J Refract Surg. 2024 Oct;40(10):e706-e715. doi: 10.3928/1081597X-20240826-01. Epub 2024 Oct 1.
To evaluate the impact of refractive couplings in myopia and myopic astigmatism with two different keratorefractive lenticule extraction (KLEx) systems.
This was a retrospective evaluation of refractive outcomes with two different lasers studying 2,841 eyes undergoing small incision lenticule extraction (SMILE) (VisuMax 500; Carl Zeiss Meditec) and 2,528 eyes undergoing SmartSight (ATOS; SCHWIND eye-tech-solutions GmbH). Coupling effects (derived from the ratio between partial slopes) were determined for sphere and cylinder and for spherical equivalent, cardinal, and oblique astigmatism separately.
Statistically significant coupling effects were observed for both the VisuMax and ATOS systems, as indicated by values less than .05. For the VisuMax, a coupling effect of 8% of cylinder into sphere and a 2% coupling of sphere into cylinder was found. For the ATOS, the coupling effect of sphere into cylinder was 1%. A 3% coupling effect of oblique astigmatism into cardinal astigmatism in the VisuMax, and conversely, a 0.1% coupling effect of defocus into oblique astigmatism in the ATOS were found. In cases with no astigmatism plan, sphere had a 2% effect on induced astigmatism in the VisuMax and 0.6% in the ATOS. In high astigmatism plans, sphere had a significant 16% impact on cylinder in the VisuMax. Additionally, the effect of defocus on cardinal astigmatism was 6% in the VisuMax and 0.8% on oblique astigmatism in the ATOS.
Despite the values less than .05 indicating statistical significance, the observed coupling effects were consistently low, with magnitudes below 10%, even for astigmatism exceeding 2.50 diopters. These couplings may be partly attributed to cross-effects of torsional eye movements. Coupling values for KLEx were markedly lower than those reported for non-aspheric excimer laser ablations. The results suggest that surgical results may be refined further by optimizing nomograms to mitigate coupling effects. .
评估两种不同的角膜屈光性透镜切除术（KLEx）系统在近视和近视散光中的折射耦合的影响。
这是一项回顾性评估，涉及 2841 只眼行小切口透镜切除术（SMILE）（VisuMax 500；卡尔蔡司 Meditec）和 2528 只眼行 SmartSight（ATOS；SCHWIND eye-tech-solutions GmbH）的两种不同激光的屈光结果。分别为球镜和柱镜以及等效球镜、主经线和斜向散光确定了耦合效应（由部分斜率比得出）。
VisuMax 和 ATOS 系统均观察到具有统计学意义的耦合效应， 值小于.05。对于 VisuMax，发现柱镜到球镜的耦合效应为 8%，球镜到柱镜的耦合效应为 2%。对于 ATOS，球镜到柱镜的耦合效应为 1%。在 VisuMax 中，斜向散光到主经线散光的耦合效应为 3%，反之，在 ATOS 中，离焦到斜向散光的耦合效应为 0.1%。在没有散光计划的情况下，球镜在 VisuMax 中对诱导散光的影响为 2%，在 ATOS 中为 0.6%。在高散光计划中，VisuMax 中球镜对柱镜的影响显著为 16%。此外，VisuMax 中离焦对主经线散光的影响为 6%，ATOS 中对斜向散光的影响为 0.8%。
尽管 值小于.05 表示具有统计学意义，但观察到的耦合效应始终较低，即使在散光超过 2.50 屈光度的情况下，其幅度也低于 10%。这些耦合可能部分归因于扭转眼球运动的交叉效应。KLEx 的耦合值明显低于非球面准分子激光消融术报道的耦合值。结果表明，可以通过优化列线图来减轻耦合效应，进一步优化手术结果。
