宁吉良; 张立军; 孙思宇; 闫春晓; 陈若语; 邢泽群; 于涛瑞

doi:10.3760/cma.j.cn115989-20211122-00637

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• 临床研究 •

近视眼SMILE与SPT-TransPRK术后早期视觉质量比较

中华实验眼科杂志, 2023,41(8) : 768-775. DOI: 10.3760/cma.j.cn115989-20211122-00637

摘要

目的

探讨飞秒激光小切口角膜基质透镜取出术(SMILE)与智能脉冲技术辅助经上皮准分子激光角膜切削术(SPT-TransPRK)术后早期视觉质量的差异和变化情况。

方法

采用队列研究方法，选取2021年2—5月于大连医科大学附属大连市第三人民医院行角膜屈光手术者92例92眼，均为右眼入组，其中SMILE组40例40眼，SPT-TransPRK组52例52眼。分别于术前及术后1个月、3个月检查受检者视力，计算有效性，有效性＝术后裸眼视力(UCVA)/术前最佳矫正视力；采用AR-1自动电脑验光仪测量屈光度；采用Sirius角膜地形图测量角膜高阶像差(HOA)，包括总HOA、球差和彗差；采用OQASⅡ视觉质量分析系统测量客观散射指数(OSI)，调制传递函数截止频率(MTF cut-off)，斯特列尔比(SR)，模拟对比度视力VA100、VA20和VA9(白天、黄昏、夜晚)。

结果

术后3个月，SMILE组与SPT-TransPRK组UCVA、有效性比较差异均无统计学意义(Z＝0.880，P＝0.380；t＝0.920，P＝0.058)，SPT-TransPRK组术后表现为低度远视。术前、术后1个月和术后3个月SMILE组总HOA分别为(0.47±0.18)、(0.70±0.22)和(0.74±0.19)μm，SPT-TransPRK组分别为(0.40±0.14)、(0.98±0.35)和(0.94±0.22)μm；术前、术后1个月和术后3个月SMILE组球差分别为(－0.20±0.09)、(－0.44±0.14)和(－0.44±0.15)μm，SPT-TransPRK组分别为(－0.20±0.10)、(－0.71±0.23)和(－0.75±0.20)μm。2个组术眼手术前后不同时间点总HOA和球差比较，差异均有统计学意义(总HOA：F_分组＝13.851，P＝0.001；F_时间＝29.960，P<0.001.球差：F_分组＝31.037，P<0.001；F_时间＝48.005，P<0.001)，其中2个组术后角膜总HOA、球差均较术前增加，差异均有统计学意义(均P<0.05)；术后1个月和3个月，SMILE组术眼总HOA和球差均小于SPT-TransPRK组，差异均有统计学意义(均P<0.05)。2个组术后1个月、3个月角膜彗差较术前增加，差异均有统计学意义(均P<0.05)。SMILE组术后1个月OSI高于术前，MTF cut-off、SR和VA9低于术前，差异均有统计学意义(均P<0.05)；术后3个月OSI高于术前，SR和VA9低于术前，差异均有统计学意义(均P<0.05)。SPT-TransPRK组术后1个月OSI高于术前，MTF cut-off、SR、VA100、VA20和VA9低于术前，差异均有统计学意义(均P<0.05)，术后3个月OSI、MTF cut-off、SR、VA100、VA20和VA9与术前比较差异均无统计学意义(均P>0.05)。2个组间术眼彗差、OSI、MTF cut-off、SR、VA100、VA20和VA9总体比较差异均无统计学意义(均P>0.05)。

结论

SMILE和SPT-TransPRK均是矫正近视的有效方法，术后早期视觉质量相似，但相较SPT-TransPRK，SMILE引起更小的角膜总HOA与球差改变。

引用本文: 宁吉良, 张立军, 孙思宇, 等. 近视眼SMILE与SPT-TransPRK术后早期视觉质量比较 [J] . 中华实验眼科杂志, 2023, 41(8) : 768-775. DOI: 10.3760/cma.j.cn115989-20211122-00637.

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近视发病率逐年升高，预计2050年全球近视人口将达到47.58亿人，占全球人口的49.8%^[1]。屈光手术是矫治近视、提高近视人群生活质量的重要手段。飞秒激光小切口角膜基质透镜取出术(small incision lenticule extraction，SMILE)和智能脉冲技术辅助经上皮准分子激光角膜切削术(smart pulse technology-assisted transepithelial photorefractive keratectomy，SPT-TransPRK)是目前基质层与表层角膜激光屈光手术最先进的2种代表术式。研究表明，SMILE和SPT-TransPRK均有良好的安全性、有效性和可预测性^[2,3,4,5]。近年来，屈光手术带来的眩光、光晕和夜间视力下降等视觉质量问题引起了人们的关注。OQAS Ⅱ视觉质量分析系统(西班牙Visiometrics公司)通过收集视网膜点光源图像，并经过双通道技术分析其点扩散函数图像，从而获得客观散射指数(objective scatter index，OSI)、调制传递函数截止频率(modulation transferfunction cut-off frequency，MTF cut-off)、斯特列尔比(Strehl ratio，SR)、模拟对比度视力等客观视觉质量参数。目前，仅少数研究对比了SMILE与准分子激光角膜表面切削术(photorefractive keratectomy，PRK)及准分子激光上皮下角膜磨镶术(laser-assisted subepithelial keratomileusis，LASEK)术后视觉质量，结果显示SMILE诱导高阶像差(higher-order aberration，HOA)变化更少^[6,7,8]。但关于SMILE与SPT-TransPRK术后早期OQAS视觉质量对比研究较少。本研究拟比较SMILE与SPT-TransPRK术后早期角膜像差与OQAS视觉质量，以期为中度近视矫正的术式选择提供参考。

贡献者信息

宁吉良

大连医科大学附属大连市第三人民医院眼科，大连　116033

张立军

大连医科大学附属大连市第三人民医院眼科，大连　116033

孙思宇

大连医科大学附属大连市第三人民医院眼科，大连　116033

闫春晓

大连医科大学附属大连市第三人民医院眼科，大连　116033

陈若语

大连医科大学附属大连市第三人民医院眼科，大连　116033

邢泽群

大连医科大学附属大连市第三人民医院眼科，大连　116033

于涛瑞

大连医科大学附属大连市第三人民医院眼科，大连　116033

通信作者

张立军

大连医科大学附属大连市第三人民医院眼科，大连　116033

Email：lijunzhangw@gmail.com

关键词

近视; 角膜激光手术; 角膜波前像差; 飞秒激光小切口角膜基质透镜取出术; 智能脉冲技术辅助经上皮准分子激光角膜切削术; 视觉质量;

基金项目

大连市科技创新基金项目（2019J13SN105）

作者声明

作者贡献声明

宁吉良：设计试验、实施研究、分析数据、起草文章；张立军：设计试验、对文章知识性内容的审阅和智力性内容的修改及定稿；孙思宇、闫春晓、陈若语、邢泽群、于涛瑞：实施研究、采集数据、分析数据

利益冲突

所有作者均声明不存在利益冲突

历史

出版日期：2023-08-10

收稿日期：2023-01-22

修回日期：2023-06-28

本文编辑

刘艳施晓萌

Clinical Science

Comparison of early postoperative visual quality between SMILE and SPT-TransPRK

Ning Jiliang, Zhang Lijun, Sun Siyu, Yan Chunxiao, Chen Ruoyu, Xing Zequn, Yu Taorui

Published 2023-08-10

Cite as Chin J Exp Ophthalmol, 2023, 41(8): 768-775. DOI: 10.3760/cma.j.cn115989-20211122-00637

Abstract

Objective

To investigate the differences and changes in early postoperative visual quality after small incision lenticule extraction (SMILE) and smart pulse technology-assisted transepithelial photorefractive keratectomy (SPT-TransPRK).

Methods

A cohort study was performed.A total of 92 patients (92 eyes) who underwent corneal laser refractive surgery were enrolled in Dalian Third People's Hospital Affiliated to Dalian Medical University from February 2021 to May 2021.The data from the right eye were collected for analysis.The patients were divided into SMILE group (40 patients, 40 eyes) and SPT-TransPRK group (52 patients, 52 eyes). Preoperative, 1- and 3-month postoperative visual acuity were measured to calculate the effectiveness, which was defined as the ratio of postoperative uncorrected visual acuity (UCVA) to preoperative best corrected visual acuity.Refraction was measured by an AR-1 autorefractor.Corneal higher-order aberration (HOA) including total HOA, spherical aberration and coma was measured by Sirius corneal topographer.Objective scatter index (OSI), modulation transfer function cut-off frequency (MTF cut-off), Strehl ratio (SR), simulated contrast visual acuity VA100 (day), VA20 (dusk) and VA9 (night) were measured via OQAS II visual quality analysis system.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the Dalian Third People's Hospital Affiliated to Dalian Medical University (No.2019-KT-010). Written informed consent was obtained from each subject.

Results

There was no significant difference in 3-month postoperative UCVA and effectiveness between the two groups (Z=0.880, P=0.380; t=0.920, P=0.058). Patients in SPT-TransPRK group showed mild hyperopia 3 months after surgery.Preoperative, 1- and 3-month postoperative total corneal HOA was (0.47±0.18), (0.70±0.22) and (0.74±0.19)μm in SMILE group, and (0.40±0.14), (0.98±0.35) and (0.94±0.22)μm in SPT-TransPRK group respectively, showing statistically significant differences (F_group=13.851, P=0.001; F_time=29.960, P<0.001). Preoperative, 1- and 3-month postoperative spherical aberration was (-0.20±0.09), (-0.44±0.14) and (-0.44±0.15)μm in SMILE group, and (-0.20±0.10), (-0.71±0.23) and (-0.75±0.20)μm in SPT-TransPRK group respectively, showing statistically significant differences (F_group=31.037, P<0.001; F_time=48.005, P<0.001). The postoperative total corneal HOA and spherical aberration were increased in both groups compared with before surgery, with statistically significant differences (all at P<0.05). The 1- and 3-month postoperative total corneal HOA and spherical aberrations were smaller in SMILE group than in SPT-TransPRK group, and the differences were statistically significant (all at P<0.05). The 1- and 3-month postoperative coma were increased in both groups compared with before surgery, showing statistically significant differences (all at P<0.05). In SMILE group, 1-month postoperative OSI was higher and 1-month postoperative MTF cut-off, SR, and VA9 were lower than those before surgery, and 3-month postoperative OSI was higher and 3-month postoperative SR and VA9 were lower than those before surgery, showing statistically significant differences (all at P<0.05). In SPT-TransPRK group, 1-month postoperative OSI was higher and 1-month postoperative MTF cut-off, SR, VA100, VA20, and VA9 were lower than those before surgery, showing statistically significant differences (all at P<0.05). There was no significant difference in OSI, MTF cut-off, SR, VA100, VA20, and VA9 between 3 months postoperatively and before surgery in the SPT-TransPRK group (all at P>0.05). There was no significant difference in coma, OSI, MTF cut-off, SR, VA100, VA20, and VA9 between two groups (all at P>0.05).

Conclusions

Both SMILE and SPT-TransPRK are effective methods for correcting myopia and they have comparable visual quality.Compared with SPT-TransPRK, corneal total HOA and spherical aberration are smaller after SMILE.

Key words:

Myopia; Corneal surgery, laser; Corneal wavefront aberration; Femtosecond small incision lenticule extraction; Smart pulse technology-assisted transepithelial photorefractive keratectomy; Visual quality

Contributor Information

Ning Jiliang