Yao Juan, Feng Jianghong, Li Weijie, Liu Chang, Li Yanlei, Wang Xiaoying
Department of Ophthalmology, Taiyuan Central Hospital, Taiyuan, Shanxi Province, 030009, China.
The Ninth Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China.
BMC Ophthalmol. 2024 Dec 4;24(1):522. doi: 10.1186/s12886-024-03790-2.
Objectively compare the changes in ocular surface parameters in myopic patients who have undergone either SMILE or Implantable Collamer Lens (ICL V4c) surgery.
This prospective cohort study enrolled 32 patients (32 eyes) undergoing SMILE surgery and 35 patients (35 eyes) receiving ICL V4c intraocular lenses. Examinations were performed at preoperative, 1-week, 1-month, and 3-month postoperative time points. The assessments included Schirmer's I Test (SIt), First Non-Invasive Break-Up Time (First-NIBUT), Average Non-Invasive Break-Up Time (Average-NIBUT), Tear Meniscus Height (TMH), Ocular Surface Disease Index (OSDI) score, conjunctival congestion score, meibomian gland loss score, lipid layer analysis score, lid margin opening detection score, and corneal fluorescein staining (CFS) score.
Repeated measures ANOVA revealed that SIT, TMH, and First-NIBUT initially decreased and then increased. At three months, SIT levels in the SMILE group were significantly lower than those in the ICL group. From the first month onward, TMH levels in the SMILE group remained significantly lower than those in the ICL group (P < 0.05). OSDI scores initially rose and then fell, with the SMILE group consistently showing higher OSDI levels than the ICL group. Conjunctival congestion scores in the SMILE group fluctuated less, while the ICL group exhibited a clear downward trend, with significant differences starting from the first week (P < 0.05). Over time, scores for meibomian gland loss, lipid layer analysis, and lid margin opening detection were all higher in the SMILE group compared to the ICL group.
SMILE surgery has a more pronounced and prolonged impact on the ocular surface and meibomian gland function compared to ICL implantation. Objective dry eye parameters in the ICL group recover more quickly than those in the SMILE group one month post-surgery.
客观比较接受全飞秒激光微小切口基质透镜切除术（SMILE）或植入式隐形眼镜（ICL V4c）手术的近视患者眼表参数的变化。
这项前瞻性队列研究纳入了32例行SMILE手术的患者（32只眼）和35例接受ICL V4c人工晶状体植入的患者（35只眼）。在术前、术后1周、1个月和3个月时间点进行检查。评估包括泪液分泌试验（SIt）、首次非侵入性泪膜破裂时间（First-NIBUT）、平均非侵入性泪膜破裂时间（Average-NIBUT）、泪河高度（TMH）、眼表疾病指数（OSDI）评分、结膜充血评分、睑板腺缺失评分、脂质层分析评分、睑缘开口检测评分和角膜荧光素染色（CFS）评分。
重复测量方差分析显示，SIt、TMH和First-NIBUT最初下降，然后上升。在三个月时，SMILE组的SIt水平显著低于ICL组。从第一个月起，SMILE组的TMH水平一直显著低于ICL组（P < 0.05）。OSDI评分最初上升然后下降，SMILE组的OSDI水平始终高于ICL组。SMILE组的结膜充血评分波动较小，而ICL组呈明显下降趋势，从第一周开始就有显著差异（P < 0.05）。随着时间的推移，SMILE组的睑板腺缺失、脂质层分析和睑缘开口检测评分均高于ICL组。
与ICL植入相比，SMILE手术对眼表和睑板腺功能的影响更显著且持续时间更长。术后1个月，ICL组的客观干眼参数比SMILE组恢复得更快。
