目的探讨0.05 D间隔球镜片验光在小切口角膜基质透镜取出术(SMILE)中的临床应用价值。
方法采用随机对照临床研究方法，纳入2021年6月至2022年2月于解放军联勤保障部队第九八九医院行SMILE的中低度近视及近视散光患者60例120眼，根据术前插片验光及红绿平衡试验采用球镜片的不同分为0.05 D组和0.25 D组，分别采用0.05 D和0.25 D间隔球镜片验光，每组30例60眼。2个组患者年龄、球镜度、柱镜度及最佳矫正视力基线资料匹配，差异均无统计学意义(均P>0.05)。比较2个组患者术前验光的单眼红绿平衡情况，以及术后1个月和3个月单眼红绿平衡、裸眼视力(UCVA)及等效球镜度。
结果术前验光0.05 D组红绿平衡率为95.00%(57/60)，高于0.25 D组的35.00%(21/60)，差异有统计学意义(Wald χ2＝17.642，P<0.001)。术后1个月和3个月，0.05 D组红绿平衡率分别为63.33%(38/60)和56.67%(34/60)，高于0.25 D组的23.33%(14/60)和21.67%(13/60)，2个组比较差异均有统计学意义(Wald χ2＝9.137，P＝0.003；Wald χ2＝7.483，P＝0.006)。术后1个月和3个月，0.05 D组UCVA(LogMAR视力)分别为－0.1(－0.1，－0.1)和－0.1(－0.1，－0.1)，优于0.25 D组的0.0(－0.1，0.0)和－0.1(－0.1，0.0)，2个组比较差异均有统计学意义(Wald χ2＝11.624，P＝0.001；Wald χ2＝12.841，P<0.001)。术后1个月和3个月，0.05 D组等效球镜度分别为－0.07(－0.25，0.13)D和－0.13(－0.25，0.13)D，0.25 D组分别为－0.13(－0.38，0.25)D和－0.13(－0.38，0.25)D，2个组比较差异均无统计学意义(Wald χ2＝0.029，P＝0.866；Wald χ2＝0.189，P＝0.664)。
结论与0.25 D间隔球镜片验光相比，0.05 D间隔球镜片验光可提高中低度近视患者SMILE术前及术后的红绿平衡率和术后视力。
ObjectiveTo investigate the clinical value of spherical lens with 0.05 D intervals in optometry for small incision lenticule extraction (SMILE) in myopic eyes.
MethodsA randomized controlled clinical study was conducted.Sixty patients (120 eyes) with low to moderate myopia and myopic astigmatism who underwent SMILE in the 989th Hospital of the PLA from June 2021 to February 2022 were enrolled.The patients were randomly divided into 0.05 D interval group (optometry with spherical lens at 0.05 D interval) and 0.25 D interval group (optometry with spherical lens at 0.25 D interval), with 30 cases (60 eyes) in each group.There was no significant difference in matched age, sphericity, cylindricity, and best corrected visual acuity (BCVA) (all at P>0.05). The preoperative monocular red-green balance, 1- and 3-month postoperative monocular red-green balance, uncorrected visual acuity and spherical equivalent of both groups were compared.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the 989th Hospital of the PLA (No.WZLL-2021-034). Written informed consent was obtained from each subject before any medical examination.
ResultsThe preoperative red-green balance rate in 0.05 D interval group was 95.00%(57/60), which was higher than 35.00%(21/60) in 0.25 D interval group, showing a statistically significant difference (Wald χ2=17.642, P<0.001). The 1- and 3-month postoperative red-green balance rates in 0.05 D interval group were 63.33%(38/60) and 56.67%(34/60), which were higher than 23.33%(14/60) and 21.67%(13/60) in 0.25 D interval group respectively, showing statistically significant differences (Wald χ2=9.137, P=0.003; Wald χ2=7.483, P=0.006). The 1- and 3-month postoperative visual acuity in 0.05 D interval group were -0.1(-0.1, -0.1) and -0.1(-0.1, -0.1), which were higher than 0.0(-0.1, 0.0) and -0.1(-0.1, 0.0) in 0.25 D interval group respectively, showing statistically significant differences (Wald χ2=11.624, P=0.001; Wald χ2=12.841, P<0.001). The 1- and 3-month postoperative spherical equivalent were -0.07(-0.25, 0.13)D and -0.13(-0.25, 0.13)D in 0.05 D interval group, which were higher than -0.13(-0.38, 0.25)D and -0.13(-0.38, 0.25)D in 0.25 D interval group respectively, showing no statistically significant difference between the two groups (Wald χ2=0.029, P=0.866; Wald χ2=0.189, P=0.664).
ConclusionsCompared with spherical lens at 0.25 D interval, 0.05 D interval can improve the accuracy of preoperative and postoperative red-green balance rate and postoperative visual acuity in patients with low to moderate myopia who undergo SMILE.
邢星,李世洋,翁维,等. 0.05 D间隔球镜片验光在近视患者SMILE手术中的应用[J]. 中华实验眼科杂志,2023,41(08)：763-767.
DOI:10.3760/cma.j.cn115989-20220718-00333版权归中华医学会所有。
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邢星：酝酿和设计试验、实施研究、采集数据、分析/解释数据、撰写文章；李世洋：酝酿和设计试验、实施研究、分析/解释数据、文章审阅修改及定稿；翁维：酝酿和设计试验、文章审阅及修改；赵爱红、刘雪雁、朱蕊：实施研究、采集数据
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