飞秒激光小切口角膜基质透镜取出术与经上皮准分子激光角膜切削术矫治中低度近视术后患者功能性光学区的对比研究

目的　探讨飞秒激光小切口角膜基质透镜取出术（small incision lenticule extraction，SMILE）与经上皮准分子激光角膜切削术（transepithelial photorefractive keratectomy，TransPRK）矫治近视术后功能性光学区的大小并分析可能的影响因素。方法　收集2017年11月至2018年2月在我院接受角膜屈光手术的近视及近视散光患者102 例，均纳入右眼进行分析。其中SMILE组62例62眼，TransPRK组40例40眼，分别于术前及术后3个月应用Pentacam三维眼前节分析系统测量功能性光学区的大小，对比分析两组术后功能性光学区的变化特点及可能的影响因素。结果　SMILE组及TransPRK组术前功能性光学区分别为（7.18±1.00）mm和（7.33±0.81）mm，术后3个月两组分别为（6.00±0.78）mm及（5.77±0.82）mm，与术前相比均显著缩小（均为P=0.000），其中SMILE组较术前缩小（1.18±1.00）mm，TransPRK组缩小（1.56±1.02）mm。SMILE组术后功能性光学区较TransPRK组大，差异有统计学意义（P=0.038）。两组术后功能性光学区的缩小与术前等效球镜度数均呈显著负相关（均为P＜0.05），与角膜曲率变化量、球差变化量及Q值变化量均呈显著正相关（均为P＜0.01）。结论　SMILE与TransPRK术后功能性光学区均显著缩小，在相同手术光学区设计的情况下，SMILE较TransPRK术后获得了更大的功能性光学区。

Comparison of the functional optical zone after small incision lenticule extraction and transepithelial photorefractive keratectomy for moderate and low myopia

Objective　To compare the functional optical zone (FOZ) after small incision lenticule extraction (SMILE) and transepithelial photorefractive keratectomy (TransPRK).Methods　One hundred and two patients (102 right eyes) who underwent SMILE and TransPRK were included，including 62 patients (62 right eyes) who had undergone SMILE and 40 patients (40 right eyes) who had undergone TransPRK.Only right eye from each patient was analyzed.FOZ was measured using Scheimpflug tomography system preoperatively and at 3 months postoperatively.Correlations between FOZ changes and the relevant parameters were analyzed after surgery.Results　The mean FOZs before and 3 months after surgery were (7.18±1.00)mm，(6.00±0.78)mm in the SMILE group and (7.33±0.81)mm，(5.77±0.82)mm in the TransPRK group，respectively.In both groups，FOZ after surgery was smaller than before surgery (both P=0.000).The magnitude of decreases in FOZ was significantly smaller in the SMILE group ［(1.18±1.00)mm］ than in the TransPRK group ［(1.56±1.02)mm］ after surgery (P=0.020).The decrease in FOZ after operation was negatively related with preoperarive spherical equivalent in both groups (both P<0.05) and significantly positively correlated with changes in K value，spherical aberration and Q value (all P<0.01).Conclusion　Both SMILE and TransPRK results in FOZ reduction during correction of moderate and low myopia.However，more FOZ can be achieved after SMILE than after TransPRK.