SMILE3.0角膜帽厚度对视敏度和角膜生物力学影响的研究作者：刘莛 白继等 作者单位：第三军医大学附属大坪医院 发表杂志：J Ophthalmol 背景 理论上，较深的角膜帽厚度可以维持更多的前周基质和角膜神经纤维，使角膜硬度增强，眼表功能恢复更快。然而，针对SMILE3.0角膜帽厚度对于视觉质量和角膜生物力学的研究尚未明确。本随机对照研究系统评价了SMILE3.0两种不同厚度角膜帽矫正近视的效果，为SMILE3.0角膜帽厚度的选择提供临床依据。 摘要 评价SMILE3.0角膜帽厚度对于视敏度和角膜生物力学影响的效果。 本前瞻性对照研究共纳入20位（40眼）行SMILE3.0矫正近视的患者。纳入患者中央角膜厚度在510至560 μm之间，术前等效球镜度在-3.00 D至-8.00 D之间。随机选取患者一眼，将角膜帽厚度设置为110 μm，另一眼角膜帽厚度为150 μm。所有患者术前记录最佳矫正视力和裸眼视力；于术后2小时、4小时及24小时检查其屈光状态、对比敏感度和客观视觉质量；于术后3个月时检查并评价校正后眼压、高阶像差和角膜结构形态学改变。 与150 μm组相比, 110 μm角膜帽厚度组OBL的发生率明显升高 (P0.004), 但2小时和24小时的裸眼视力、斯特列尔比(SR)、目标散射指数(OSI)、调制传递函数(MTF)截止频率、明暗对比敏感度和介质空间频率均明显更优 (P < 0.05)。术后3个月，110="" μm组角膜球差和矫正iop都显著的高于150="" μm组="" (p=""><> SMILE3.0角膜帽厚度110 μm和150 μm组矫正近视均安全有效。与150 μm组相比，110 μm角膜帽组术中产生更多的OBL，但术后视觉质量更好。而150 μm组术后3个月时，术后产生球差更少且矫正眼压较低。  Corneal Cap Thickness and Its Effect on Visual Acuity and Corneal Biomechanics in Eyes Undergoing Small Incision Lenticule Extraction Abstract To evaluate the effect of corneal cap thickness on visual acuity and corneal biomechanics in small incision lenticule extraction (SMILE) for the treatment of myopia. Forty eyes of 20 patients undergoing SMILE for the treatment of myopia were enrolled in this prospective controlled study. The patients with 510 μm–560 μm central corneal thickness (CCT) and a refractive spherical equivalent of −3.00D to −8.00D were included. It was designed randomly to undergo SMILE with a 110 μm cap thickness in one eye and 150 μm cap thickness in the other. Ophthalmic examinations included best-corrected and uncorrected visual acuity (UCVA); refractive status, contrast sensitivity, and objective visual quality were evaluated at 2 h, 4 h, and 24 h postoperatively; while at 3 months after theprocedure, corrected intraocular pressure (IOP), higher order aberrations (HOAs), and morphologic modifications of corneal architecture of both eyes were assessed. Compared with the 150 μm group, the incidence of OBL was significantly higher in the 110 μm cap thickness group (P < 0.004),="" and="" ucva,="" strehl="" ratio="">objective scatter index (OSI), modulation transfer function (MTF) cut off frequency, and photopic and scotopic contrast sensitivity at medium spatial frequency were all significantly better in 110 μm group at 2 h and 24 h postoperatively (P < 0.05).="" corneal="" spherical="" aberration="" and="" corrected="" iop="" by="" corvis="" st="" were="" significantly="" higher="" in="" the="" 110="" μm="" group="" at="" 3="" months="" postoperatively="" (p="">< 0.05).="" no="" statistically="" significant="" differences="" were="" found="" in="" manifest="" refraction,="" ucva,="" sr,="" osi,="" mtfcutoff,="" and="" mesopic="" and="" photopic="" contrast="" sensitivity="" at="" low="" frequency,="" photopic="" contrast="" sensitivity="" at="" high="" frequency,="" endothelial="" density,="" corneal="" coma,="" and="" total="" hoas="" at="" 3="" months="" after="" the="" procedure.="" no="" visual="" decline="" was="" found="" in="" the="" patients="" in="" this=""> Both 110 μm and 150 μm cap thickness in SMILE were safe and effective for treatment of myopia. A 110μm cap thickness demonstrated better visual outcomes during early and late postoperative periods with higher corneal spherical aberration and corrected IOP at 3 months postoperatively. 通讯作者简介 |
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