LASIK 组中央区和旁中央区上皮厚度差异较大，与术后球镜等效（SE）呈负相关，与球差呈正相关（均 P<0.05），但与两组的 QoV 评分和总体满意度均无相关性（均 P>0.05）。基质厚度和总角膜厚度无统计学差异（均 P>0.05）。大多数上皮和基质厚度的环形与术前 SE 呈线性相关（均 P<0.05）。黄斑厚度、节细胞复合体厚度和视网膜神经纤维层厚度在两组和四个眼底镶嵌分级之间的数值相当，与术后 SE 无显著相关性（均 P>0.05）。
与 SMILE 相比，FS-LASIK 术后 5 年中央区上皮厚度比周边区更厚的趋势更明显。这种上皮厚度的不均匀分布可能在近视回退和 HOAs 变化中起作用，尤其是在高度近视患者中，但对患者的主观视觉质量和满意度影响不大。视网膜厚度不受这两种手术方法的影响，也似乎不是近视回退或眼底镶嵌进展的临床指标。
