SMILE手术前后全眼高阶像差与角膜生物力学变化

目的：探讨飞秒激光小切口角膜基质透镜取出术（SMILE）前后全眼高阶像差和角膜生物力学参数 的变化，并分析角膜生物力学对全眼高阶像差的影响。方法：前瞻性临床研究。选择2019年3月 至2020年3月在西安爱尔眼科医院行SMILE的屈光不正患者160例，术后随访6个月。手术前、后 使用iTrace视觉功能分析仪测量角膜及全眼球差、彗差、三叶草、总高阶像差（HOA）；使用Corvis-ST 生物力学分析仪测量角膜硬度参数（SP-A1）和最大形变幅度（DA）。采用配对t检验、单因素方差 分析、Pearson线性相关分析等对高阶像差变化量（角膜ΔHOA、全眼ΔHOA）及生物力学改变 量（ΔSP-A1、ΔDA）进行分析。结果：SMILE术后6个月，150例（295眼）（随访率为94%）角膜HOA 为（0.37±0.01）μm，全眼HOA为（0.24±0.01）μm，角膜HOA较术前增加15.63%，全眼HOA较术 前减少35.14%，角膜HOA、全眼HOA的手术前后差异均有统计学意义（t=3.76，P=0.002；t=10.04， P=0.001）；SP-A1为（77.29±11.86）mmHg/mm，较术前下降29.6%，DA为（1.19±0.68）mm，较术 前增加10.4%，手术前、后SP-A1、DA差异均有统计学意义（t=32.98、20.62，P<0.001）。ΔSP-A1、 ΔDA与全眼ΔHOA均呈正相关（r=0.19，P<0.001；r=0.17，P=0.002）。结论：SMILE术后6个月的全 眼HOA减小，角膜生物力学改变与全眼HOA的变化具有相关性。

Change of Total Ocular High Order Aberrations and Corneal Biomechanical Effects by Small Incision Lenticule Extraction

Objective: To investigate the change of high order aberration of total eye and corneal biomechanics in patients undergoing small incision lenticule extraction (SMILE) and to examine the higher order aberrations(HOA) in relation to corneal biomechanical changes. Methods: Prospective clinical study. A total of 160 patients underwent SMILE in Xi 'an Aier Eye Hospital were selected from March 2019 to March 2020. The cornea and total spherical aberration, coma, trefoil and total HOA were measured by iTrace. Corvis-ST was used to measure the corneal stiffness parameters at the first applanation (SP-A1) and deformation amplitude (DA). Paired t-test, One-way ANOVA and Pearson correlation analysis were used for changes of HOA (Corneal ΔHOA, Total ocular ΔHOA) and corneal biomechanical parameters (ΔSP-A1,ΔDA). Results: Six months later, 150 patients (295 eyes) were in follow-up team (follow-up rate, 94%) and the corneal HOA was 0.37±0.01 μm and the total ocular HOA was 0.24±0.01 μm. The corneal HOA was increased by 15.63% and the total ocular HOA was decreased by 35.14% with statistically significant differences (t=3.76, P=0.002; t=10.04, P=0.001). SP-A1 (77.29±11.86)mmHg/mm was decreased by 29.6% and DA (1.19±0.68) mm was increased by 10.4% with statistically significant differences (t=32.98,20.62, P<0.001). ΔSP-A1, ΔDA and total ocular ΔHOA were significantly correlated (r=0.19, P<0.001; r=0.17, P=0.002). Conclusions: The total ocular HOA decreased after SMILE and the alterations in corneal morphology caused by biomechanics may affect HOA.