Ma Yunjing, Li Qi, Guo Qian, Huang Yue, Yang Ruibo, Liu Hui, Zhang Chen, Zhao Shaozhen
Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute, School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China.
BMC Ophthalmol. 2025 Jun 5;25(1):336. doi: 10.1186/s12886-025-04168-8.
To investigate the corneal epithelial remodeling profile after small incision lenticule extraction (SMILE) and femtosecond laser in situ keratomileusis (FS-LASIK) for high myopia, as well as its possible consequence for subjective and objective changes in visual quality.
This prospective observational study included 72 eyes with high myopia, divided into two groups, who underwent either SMILE or FS-LASIK. In addition to standard evaluation, anterior segment optical coherence tomography was used to assess central 6-mm corneal epithelial thickness (ET) before surgery and at 1 week, 1, 3, and 6 months after surgery; ET inhomogeneity across the central 5- and 6-mm cornea was quantified using the coefficient of variance (CV). The objective optical quality includes the modulation transfer function cut off frequency (MTF cut off), Strehl ratio, objective scatter index (OSI), and mean OSI obtained using the Optical Quality Analysis System-II. Patient-reported quality of vision was determined with a modified National Eye Institute Refractive Error Quality of Life questionnaire. The correlation of postoperative ET and treatment parameters with visual quality related parameters was analyzed.
Both ET and CV were significantly increased in the SMILE and FS-LASIK groups at 6 months postoperatively (P < 0.001). Paracentral ET was positively correlated with changes in MTF cut off and Strehl ratio at 1 week after SMILE (0.338, 0.405, separately, P < 0.05). For FS-LASIK, ET was negatively correlated with MTF cut off change at 1, 3, 6 months postoperatively (-0.334, -0.385, -0.375, separately, P < 0.05); Central 6-mm CV and Strehl ratio significant correlated at 6 months (-0.427, P = 0.01); ET was significantly correlated with patient-reported quality of vision (P < 0.05). No correlation was found between preoperative spherical equivalent, keratometry values, total corneal thickness, optical zone, and ablation depth and changes in visual quality parameters.
Correction of high myopia with SMILE and FS-LASIK induced epithelial remodeling involved an increase in ET and ET inhomogeneity. Epithelial changes in different regions have different effects on subjective and objective visual quality, which may have a certain clinical relevance of the corneal epithelial thickness measurement for visual quality assessment after refractive surgery.
探讨高度近视患者行小切口飞秒透镜切除术（SMILE）和飞秒激光原位角膜磨镶术（FS-LASIK）后角膜上皮重塑情况，及其对视觉质量主观和客观变化的可能影响。
这项前瞻性观察性研究纳入72只高度近视眼睛，分为两组，分别接受SMILE或FS-LASIK手术。除标准评估外，使用眼前节光学相干断层扫描术评估手术前以及术后1周、1个月、3个月和6个月时中央6毫米角膜上皮厚度（ET）；使用变异系数（CV）量化中央5毫米和6毫米角膜上ET的不均匀性。客观光学质量包括调制传递函数截止频率（MTF截止）、斯特列尔比值、客观散射指数（OSI）以及使用光学质量分析系统-II获得的平均OSI。使用改良的美国国立眼科研究所屈光不正生活质量问卷确定患者报告的视觉质量。分析术后ET和治疗参数与视觉质量相关参数之间的相关性。
SMILE组和FS-LASIK组术后6个月时ET和CV均显著增加（P<0.001）。SMILE术后1周时，旁中央ET与MTF截止变化和斯特列尔比值变化呈正相关（分别为0.338、0.405，P<0.05）。对于FS-LASIK，术后1个月、3个月、6个月时ET与MTF截止变化呈负相关（分别为-0.334、-0.385、-0.375，P<0.05）；术后6个月时中央6毫米CV与斯特列尔比值显著相关（-0.427，P=0.01）；ET与患者报告的视觉质量显著相关（P<0.05）。术前等效球镜度、角膜曲率值、角膜总厚度、光学区和切削深度与视觉质量参数变化之间未发现相关性。
SMILE和FS-LASIK矫正高度近视引起的上皮重塑涉及ET增加和ET不均匀性增加。不同区域的上皮变化对主观和客观视觉质量有不同影响，这可能使角膜上皮厚度测量在屈光手术后视觉质量评估中具有一定临床意义。
