目的采用矢量分析法比较角膜地形图引导的飞秒激光辅助的准分子激光原位角膜磨镶术(FS-LASIK)与飞秒激光小切口角膜基质微透镜取出术(SMILE)矫治散光的精准性和稳定性。
方法采用非随机对照研究设计，选取2020年1月—7月在河南省立眼科医院行FS-LASIK或SMILE手术的近视性散光患者120例214眼，按照自愿原则将患者分为FS-LASIK组58例105眼和SMILE组62例109眼。分别于术前及术后1周、1个月和3个月对术眼进行视力、屈光度、眼压及角膜地形图检查，比较各组散光矢量分析结果，包括目标散光矢量(TIA)、术后3个月手术引起的散光矢量(SIA)、误差幅度(ME)、误差角度绝对值(|AE|)、差异矢量绝对值(|DV|)、矫正指数(CI)和成功指数(IOS)。
结果术后3个月，FS-LASIK组术眼无散光11眼，占10.5%，顺规性散光23眼，占21.9%，逆规性散光和斜轴散光共71眼，占67.6%；SMILE组无散光35眼，占32.1%，顺规性散光58眼，占53.2%，逆规性散光和斜轴散光共16眼，占14.7%；2个组间术后不同散光轴向眼数占比差异有统计意义( χ 2＝48.20， P<0.05)。术后3个月SMILE组术眼SIA、|AE|、|DV|、CI和IOS均小于FS-LASIK组，差异均有统计学意义(均 P<0.05)；FS-LASIK组术眼ME为-0.20(-0.37，0.00)D，散光轻度过矫，SMILE组为0.20(0.00，0.25)D，散光轻度欠矫。FS-LASIK组术后不同时间点ME比较差异无统计学意义( P>0.05)，SMILE组术后不同时间点等效球镜度(SE)比较差异无统计学意义( P>0.05)，各组内术后不同时间点其余散光矢量分析结果比较差异均有统计学意义(均 P<0.05)。
结论FS-LASIK和SMILE对散光均有良好的矫治效果。FS-LASIK术后散光呈轻度过矫状态，而SMILE术后散光呈轻度欠矫状态。SMILE术后轴向误差更小，术后3个月内SE稳定性更好。
ObjectiveTo compare the accuracy and stability between corneal topography-guided femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) for myopic astigmatism by vector analysis.
MethodsA non-randomized controlled clinical trial was performed.One hundred and twenty patients (214 eyes) with myopic astigmatism who underwent the FS-LASIK or SMILE in Henan Eye Hospital from January 2020 to July 2020 were enrolled.The patients were divided into FS-LASIK group (58 cases, 105 eyes) and SMILE group (62 cases, 109 eyes) according to different surgeries.The visual acuity, refraction, intraocular pressure and corneal topography were examined before and 1 week, 1 month and 3 months after operation.The results of vector analysis between the two groups were compared, including target induced astigmatism vector (TIA), surgically induced astigmatism vector (SIA), magnitude of error (ME), angle of error (|AE|), difference vector (|DV|), correction index (CI), and index of success (IOS) 3 months after operation.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Henan Eye Hospital (No.HNEECKY-2020[25]). Written informed consent was obtained from each patient before operation.
ResultsThree months after surgery, no astigmatism was found in 11 eyes (10.5%), and with the rule (WTR) astigmatism was in 23 eyes (21.9%), and against the rule (ATR) and oblique astigmatism were in 71 eyes (67.6%) in FS-LASIK group.In SMILE group, no astigmatism was detected in 35 eyes (32.1%), and WTR astigmatism was in 58 eyes (53.2%), and ATR and oblique astigmatism were in 16 eyes (14.7%), showing a statistically significant difference between them ( χ 2 =48.20, P<0.05). The postoperative SIA, |AE|, |DV|, CI and IOS values in the SMILE group were lower than those in the FS-LASIK group, showing statistically significant differences between them (all at P<0.05). The ME was -0.20 (-0.37, 0.00)D in FS-LASIK group and 0.20 (0.00, 0.25)D in SMILE group.Within 3 months after operation, there was no significant difference in ME among different time points in the FS-LASIK group (all at P>0.05) and in spherical equivalent (SE) among different time points in the SMILE group (all at P>0.05). There was significant difference in the results of vector analysis among different time points in the two groups (all at P<0.05).
ConclusionsBoth FS-LASIK and SMILE are effective in the correction of myopic astigmatism.Astigmatism is slightly overcorrected by FS-LASIK and slightly undercorrected by SMILE.The axial error is smaller and the SE is more stable after SMILE within 3 months postoperatively.
王树林,庞辰久,王浩,等. FS-LASIK与SMILE矫治散光的矢量分析及临床效果比较[J]. 中华实验眼科杂志,2022,40(03)：227-234.
DOI:10.3760/cma.j.cn115989-20201206-00827版权归中华医学会所有。
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王树林：试验选题与设计、收集数据、资料的分析和解释、撰写论文、根据编辑部的修改意见进行修改；庞辰久：参与试验选题与设计、修改论文的结果和结论；王浩、张波、顾宇伟、李金：收集数据、参与试验设计及资料的分析和解释
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