山东大学耳鼻喉眼学报 ›› 2023, Vol. 37 ›› Issue (1): 85-93.doi: 10.6040/j.issn.1673-3770.0.2021.465

• 论著 • 上一篇    

Trans-PRK、FS-LASIK和SMILE矫正近视散光的对比观察

周其亮1,周跃华1,2,周春阳1,于嘉1,李辰1   

  1. 1.成都中医药大学 眼科学院, 四川 成都 610075;
    2.北京茗视光眼科, 北京 100191
  • 发布日期:2023-02-06
  • 通讯作者: 周跃华. E-mail:yh0220@yahoo.com

Comparative observation of Trans-PRK, FS-LASIK, and SMILE for myopia with astigmatism

ZHOU Qiliang1, ZHOU Yuehua1,2, ZHOU Chunyang1, YU Jia1, LI Chen1   

  1. 1. The Academy of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, Sichuan, China;
    2. Ophthalmology Beijing Ming Vision, Beijing 100062, China
  • Published:2023-02-06

摘要: 目的 探讨Trans-PRK、FS-LASIK和SMILE矫正近视散光的临床效果。 方法 选择Trans-PRK组54眼、FS-LASIK 组55眼和SMILE组 56眼进行回顾性病例研究,随访6个月,比较三组的术前术后各个时间点的视力、屈光度、高阶像差,评估三种不同术式的安全性、有效性。 结果 (1)三组术前基线数据差异无统计学意义(P=0.148, 0.148, 0.31, 0.285, 0.283, 0.901);(2)术后1、3、6个月三组之间的UCVA差异无统计学意义(P=0.902),组内比较时Trans-PRK组术后6个月视力高于术后1个月差异具有统计学意义(χ2=0.571,P=0.014);(3)三组间只有在术后1个月柱镜度数差异具有统计学意义(χ2=9.411,P=0.009),两两比较时FS-LASIK组柱镜度数小于SMILE组差异具有统计学意义(χ2=24.400,P=0.004),在术后3、6个月三组之间的柱镜度数差异无统计学意义(P=0.159, 0.106);(4)术后1、3、6个月三组之间的SE差异无统计学意义(P=0.132, 0.299, 0.643);(5)术后1、3、6个月三组间彗差差异具有统计学意义(χ2 =20.939,20.129,19.208,P均<0.001),Trans-PRK组小于FS-LASIK组及SMILE组差异具有统计学意义(P=0.008, 0.019, 0.034,<0.001,<0.001, <0.001),组内比较Trans-PRK组及FS-LASIK组术后3、6个月彗差高于术前差异具有统计学意义(P=0.003,<0.001),SMILE组术后1、3、6个月彗差高于术前差异具有统计学意义(P均<0.001);(6)术后1、3、6个月三组间球差差异具有统计学意义(χ2=47.363,24.167, 22.913, P均<0.001),FS-LAISK组在术后的1、3、6个月球差均高于Trans-PRK组与SMILE组差异具有统计学意义(P<0.001,<0.001,0.005,<0.001,0.007,<0.001),组内比较时Trans-PRK、组与FS-LASIK组术后1、3、6个月球差高于术前差异具有统计学意义(P均<0.001),SMILE组术后3、6个月球差高于术前差异具有统计学意义(χ2=-1.726,-1.858,P均<0.001),SMILE组术后1月球差低于术后3、6个月差异具有统计学意义(χ2=-1.085,-1.217,P均<0.001);(7)三组患者在术后1、3、6个月的高阶像差差异有统计学意义(χ2=14.267,25.460,13.210, P=0.001,<0.001,0.001),术后1、3、6个月Trans-PRK组总高阶像差低于FS-LASIK组差异具有统计学意义(P=0.004, <0.001,0.001),术后3个月FS-LASIK组总高阶像差大于SMILE组差异具有统计学意义(P=0.009),组内比较时,三组在术后1、3、6个月的总高阶像差高于术前有统计学意义(P均<0.001);(8)三组术后6个月有效性及安全性差异无统计学意义(χ2=0.851,0.893, P=0.653,0.640)。 结论 Trans-PRK、常规FS-LASIK、SMILE矫正近视散光都具有很好的安全性、有效性,术后均不同程度地引入了高阶像差,Trans-PRK组术后彗差小于常规FS-LASIK组及SMILE组,常规FS-LAIK组的球差明显高于Trans-PRK组与SMILE组,行常规FS-LAIK组的总高阶像差明显高于Trans-PRK组。

关键词: Trans-PRK手术, FS-LASIK手术, SMILE手术, 屈光度, 高阶像差

Abstract: Objective This paper was aimed to investigate the clinical effect of Trans-PRK, conventional FS-LASIK, and SMILE for the correction of myopia and astigmatism. Methods In this retrospective study, we evaluated 54 eyes in the Trans-PRK group, 55 eyes in the FS-LASIK group, and 56 eyes in the SMILE group. ALL eyes follow-up period was 6 months. The visual acuity, diopters, and higher-order aberrations of the three groups were compared before and after surgery, and the safety and effectiveness of the three different methods were evaluated. Results (1)There was no significant difference in the preoperative baseline data among the three groups(P=0.148, 0.148, 0.31, 0.285, 0.283, 0.901). (2)There was also no significant difference in uncorrected visual acuity among the three groups at 1, 3, and 6 months after surgery(P=0.902). In the intra-group comparison, the UCVA at 6 months after surgery in the Trans-PRK group was higher than that at 1 month after surgery(χ2= 0.571, P=0.014). (3)The power of the cylinder among the three groups differed only at 1 month after the operation(χ2= 9.411, P=0.009). The degree of the cylinder in the FS-LASIK group was statistically significantly less than that in the SMILE group at 1-month post-operatively(χ2=24.400, P=0.004), while there was no significant difference among the three groups at 3 and 6 months after surgery(P=0.159, 0.106). (4)There was no significant difference in spherical equivalent among the three groups at 1, 3, and 6 months after the operation(P=0.132, 0.299, 0.643). (5)There was a significant difference in coma among the three groups at 1, 3, and 6 months post-operatively(χ2=20.939, 20.129, 19.208, all P<0.001), and the coma of the Trans-PRK group being statistically significantly less than that of the other two groups(P=0.008, 0.019, 0.034, <0.001, <0.001, <0.001). In the intra-group comparison, the coma of the Trans-PRK and FS-LASIK groups at 3 and 6 months after surgery were significantly higher than that before surgery(P=0.003, <0.001). The coma of the SMILE group at 1, 3, and 6 months postoperatively was significantly higher than that before surgery(all P<0.001). (6)There was a significant difference in spherical aberration difference among the three groups at 1, 3, and 6 months after surgery(χ2=47.363, 24.167, 22.913, all P<0.001). The spherical aberration at 1, 3, and 6 months after surgery was higher in the FS-LASIK group than in the Trans-PRK and SMILE groups(P<0.001, <0.001, 0.005, <0.001, 0.007, <0.001). In the intra-group comparison, the spherical aberration of the Trans-PRK group and FS-LASIK group at 1, 3, and 6 months after surgery was higher than that before surgery(all P<0.001). The spherical aberrations in smile group were higher than those before operation at 3 and 6 months after operation, and the difference was statistically significant(χ2=-1.726,-1.858, all P<0.001). The spherical aberration in the SMILE group was statistically significantly lower than that at 3 and 6 months after the operation, and the difference was statistically significant(χ2=-1.085,-1.217, all P<0.001). (7)There was a significant difference in higher-order aberrations among the three groups at 1, 3, and 6 months after surgery(χ2=14.267, 25.460, 13.210, and P=0.001, <0.001, 0.001, respectively). The total number of higher-order aberrations in the Trans-PRK group was lower than those in the FS-LASIK group at 1, 3, and 6 months after the operation(P=0.004, <0.001, 0.001). The total number of higher-order aberrations in the FS-LASIK group was greater than that in the SMILE group at 3 months post-operatively(P=0.009). The total number of higher-order aberrations in the SMILE group at 6 months was significantly higher than those before surgery(all P<0.001). (8)There was no significant difference in efficacy and safety among the three groups at 6 months after surgery(χ2=0.851, 0.893, and P=0.653, 0.640, respectively). Conclusion Trans-PRK, conventional FS-LASIK, and SMILE are safe and effective in correcting myopia astigmatism. Higher-order aberrations were introduced to varying degrees postoperatively. The coma in the Trans-PRK group was smaller than that in the conventional FS-LASIK and SMILE groups. The spherical aberration of the conventional FS-LASIK group was significantly higher than those of the Trans-PRK and SMILE groups. The total number of higher-order aberrations of the conventional FS-LASIK group was significantly higher than that in the Trans-PRK and SMILE groups.

Key words: Trans-PRK, FS-LASIK, SMILE, Diopter, Higher-order aberrations

中图分类号: 

  • R771
[1] 靳琳,张铎龄,于春晶,等. 中低度近视眼Trans-PRK术中使用丝裂霉素C对术后haze影响的研究[J]. 中华眼科杂志,2022,58(2):130-136. doi:10.3760/cma.j.cn112142-20210320-00139 Jin Lin, Zhang duoling, Yu Chunjing, et al. Efficacy of mitomycin C 0.02% for prevention of haze after transepithelial photorefractive keratectomy for mild and moderate myopia [J] Chinese Journal of Ophthalmology, 2022, 58(2): 130-136. doi:10.3760/cma. j.cn112142-20210320-00139
[2] 靳琳,张铎龄,于春晶,等. 高度近视行Trans-PRK术中联合MMC对术后haze的影响[J]. 国际眼科杂志, 2021,21(8):1490-1493. doi:10.3980/j.issn.1672-5123.2021.8.37 Jin Lin, Zhang duoling, Yu Chunjing, et al. Effect of intraoperative Trans-PRK combined with MMC on postoperative haze in the treatment of high myopia [J] International Journal of Ophthalmology, 2021, 21(8): 1490-1493. doi:10.3980/j.issn. 1672-5123.2021.8.37
[3] Naderi M, Jadidi K, Mosavi SA, et al. Transepithelial photorefractive keratectomy for low to moderate myopia in comparison with conventional photorefractive keratectomy[J]. Journal of Ophthalmic & Vision Research, 2016, 11(4):358-362
[4] 周跃华. 重视准分子激光角膜屈光手术方式的精准个性化选择[J]. 中华实验眼科杂志, 2019, 37(7): 497-500. doi:10.3760/cma.j.issn.2095-0160.2019.07.001 Zhou Yuehua. Importance of the precise and personalized selection of laser corneal refractive surgery[J] Chinese Journal of Experimental Ophthalmology, 2019, 37(7): 497-500. doi:10.3760/cma. j.issn. 2095-0160.2019.07.001
[5] Zheng Y, Zhou YH, Zhang J, et al. Comparison of Visual Outcomes After Femtosecond LASIK, Wave Front-Guided Femtosecond LASIK, and Femtosecond Lenticule Extraction[J]. Cornea, 2016, 35(8):1057.
[6] Kuryan J, Cheema A, Chuck RS. Laser-assisted subepithelial keratectomy(LASEK)versus laser-assisted in situ keratomileusis(LASIK)for correcting myopia[J]. Cochrane Database Syst Rev, 2017, 2(2): CD011080. doi:10.1002/14651858
[7] 易允娣, 王静, 陶黎明. SMART与TransPRK术后早期疗效的比较[J]. 国际眼科杂志, 2019, 19(5): 870-873. doi:10.3980/j.issn.1672-5123.2019.5.40 YI Yundi, WANG Jing, TAO Liming. Comparison of early postoperative effects between SMART and TransPRK[J]. International Eye Science, 2019, 19(5): 870-873. doi:10.3980/j.issn.1672-5123.2019.5.40
[8] 杜玉芹, 周春阳, 文龙, 等. 智能脉冲技术辅助的经上皮准分子激光角膜切削术(Trans-PRK)矫正中低度近视[J]. 眼科新进展, 2019, 39(10): 973-975, 979. doi:10.13389/j.cnki.rao.2019.0222 DU Yuqin, ZHOU Chunyang, WEN Long, et al. Smart pulse technology-assisted transepithelial photorefractive keratectomy(Trans-PRK)for the correction of moderate to low myopia[J]. Recent Advances in Ophthalmology, 2019, 39(10): 973-975, 979. doi:10.13389/j.cnki.rao.2019.0222
[9] 王宁宁, 卢成戎, 樊郑军. 智能脉冲技术辅助TPRK术的临床疗效[J]. 国际眼科杂志, 2019, 19(6): 1079-1081. doi:10.3980/j.issn.1672-5123.2019.6.43 WANG Ningning, LU Chengrong, FAN Zhengjun. Clinical efficacy of TPRK assisted by smart pulse technology[J]. International Eye Science, 2019, 19(6): 1079-1081. doi:10.3980/j.issn.1672-5123.2019.6.43
[10] 赵博, 卫晶仙, 付明山. 智能脉冲技术辅助的TransPRK手术矫正中高度散光[J]. 中华眼视光学与视觉科学杂志, 2019, 21(10): 727-733. doi:10.3760/cma.j.issn.1674-845X.2019.10.002 ZHAO Bo, WEI Jingxian, FU Mingshan. Clinical outcomes of smart pulse technology assisted TransPRK to treat moderate to high astigmatism[J]. Chinese Journal of Optometry Ophthalmology and Visual Science, 2019, 21(10): 727-733. doi:10.3760/cma.j.issn.1674-845X.2019.10.002
[11] Lin DTC, Holland SP, Verma S, et al. Postoperative corneal asphericity in low, moderate, and high myopic eyes after transepithelial PRK using a new pulse allocation[J]. J Refract Surg, 2017, 33(12): 820-826. doi:10.3928/1081597X-20170920-02
[12] 苏小连, 王雁, 吴文静, 等. SMILE和飞秒激光制瓣的LASIK术后角膜前表面非球面性的对比研究[J]. 中华眼科杂志, 2016, 52(9): 681-685. doi:10.3760/cma.j.issn.0412-4081.2016.09.009 SU Xiaolian, WANG Yan, WU Wenjing, et al. Comparison of the anterior corneal asphericity after small incision lenticule extraction and;femtosecond laser in situ keratomileusis[J]. Chinese Journal of Ophthalmology, 2016, 52(9): 681-685. doi:10.3760/cma.j.issn.0412-4081.2016.09.009
[13] Zhang JF, Feng QQ, Ding WZ, et al. Comparison of clinical results between trans-PRK and femtosecond LASIK for correction of high myopia[J]. BMC Ophthalmol, 2020, 20(1): 243. doi:10.1186/s12886-020-01515-9
[14] 杜玉芹, 周春阳, 周跃华, 等. 智能脉冲技术的TransPRK与SMILE矫正近视的疗效比较[J]. 中华实验眼科杂志, 2020, 38(6): 489-493. doi:10.3760/cma.j.cn115989-20200327-00216 DU Yuqin, ZHOU Chunyang, ZHOU Yuehua, et al. Comparison of clinical effects between TransPRK with intelligent pulse technology and SMILE for myopia[J]. Chinese Journal of Experimental Ophthalmology, 2020, 38(6): 489-493. doi:10.3760/cma.j.cn115989-20200327-00216
[15] Hansen RS, Lyhne N, Grauslund J, et al. Four-year to seven-year outcomes of advanced surface ablation with excimer laser for high myopia[J]. Graefes Arch Clin Exp Ophthalmol, 2015, 253(7): 1027-1033. doi:10.1007/s00417-014-2920-z
[16] Aslanides IM, Kymionis GD. Trans advanced surface laser ablation(TransPRK)outcomes using SmartPulseTechnology[J]. Cont Lens Anterior Eye, 2017, 40(1): 42-46. doi:10.1016/j.clae.2016.11.004
[17] 郑燕, 周跃华, 张晶, 等. FS-LASIK、WF-LASIK与SMILE术后视觉质量比较的研究[J]. 中华眼科杂志, 2020, 56(2): 118-125. doi:10.3760/cma.j.issn.0412-4081.2020.02.004 ZHENG Yan, ZHOU Yuehua, ZHANG Jing, et al. Comparison of the visual quality at 1 year following femtosecond laser-assisted LASIK, wavefront-guided femtosecond LASIK and small incision lenticule extraction for myopia and astigmatism[J]. Chinese Journal of Ophthalmology, 2020, 56(2): 118-125. doi:10.3760/cma.j.issn.0412-4081.2020.02.004
[18] Wang JJ, Lopes BT, Li HC, et al. Unintended changes in ocular biometric parameters during a 6-month follow-up period after FS-LASIK and SMILE[J]. Eye Vis(Lond), 2021, 8(1): 9. doi:10.1186/s40662-021-00232-8
[19] Liu T, Lu GT, Chen KJ, et al. Visual and optical quality outcomes of SMILE and FS-LASIK for myopia in the very early phase after surgery[J]. BMC Ophthalmol, 2019, 19(1): 88. doi:10.1186/s12886-019-1096-z
[20] 黄丹, 张瑜, 李伟, 等. 角膜地形图引导的FS-LASIK对近视眼患者术后视觉质量的影响[J]. 航空航天医学杂志, 2021, 32(1): 10-11. doi: 10.3969/j.issn.2095-1434.2021.01.006 HUANG Dan, ZHANG Yu, LI Wei, et al. The effect of corneal topography guided FS-LASIK on postoperative visual quality of myopic patients[J]. Journal of Aerospace Medicine, 2021, 32(1): 10-11. doi: 10.3969/j.issn.2095-1434.2021.01.006
[21] Liu CL, Wang Z, Wu D, et al. Comparison of 1-year outcomes between small incision lenticule extraction with prophylactic cross-linking and femtosecond laser-assisted in situ keratomileusis with prophylactic cross-linking[J]. Cornea, 2021, 40(1): 12-18. doi:10.1097/ICO.0000000000002547
[22] 陶冶, 周跃华, 李福生,等. FS-LASIK与SMILE术后角膜上皮重塑的比较[J]. 山东大学耳鼻喉眼学报, 2020, 34(2): 61-66. doi: 10.6040/j.issn.1673-3770.1.2020.003 TAO Ye, ZHOU Yuehua, LI Fusheng, et al. Comparison of corneal epithelial remodeling after FS-LASIK and SMILE treatment for myopia and astigmatism[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(2): 61-66. doi: 10.6040/j.issn.1673-3770.1.2020.003
[23] 黄青, 夏丽坤. SMILE与FS-LASIK矫正近视术后优势与不足的研究[J]. 国际眼科杂志, 2018, 18(2): 275-278. doi:10.3980/j.issn.1672-5123.2018.2.17 HUANG Qing, XIA Likun. Research advances on the advantages and disadvantages of SMILE and FS-LASIK on correction of myopia[J]. International Eye Science, 2018, 18(2): 275-278. doi:10.3980/j.issn.1672-5123.2018.2.17
[24] 中华医学会眼科学分会眼视光学组.我国角膜地形图引导个性化激光角膜屈光手术专家共识(2018年)[J]. 中华眼科杂志, 2018, 54(1):23-26. doi: 10.3760/cma.j.issn.0412-4081.2018.01.00
[1] 黄子彦综述 段国平审校. 高阶像差对白内障人工晶状体植入术后视觉质量的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(6): 13-18.
[2] 孙璐,张顺华,吴昱舟,陈露璐,曹迪,干霖洋. 关于Alpha角0.5~0.8 mm的患者植入区域折射型人工晶状体的短期临床观察[J]. 山东大学耳鼻喉眼学报, 2022, 36(6): 32-37.
[3] 代诚李宾中. 多焦点软性角膜接触镜应用研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 100-105.
[4] 彭娇,钟定娟,陈蛟,左筠,王华. 光学区直径与暗瞳直径的关系对不同程度近视患者SMILE术后视觉质量的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(2): 100-107.
[5] 梁刚,马蓉,张丰菊. SMILE术中角膜帽下地塞米松平衡液冲洗与否的早期临床观察[J]. 山东大学耳鼻喉眼学报, 2020, 34(2): 22-31.
[6] 田靖,廖萱,兰长骏,谭青青,林佳,文佰伟. 不同球差非球面人工晶状体眼高阶像差比较[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 13-17.
[7] 刘文静. TransPRK与LASEK对薄角膜近视眼术后视力、屈光度及角膜生物力学性能的影响[J]. 山东大学耳鼻喉眼学报, 2016, 30(6): 70-74.
[8] 严涛, 栾国刚, 谌金金, 陈雯. 角膜塑形镜矫正近视对青少年眼屈光系统及眼压的影响[J]. 山东大学耳鼻喉眼学报, 2015, 29(1): 69-71.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!