CAJ | 학술논문

目的根据SMILE术矫正近视的初期临床结果,评估其对视力、高阶像差及对比敏感度的影响,分析术前屈光度与术后高阶像差的关系.方法回顾性病例研究.选择在南京军区南京总医院眼科进行SMILE术的40例近视患者(76眼).利用iTrace视觉分析仪测量并计算出术前,术后1d、1周、1个月、3个月在小瞳孔(3 mm)及中等瞳孔(5 mm)时的角膜总高阶像差、球差、彗差、三叶草的均方根值(RMS),并检测屈光度、UCVA、调制传递函数(MTF)值、对比敏感度.对结果数据进行方差分析和直线相关分析.结果手术后,5 mm瞳孔直径和3 mm瞳孔直径下高阶像差均轻微增高.5 mm瞳孔下,术后1个月总高阶像差、球差RMS值较术前明显增加(P＜0.05),术后3个月球差RMS值有所增加(P＜0.05);3 mm瞳孔下,术后1个月球差RMS值与术前相比,差异无统计学意义,术后3个月球差RMS值较1个月时明显增加(P＜0.05).无论瞳孔大小,术后总高阶像差、彗差、三叶草RMS值与术前屈光度存呈正相关.5、10、15、20、25、30 c/d空间频率下,术后1 d MTF值较术前明显增加,差异有统计学意义(P＜0.01),术后1周较术后1d有所减少(P＜0.05).在3、6、12、18 c/d下术后对比敏感度随着随访时间的增加而增加.术中、术后没有发现严重的并发症.结论 SMILE术能有效矫正近视,提高UCVA,但是高阶像差有所增加,尤以球差最明显.术前屈光度越高,手术所导致的高阶像差也越大.
목적 근거SMILE술교정근시적초기림상결과,평고기대시력、고계상차급대비민감도적영향,분석술전굴광도여술후고계상차적관계.방법 회고성병례연구.선택재남경군구남경총의원안과진행SMILE술적40례근시환자(76안).이용iTrace시각분석의측량병계산출술전,술후1d、1주、1개월、3개월재소동공(3 mm)급중등동공(5 mm)시적각막총고계상차、구차、혜차、삼협초적균방근치(RMS),병검측굴광도、UCVA、조제전체함수(MTF)치、대비민감도.대결과수거진행방차분석화직선상관분석.결과 수술후,5 mm동공직경화3 mm동공직경하고계상차균경미증고.5 mm동공하,술후1개월총고계상차、구차RMS치교술전명현증가(P＜0.05),술후3개월구차RMS치유소증가(P＜0.05);3 mm동공하,술후1개월구차RMS치여술전상비,차이무통계학의의,술후3개월구차RMS치교1개월시명현증가(P＜0.05).무론동공대소,술후총고계상차、혜차、삼협초RMS치여술전굴광도존정정상관.5、10、15、20、25、30 c/d공간빈솔하,술후1 d MTF치교술전명현증가,차이유통계학의의(P＜0.01),술후1주교술후1d유소감소(P＜0.05).재3、6、12、18 c/d하술후대비민감도수착수방시간적증가이증가.술중、술후몰유발현엄중적병발증.결론 SMILE술능유효교정근시,제고UCVA,단시고계상차유소증가,우이구차최명현.술전굴광도월고,수술소도치적고계상차야월대.
Objective To evaluate the changes in higher order aberration (HOA) in myopic patients after small incision lenticular extraction (SMILE); to compare the relationship between spherical equivalent refractive error (SE) and aberrations.Methods This was a retrospective study.Forty patients (76 eyes) with myopia underwent small-incision lenticular extraction using the Visumax femtosecond laser.Postoperative changes in corneal HOA,uncorrected visual acuity (UCVA) and SE were analyzed during a 3 months follow-up period.The main outcome measures of HOA,UCVA and SE before and after the surgery were evaluated.Data were analyzed using ANOVA and pearson correlation.Results Corneal HOAs for 3 mm and 5 mm corneal diameters increased slightly.For the 5 mm corneal diameter,significant increases in corneal HOA and spherical aberrations (SA) were measured 1 month after surgery (P＜0.05).Three months after surgery,SA also increased compared to measurements 1 month after surgery (P＜0.05),for the 3 mm corneal diameter,SA also increased compared to 1 month after surgery (P＜0.05).Significant correlations were found between preoperative SE and total HOA,coma aberrations,or trefoil aberrations.At spatial frequencies of 5,10,15,20,25,and 30 c/d,modulation transfer function (MTF) 1 day after surgery increased significantly compared to preoperative measurements (P＜0.01),and then decreased 1 week after surgery (P＜0.05).At 3,6,12,18 c/d,contrast sensitivity (CS) slightly increased over time.There were no serious intraoperative or postoperative complications in this study.Conclusion Significant improvement in UCVA and was observed after surgery,but there was also an increase in HOA,especially SA.More HOA were induced after surgery with a larger preoperative SE.