标题：SMILE与LASEK术治疗高度近视对患者视力恢复及并发症的影响

      作者：曹记红 1，蒋海翔 1，张丹 2    1.西安新城海翔眼科医院屈光中心，陕西 西安 710032；2.西安普瑞眼科医院屈光中心，陕西 西安 710000

      卷次： 2023年34卷1期

      【摘要】 目的 观察飞秒激光小切口角膜基质透镜取出术(SMILE)与准分子激光上皮瓣下角膜磨镶术(LASEK)对高度近视患者视力恢复、角膜生物力学及并发症的影响。方法 回顾性分析西安新城海翔眼科医院2019年1月至2020年12月101例(195眼)高度近视患者的临床资料，根据术式选择不同分为SMILE组53例(103眼)和LASEK组48例(92眼)。术后随访6个月，比较两组患者的裸眼视力、客观视觉质量[客观散射指数值(OSI)、调制传递函数截止频率(MTF cut-off值)、斯特列尔比值(SR)]恢复情况；比较两组患者术前、术后1月的角膜生物力学指标[角膜阻力因子(CRF)、角膜滞后量(CH)]，并统计两组患者的并发症发生情况。结果 术后1周、1个月、3个月和6个月，两组患者裸眼视力均较术前改善，且SMILE组患者术后1周、1个月的裸眼视力优于LASEK组同时间点，差异均有统计学意义(P<0.05)；术后 1周、1个月，两组患者的OSI均较术前升高，MTF cut-off值均较术前下降，且SMILE组患者的OSI明显低于LASEK组同时间点，差异均有统计学意义(P<0.05)，但术后3个月和6个月，两组患者的OSI、MTF cut-off值与术前比较及两组同时间点比较差异均无统计学意义(P>0.05)；两组患者术后各时间点的SR与术前比较以及两组同时间点SR比较差异均无统计学意义(P>0.05)；术后1个月，两组患者的CRF、CH均较术前下降，但SMILE组患者的下降幅度均小于LASEK组，差异均有统计学意义(P<0.05)；SMILE组患者术后干眼症发生率为3.77%，并发症总发生率为7.55%，明显低于LASEK组的16.67%、29.17%，差异均有统计学意义(P<0.05)。结论 SMILE与LASEK术均能有效矫正高度近视者视力，但相比之下，SMILE术更利于患者早期裸眼视力及视觉质量恢复，对角膜生物力学影响小，可减少术后并发症风险。
      【关键词】 高度近视；飞秒激光小切口角膜基质透镜取出术；准分子激光上皮瓣下角膜磨镶术；视力；并发症
      【中图分类号】 R778.1+1 【文献标识码】 A 【文章编号】 1003—6350（2023）01—0071—05

Effects of small incision lenticule extraction and laser epithelial keratomileusis on visual acuity recovery andcomplications in the treatment of patients with high myopia.
CAO Ji-hong 1, JIANG Hai-xiang 1, ZHANG Dan 2. 1.Refractive Center, Xi'an Xincheng Haixiang Ophthalmic Hospital, Xi'an 710032, Shaanxi, CHINA; 2.Refractive Center,Xi'an Purui Ophthalmic Hospital, Xi'an 710000, Shaanxi, CHINA
【Abstract】 Objective To observe the effects of femtosecond laser small incision lenticule extraction (SMILE)and laser epithelial keratomileusis (LASEK) on visual acuity recovery, corneal biomechanics, and complications in pa-tients with high myopia. Methods The clinical data of 101 patients (195 eyes) with high myopia in Xi’an XinchengHaixiang Ophthalmic Hospital between January 2019 and December 2020 were retrospectively analyzed. According todifferent surgical methods, the patients were divided into SMILE group (53 cases, 103 eyes) and LASEK group (48 cas-es, 92 eyes). At 6 months of follow-up after surgery, the recovery status of uncorrected visual acuity, objective visualquality [objective scattering index (OSI), modulation transfer function cut-off frequency (MTF cut-off value), Strehl ra-tio (SR)] were compared between the two groups. The corneal biomechanical indicators [corneal resistance factor (CRF),corneal hysteresis (CH)] of the two groups were compared before surgery and at 1 month after surgery, and the occur-rence of complications were statistically analyzed in both groups. Results At 1 week, 1 month, 3 months, and 6 monthsafter surgery, the uncorrected visual acuity in the two groups of patients was improved compared with that before sur-gery, and the uncorrected visual acuity in SMILE group was better than that in LASEK group at 1 week and 1 month af-ter surgery, with statistically significance differences (P<0.05). At 1 week and 1 month after surgery, the OSI in the twogroups of patients was higher than that before surgery, while the MTF cut-off value was lower than that before surgery,and the OSI in SMILE group was significantly lower than that in LASEK group at the same time point (P<0.05); howev-er, there were no significant differences in the OSI and MTF cut-off value in the two groups at 3 and 6 months after sur-gery compared with those before surgery, and also between the two groups (P>0.05). There was no significant signifi-cance in SR in the two groups at each time point after surgery compared with those before surgery, and also between thetwo groups (P>0.05). At 1 month after surgery, the CRF and CH in the two groups were lower than those before surgery,but the reductions in the SMILE group was smaller than that in the LASEK group, with statistically significance differ-ence (P<0.05). The incidence rate of postoperative xerophthalmia and total incidence rate of complications in SMILEgroup were 3.77% and 7.55% , which were significantly lower than 16.67% and 29.17% in LASEK group (P<0.05).