两例 SMILE 术中特殊情况更改 SBK 手术的疗效观察

目的：通过对同一患者双眼不同手术方式的自身对比，了解飞秒扫描后改SBK手术的疗效差异，为不同患者屈光手术方式的选择提供临床指导依据。方法回顾分析2例右眼行飞秒激光小切口透镜取出术（ SMILE），左眼SMILE术中负压环脱失和激光扫描不良透镜分离困难而改行机械刀制瓣准分子激光手术（ SBK）的患者，比较术后视力、等效球镜（ SE）、对比敏感度（ CSF）、波前像差（ HAOS）以及泪膜破裂时间（ BUT）、泪液分泌功能试验（ Schimer I）和SPEED、OSDI干眼症状问卷调查分析差异。结果（1）术后个月，均能达到最佳矫正视力（BSCVA），等效球镜均在±0．75 D以内，双眼比较无显著性差异。（2）CSF的比较，左右眼无显著性差异，略低于正常水平。（3）术后3个月，BUT和Schimer检查中，双眼无显著性差异。（4）HAOS比较中，总像差RMS和高阶像差这两项， SMILE眼低于SBK眼；球差（S）的比较，SMILE眼高于SBK眼。（5）SPEED和OSDI问卷评分双眼无显著差异。结论 SMILE失败眼改SBK后视觉质量与SMILE眼无显著差异，其视觉质量、疗效不受影响。

Observation of the curative effect of SBK operation in two cases of SMILE

Objective To compare two different corneal refractory surgical methods performed on same patients, and to understand the effects of modified SBK after SMILE failed.Methods This is a retrospective analysis of two cases in which femtosecond laser small incision lenticule extraction ( SMILE) was performed successfully in patients'right eyes, but was unsuccessful in patients'left eyes.Failure of SMILE in left eyes was due to negative pressure annular depigmentation and poor laser scanning results, so that it was difficult to separate lenses.The procedure was then changed to use mechani-cal knife flap excimer laser ( SBK) .Postoperative visual acuity, spherical equivalent ( equipotent spherical, Se) , contrast sensitivity (CSF), higher order aberrations (HAOS) and tear film break-up time (BUT), tear secretion function test ( SchimerI) , SPEED, OSDI dry eye symptom questionnaire were investigated to compare the visual quality and symptoms between right eye and left eye.Results (1) After the operation, best corrected visual acuity ( BCVA) was achieved in 1 moth, and the equivalent spherical mirror was within the range of +/-0.75 D in both eyes.There was no significant difference between the two eyes.(2) CSF was slightly lower in both eyes but there was no difference between the two eyes. (3)Tear film function tests, including Schimer I and BUT, showed no significant difference between the two eyes.(4)To-tal aberration RMS and higher-order aberrations were higher in left eyes in which surgical procedure changed to SBK after failed SMILE; while the right eyes showed higher spherical aberrations than left eyes.( 5 ) There was no difference in SPEED and OSDI.Conclusion There is no significant difference in visual quality and symptoms between right eyes that received successful SMILE and left eyes in which initial SMILE procedures failed and SBK was done.