中华眼视光学与视觉科学杂志
中華眼視光學與視覺科學雜誌
중화안시광학여시각과학잡지
Chinese Journal of Optometry Ophthalmology and Visual Science
2015年
10期
609-613
,共5页
李晓晶%王雁%窦瑞%张佳媚%李华
李曉晶%王雁%竇瑞%張佳媚%李華
리효정%왕안%두서%장가미%리화
近视%屈光外科手术%飞秒激光小切口角膜基质透镜取出术%微切口%像差
近視%屈光外科手術%飛秒激光小切口角膜基質透鏡取齣術%微切口%像差
근시%굴광외과수술%비초격광소절구각막기질투경취출술%미절구%상차
Myopia%Refractive surgical procedures%Small incision lenticule extraction%Micro-incision%Aberrations
目的：探讨2 mm微切口与3~5 mm切口飞秒激光小切口角膜基质透镜取出术（SMILE）后角膜前后表面及整体角膜高阶像差的变化。方法对照研究。选取行SMILE手术的患者61例（61眼），取右眼作为研究对象，其中行2 mm微切口SMILE术的26例（26眼）作为MILE组，行3~5 mm 切口SMILE术的35例（35眼）作为对照组，采用Pentacam 测量患者术前、术后1个月和6个月的角膜前、后表面及整体角膜的波前像差值。术后6个月时，MILE组和对照组完成随访的病例数分别为20例和35例。采用重复测量方差分析进行同一组内手术前后像差值的比较，采用独立样本t检验比较2组间的像差值。结果在对照组，术后不同时间角膜前、后表面及整体角膜的总高阶像差（tHOA）、垂直彗差（Z3-1）、水平彗差（Z31）和球差（Z40）与术前相比差异均有统计学意义（P<0.05）。在MILE组，术后1个月和6个月角膜前表面和整体角膜的tHOA、Z3-1、Z31和Z40与术前相比差异有统计学意义（均P<0.01），角膜后表面的Z3-1和Z40与术前相比差异有统计学意义（P<0.01）。2组间的角膜前表面tHOA、Z3-1和Z31在术后1个月和6个月差异均有统计学意义（t1个月=3.509、-4.103、2.418，P<0.05；t6个月=2.248、-2.628、2.617，P<0.05），2组间角膜后表面的Z31在术后1个月和6个月差异均有统计学意义（t=-2.416、-2.852， P<0.05），2组间整体角膜tHOA、Z3-1和Z31在术后1个月差异均有统计学意义（t=2.376、-3.323、2.623， P<0.05）。结论不同切口大小对角膜前、后表面及整体角膜不同项高阶像差的影响不同，术后6个月时切口大小对整体角膜的tHOA，Z3-1、Z31和Z40无影响，2 mm 的微切口对角膜后表面像差的影响相对较小。
目的：探討2 mm微切口與3~5 mm切口飛秒激光小切口角膜基質透鏡取齣術（SMILE）後角膜前後錶麵及整體角膜高階像差的變化。方法對照研究。選取行SMILE手術的患者61例（61眼），取右眼作為研究對象，其中行2 mm微切口SMILE術的26例（26眼）作為MILE組，行3~5 mm 切口SMILE術的35例（35眼）作為對照組，採用Pentacam 測量患者術前、術後1箇月和6箇月的角膜前、後錶麵及整體角膜的波前像差值。術後6箇月時，MILE組和對照組完成隨訪的病例數分彆為20例和35例。採用重複測量方差分析進行同一組內手術前後像差值的比較，採用獨立樣本t檢驗比較2組間的像差值。結果在對照組，術後不同時間角膜前、後錶麵及整體角膜的總高階像差（tHOA）、垂直彗差（Z3-1）、水平彗差（Z31）和毬差（Z40）與術前相比差異均有統計學意義（P<0.05）。在MILE組，術後1箇月和6箇月角膜前錶麵和整體角膜的tHOA、Z3-1、Z31和Z40與術前相比差異有統計學意義（均P<0.01），角膜後錶麵的Z3-1和Z40與術前相比差異有統計學意義（P<0.01）。2組間的角膜前錶麵tHOA、Z3-1和Z31在術後1箇月和6箇月差異均有統計學意義（t1箇月=3.509、-4.103、2.418，P<0.05；t6箇月=2.248、-2.628、2.617，P<0.05），2組間角膜後錶麵的Z31在術後1箇月和6箇月差異均有統計學意義（t=-2.416、-2.852， P<0.05），2組間整體角膜tHOA、Z3-1和Z31在術後1箇月差異均有統計學意義（t=2.376、-3.323、2.623， P<0.05）。結論不同切口大小對角膜前、後錶麵及整體角膜不同項高階像差的影響不同，術後6箇月時切口大小對整體角膜的tHOA，Z3-1、Z31和Z40無影響，2 mm 的微切口對角膜後錶麵像差的影響相對較小。
목적：탐토2 mm미절구여3~5 mm절구비초격광소절구각막기질투경취출술（SMILE）후각막전후표면급정체각막고계상차적변화。방법대조연구。선취행SMILE수술적환자61례（61안），취우안작위연구대상，기중행2 mm미절구SMILE술적26례（26안）작위MILE조，행3~5 mm 절구SMILE술적35례（35안）작위대조조，채용Pentacam 측량환자술전、술후1개월화6개월적각막전、후표면급정체각막적파전상차치。술후6개월시，MILE조화대조조완성수방적병례수분별위20례화35례。채용중복측량방차분석진행동일조내수술전후상차치적비교，채용독립양본t검험비교2조간적상차치。결과재대조조，술후불동시간각막전、후표면급정체각막적총고계상차（tHOA）、수직혜차（Z3-1）、수평혜차（Z31）화구차（Z40）여술전상비차이균유통계학의의（P<0.05）。재MILE조，술후1개월화6개월각막전표면화정체각막적tHOA、Z3-1、Z31화Z40여술전상비차이유통계학의의（균P<0.01），각막후표면적Z3-1화Z40여술전상비차이유통계학의의（P<0.01）。2조간적각막전표면tHOA、Z3-1화Z31재술후1개월화6개월차이균유통계학의의（t1개월=3.509、-4.103、2.418，P<0.05；t6개월=2.248、-2.628、2.617，P<0.05），2조간각막후표면적Z31재술후1개월화6개월차이균유통계학의의（t=-2.416、-2.852， P<0.05），2조간정체각막tHOA、Z3-1화Z31재술후1개월차이균유통계학의의（t=2.376、-3.323、2.623， P<0.05）。결론불동절구대소대각막전、후표면급정체각막불동항고계상차적영향불동，술후6개월시절구대소대정체각막적tHOA，Z3-1、Z31화Z40무영향，2 mm 적미절구대각막후표면상차적영향상대교소。
Objective To evaluate the changes in higher order aberrations in the anterior and posterior corneal surfaces and the total cornea after 2 mm micro-incision small incision lenticule extraction (SMILE) and 3-5 mm SMILE. Methods Sixty-one subjects (61 eyes) were enrolled in this prospective study. Although the surgery was performed on both eyes , only the right eyes were chosen for analysis. Two mm micro-incision SMILE surgery was performed on 26 subjects and SMILE surgery with an incision ranging from 3-5 mm was performed on another 35 subjects. Aberrations on the anterior and posterior corneal surfaces and total corneal aberrations were measured by Pentacam topography preoperatively and 1 month and 6 months postoperatively. Twenty subjects (20 eyes) who underwent the 2 mm SMILE surgery remained after 6 months and all 35 subjects (35 eyes) who underwent the 3-5 mm SMILE surgery remained. Repeated ANOVA was used to compare the Zernike coefficients of the corneal aberrations before and after surgery. The difference in aberrations between the 2 mm and 3-5 mm SMILE groups was compared with an independent t test. Results In the 2 mm SMILE group, the total higher order aberrations (tHOA), vertical coma (Z3-1), horizontal coma (Z31) and spherical aberrations ( Z40 ) for the anterior corneal surface and total corneal had increased significantly 1 month and 6 months postoperatively (all at P<0.05). There were significant differences in Z3-1 and Z40 for the posterior corneal surface postoperatively compared with preoperative values (all at P<0.05). While in the 3-5 mm SMILE group, significant differences were found in tHOA, Z3-1, Z31 and Z40 for the anterior and posterior corneal surfaces and the complete cornea at various follow-up visits (all at P<0.01). Differences in the anterior corneal surface between the 2 mm SMILE and 3-5 mm SMILE groups were found in tHOA , Z3-1, Z31 at 1 month and 6 months postoperatively (t1 m=3.509, -4.103, 2.418, all at P<0.05, t6 m=2.248, -2.628, 2.617, all at P<0.05). There was a significant difference in Z31 for the posterior corneal surface between the two groups at 1 month and 6 months postoperatively ( t=-2 . 416 , -2 . 852 , all at P<0 . 05 ) . The difference in total corneal aberrations between the two groups was noted for tHOA, Z3-1 and Z31 1 month after surgery (t=2.376,-3.323, 2.623, all at P<0.05). Conclusion Different changes in aberrations of the anterior and posterior corneal surfaces and total cornea were noted after 2 mm and 3-5 mm SMILE surgery. There was no significant difference in total corneal aberrations between the 2 mm and 3-5 mm SMILE groups for tHOA, Z3-1, Z31 and Z40 at 6 months postoperatively. The influence of 2 mm micro-incision SMILE on the posterior corneal surface was relatively slight compared with that for the 3-5 mm SMILE group.
