CAJ | 학술논문

目的探讨飞秒激光透镜切除矫正近视及近视散光手术中,角膜透镜定位对手术疗效的影响,评估手术的安全性与可预测性.方法前瞻性队列研究.收集近视及近视散光病例共计115例(229眼).术前屈光状态:等效球镜度-2.25～-9.75 D,平均(5.13+2.11)D；散光0～4.25 D,平均(1.12±0.68)D.应用全飞秒激光完成角膜基质层间透镜切除,依据术中透镜中心偏离预期定位中心的大小程度依次分为A组(＜80μm)、B组(80～150 μm)及C组(＞150 μm).术后检查裸眼视力、像差及残余散光.数据采用方差分析、K-WH检验、卡方检验的连续校正公式进行分析.结果各组病例术中及术后无意外及严重并发症发生,术眼的裸眼视力均有明显提高,术后1d、3个月,3组差异均有统计学意义(x2=50.713,F=19.011,P＜0.01).3组术后1d及3个月术眼残余散光差异均有统计学意义(x2=28.272、34.721,P＜0.01).各组术后角膜前表面彗差(C7、C8)及球差均有增加.其中C组术后彗差增加最为明显,B组次之,A组最小,3组比较差异有统计学意义(x2=51.533、49.804,P＜0.05)；而各组间球差改变量的差异无统计学意义(x2=2.794,P＞0.05).结论加强术中透镜定位的准确性可提高飞秒激光透镜切除手术疗效,降低手术眼残余散光及彗差.
목적 탐토비초격광투경절제교정근시급근시산광수술중,각막투경정위대수술료효적영향,평고수술적안전성여가예측성.방법 전첨성대렬연구.수집근시급근시산광병례공계115례(229안).술전굴광상태:등효구경도-2.25～-9.75 D,평균(5.13+2.11)D；산광0～4.25 D,평균(1.12±0.68)D.응용전비초격광완성각막기질층간투경절제,의거술중투경중심편리예기정위중심적대소정도의차분위A조(＜80μm)、B조(80～150 μm)급C조(＞150 μm).술후검사라안시력、상차급잔여산광.수거채용방차분석、K-WH검험、잡방검험적련속교정공식진행분석.결과 각조병례술중급술후무의외급엄중병발증발생,술안적라안시력균유명현제고,술후1d、3개월,3조차이균유통계학의의(x2=50.713,F=19.011,P＜0.01).3조술후1d급3개월술안잔여산광차이균유통계학의의(x2=28.272、34.721,P＜0.01).각조술후각막전표면혜차(C7、C8)급구차균유증가.기중C조술후혜차증가최위명현,B조차지,A조최소,3조비교차이유통계학의의(x2=51.533、49.804,P＜0.05)；이각조간구차개변량적차이무통계학의의(x2=2.794,P＞0.05).결론 가강술중투경정위적준학성가제고비초격광투경절제수술료효,강저수술안잔여산광급혜차.
Objective To investigate the effect of varying degree lenticule offset in small incision lenticule extraction (SMILE) for the correction of myopia and myopic astigmatism,and to evaluate the safety,efficacy,and predictability of the SMILE.Methods In this prospective cohort study,229 eyes of 115 patients underwent SMILE with VisuMax laser (Carl Zeiss).The mean spherical equivalent (SE) was-2.25 to-9.75 D,with an average of-5.13±2.11 D,astigmatism was 0 to 4.25 D,with an average of 1.12±0.68 D.Based on the degree of lenticule center deviates from the standard center,patients were divided into group A (less than 80 μm),group B (80 to 150 μm) and group C (more than 150 μm).Uncorrected visual acuity (UCVA),aberration and residual astigmatism after surgery were measured.Data were compared using a ANONA,K-WH test and corrected chi-square test.Results There were no intraoperative and postoperative accidents and serious complications,and postoperative UCVA improved markedly.One day,3 months postoperation the differences were statistically significant (x2=50.713,F=19.011,P＜0.01).The differences of residual astigmatism between the 3 groups 1 day and 3 months postoperation were significantly (x2=28.272,34.721,P＜0.01).The anterior corneal surface coma and spherical aberration postoperative were increased.Group C had the most significant increase in coma (C7,C8),followed by group B,group A minimum,the differences between the 3 groups were significant (x2=51.533,49.804,P＜0.01).While the differences in the changes in spherical aberrations between the groups were not statistically significant (x2=2.794,P＞ 0.05).Conclusion Attention to the accuracy of lens positioning can improve the effectiveness of surgery,and reduce the occurrence of postoperative astigmatism and coma.