角膜标记法飞秒激光小切口角膜基质透镜取出术对角膜像差的影响

目的　观察角膜标记法飞秒激光小切口角膜基质透镜取出术（SMILE）后，角膜像差的差异及其相关影响因素。方法　随机对照研究。选取2020年1月至6月在抚顺市眼病医院激光近视眼治疗中心接受SMILE的患者49例（98眼）纳入研究，随机分为标记组和对照组；按照术前屈光状态柱镜度不同将标记组患者分为2组:低散光组（柱镜度为-0.75～-1.50 D）和高散光组（柱镜度＞-1.50 D）。标记组患者术前使用医用记号笔在角膜3点和9点钟位近角膜缘处标记水平轴。分别对比分析各组术前及术后5 mm瞳孔直径下角膜光学区域的总角膜像差、总高阶像差、散光、彗差、三叶草差、球面像差及视力。结果　术后1个月、3个月标记组与对照组相比，裸眼视力（UCVA）差异均无统计学意义（均为P>0.05），总角膜像差、总高阶像差、散光、彗差、三叶草差及球面像差两组间差异均有统计学意义（均为P=0.000）。术后1个月、3个月高散光组与低散光组相比，总角膜像差、总高阶像差、彗差、三叶草差及球面像差差异均无统计学意义（均为P>0.05）。结论　角膜标记法SMILE术后患眼角膜像差较未进行标记者降低，可获得更佳的视觉质量。

Corneal aberrations after SMILE by the cornea-marking methods

Objective　To observe the difference in corneal aberrations between cornea-marking or not after femtosecond laser small incision lenticule extraction (SMILE) surgery and its related influencing factors.Methods　This was a randomized controlled study. Ninety-eight eyes of 49 patients of myopia undergoing SMILE were collected in this study from Jan. 2020 to Jun. 2020 in Laser Myopia Treatment Center of Fushun Ophthalmic Hospital. The patients were randomly divided into marker group and control group. Based on the difference of preoperative cylinder power, the patients of marker group were divided into two groups:the low cylinder group (the cylinder power was from -0.75 D to -1.50 D) and the high cylinder group (the cylinder power was above -1.50 D). Before the operation, the horizontal axis of the cornea at 3 o’clock and 9 o’clock near the limbus was marked with a medical marker. Total corneal aberration, higher-order aberration, astigmatism, coma, trefoil aberration and spherical aberration of corneal optical area in 5 mm pupil diameter and visual acuity were calculated before and after operation.Results　There was no significant difference in uncorrected visual acuity (UCVA) between the marker group and the control group at 1 month and 3 months after surgery (all P>0.05). The differences in total corneal aberration, higher-order aberration, astigmatism, coma, trefoil aberration and spherical aberration were statistically significant between the marker group and the control group at 1 month and 3 months after surgery (all P=0.000). There was no significant difference in total corneal aberration, higher-order aberration, coma, trefoil aberration and spherical aberration between the high cylinder group and the low cylinder group at 1 month and 3 months after surgery (all P>0.05).Conclusion　Patients will achieve lower aberration and better visual quality after SMILE with cornea marking than with no corneal marking.