目的探讨Kappa角大小对飞秒激光小切口角膜基质透镜取出术(SMILE)前后全眼高阶像差(HOA)的影响。
方法采用系列病例观察研究方法，纳入2015年4月至2016年5月在天津市眼科医院屈光手术中心行SMILE手术的近视及近视散光患者98例98眼，均选取右眼进行研究。测量患者术前及术后1个月、3个月的裸眼视力(UCVA)、球镜度及柱镜度；采用Pentacam眼前节分析系统测量术前Kappa角大小；采用WaveScan波阵面像差仪测量术前及术后各时间点的全眼像差。比较手术前后UCVA、屈光度及各项HOA；采用Pearson线性相关分析评估Kappa角大小与各项HOA之间的关系。根据Kappa角的范围及分布情况，将Kappa角位移距离≥0.20 mm的34眼作为较大Kappa角组，在位移距离<0.20 mm的64眼中随机选取34眼作为较小Kappa角组，比较不同Kappa角组手术前后各项HOA的差异。
结果术前、术后1个月及3个月，患者UCVA(LogMAR视力)分别为0.06±0.23、-0.03±0.07和-0.05±0.07，总体比较差异有统计学意义( F＝779.330， P<0.001)，其中术后1个月及3个月UCVA均优于术前，差异均有统计学意义(均 P<0.001)。术眼手术前后球镜度、柱镜度和等效球镜度(SE)总体比较差异均有统计学意义( F＝1 107.811、127.786、1 191.266，均 P<0.001)，其中术眼术后各时间点球镜度、柱镜度和SE较术前均明显降低，差异均有统计学意义(均 P<0.001)。手术前后总HOA、球差、彗差、第3阶像差(S3)、第4阶像差(S4)、第5阶像差(S5)、第6阶像差(S6)总体比较差异均有统计学意义( F＝75.915、78.231、66.186、64.521、97.161、36.623、28.852，均 P<0.001)，其中术后各时间点总HOA、球差、彗差、S3、S4、S5和S6均较术前明显增大，差异均有统计学意义(均 P<0.05)。术后1个月及3个月Kappa角大小与总HOA、彗差、S3均呈正相关(总HOA： r＝0.357、0.363，均 P<0.001；彗差： r＝0.310、0.341，均 P<0.01；S3： r＝0.343、0.371，均 P<0.01)。手术前后不同大小Kappa角组患者总HOA、彗差、S3总体比较，差异均有统计学意义( F 分组＝3.363、4.277、4.029，均 P<0.05)，其中术后1个月及3个月，较大Kappa角组总HOA、彗差及S3均大于较小Kappa角组，差异均有统计学意义(均 P<0.05)。
结论较大的Kappa角在SMILE术中可能会引入更多的高阶像差。
ObjectiveTo investigate the influence of angle Kappa on total high-order aberration (HOA) before and after small incision lenticule extraction (SMILE).
MethodsAn observational case series study was conducted.Right eyes of 98 patients with myopia and myopic astigmatism who underwent SMILE surgery at Tianjin Eye Hospital from April 2015 to May 2016 were selected.Uncorrected visual acuity (UCVA), spherical diopter and cylindrical diopter under cycloplegic condition were examined before the surgery and at l and 3 months postoperatively.The chord distance of angle Kappa was measured by Pentacam topography.Wavefront aberrations were measured by WaveScan aberrometer.Pre- and postoperative UCVA, refractive status and each HOA were analyzed.The relationship between angle Kappa and each HOA was analyzed by Pearson correlation.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Tianjin Eye Hospital (No.TJYYLL-2017-17). Written informed consent was obtained from each subject.
ResultsThe preoperative, postoperative 1-month and postoperative 3-month UCVA (LogMAR) were 0.06±0.23, -0.03±0.07 and -0.05±0.07, respectively, showing a statistically significant difference ( F=779.330, P<0.001). There were statistically significant differences in spherical diopter, cylinder diopter and spherical equivalent (SE) between before and after operation ( F=1 107.811, 127.786, 1 191.266; all at P<0.001), and the postoperative spherical diopter, cylinder diopter and SE were significantly lower than those before surgery (all at P<0.001). At 6-mm pupil diameter, significant differences were found between postoperative total HOA, spherical aberration, coma, the third-order aberration (S3), fourth-order aberration (S4), fifth-order aberration (S5) and sixth-order aberration (S6) and the preoperative values ( F=75.915, 78.231, 66.186, 64.521, 97.161, 36.623, 28.852; all at P<0.001). The postoperative 1- and 3-month total HOA, spherical aberration, coma, S3, S4, S5 and S6 were significantly increased in comparison with those before surgery (all at P<0.05). There was a positive correlation between angle Kappa and total HOA, coma and S3 at 1 and 3 months after surgery (total HOA: r=0.357, 0.363; both at P<0.001.coma: r=0.310, 0.341; both at P<0.01.S3∶ r=0.343, 0.371; both at P<0.01). Significant differences were found in preoperative, postoperative 1-month and 3-month total HOA, coma and S3 between groups with different angle Kappa ( F group=3.363, 4.277, 4.029; all at P<0.05). The postoperative total HOA, coma and S3 of the larger angle Kappa group were greater than those of the smaller angle Kappa group, with statistically significant differences between them (all at P<0.05).
ConclusionsA larger angle Kappa may induce HOAs in SMILE surgery.
邵婷,王雁,郝维婷,等. Kappa角大小对SMILE手术前后全眼像差的影响及其意义[J]. 中华实验眼科杂志,2022,40(06)：525-532.
DOI:10.3760/cma.j.cn115989-20190305-00098版权归中华医学会所有。
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邵婷：参与选题、酝酿和设计试验、实施研究、采集数据、分析/解释数据、起草文章、对文章知识性内容的审阅和智力性内容的修改；王雁：参与选题、酝酿和设计试验、实施研究、对文章知识性内容的审阅和智力性内容的修改及定稿；郝维婷：采集数据、分析/解释数据、起草文章；张佳媚：对文章知识性内容的审阅和智力性内容的修改；崔彤：参与选题、酝酿和设计试验
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