【摘要】 目的 分析飞秒制瓣SBK（FS-SBK）、SBK和SMILE 3种术式矫正近视后的眩光指数和视觉质量参数的变化，评估3种手术在不同屈光度范围内对视觉质量的影响。方法 前瞻性病例对照研究。收集2013年8-10月行近视矫正手术的122例（122眼），根据患者选择的手术方式分别行FS-SBK（26例）、SBK（48例）和SMILE（48例）手术，并根据屈光度分为高、中、低度近视组。使用OQAS视觉质量分析系统、采集手术前和术后1 d、1周、1个月时复查的眩光指数（OSI）和调制传递函数截止频率（MTF cut-off），采用方差分析评价在不同屈光度组施行不同手术方式对OSI和MTF cut-off值变化的影响。结果 手术方式对术后视觉质量的影响：①视力：术后视力较术前明显提高，3种手术在各时间点组间比较差异均无统计学意义。②OSI值：SBK和FS-SBK组手术前后差异均无统计学意义。SMILE低度组术后OSI与术前比较，差异无统计学意义，中、高度组术后OSI升高，术后与术前比较，差异有统计学意义（F=8.316、8.789，P<0.01）。③MTF cut-off值：FS-SBK组手术前后差异无统计学意义。SBK组和SMILE组中度近视术后1周与术前、术后1个月差异有统计学意义（F=4.469，P<0.05）。屈光度对术后视觉质量的影响：高、中、低度近视组内，术前和术后各时间点3种手术方式之间差异无统计学意义。结论 3种屈光手术术后视力明显提高，术式对术后视力影响不显著。中、高度近视SMILE术后眩光指数升高，因此准分子激光切削对减少眩光比SMILE有优势。视觉质量参数MTF cut-off在FS-SBK手术前后变化不显著，而SBK和SMILE术后较术前有下降，在1周时明显，到1个月时上升，且基本接近术前水平，这种优势在中度近视较突出。
【关键词】 飞秒激光； 飞秒激光小切口基质透镜取出术； 角膜磨镶术，前弹力层下； 眩光指数； 调制传递函数截止频率； 视觉质量
DOI：10.3760/cma.j.issn.1674-845X.2014.07.009
作者单位：610041 成都，四川医院眼科
通信作者：邓应平，Email：dyp558@163.com
Comparative study of scatter-related visual quality after FS-SBK， SBK and SMILE refractive surgeries Tang Jing， Qiu Lemei， Zhang Xiaolan， Sun Chengshu， Wang Shunqing， Deng Yingping. Department of Ophthalmology， West China Hospital of Sichuan University， Chengdu 610041， China
Corresponding author：Deng Yingping，Email：dyp558@163.com
【Abstract】 Objective To investigate the influence of FS-SBK， SBK， and SMILE refractive surgeries on visual quality by analyzing variations in the glare index and the visual quality parameters of distinct refractive errors. Methods In this prosective cases control study， 122 patients， who underwent SBK， FS-SBK or SMILE surgery， were enrolled from August to October 2013 and divided into high， moderate and low myopia groups. The glare index （opposite sector index， OSI） and modulation transfer function cut-off （MTF cut-off） were measured with a OQAS visual quality analyzing system preoperatively and one day， one week and one month postoperatively. Additional measurements were made to evaluate the differences among the three surgical methods. Results The effects on postoperative visual quality due to the different surgical procedures were as follows： ①Vision： visual acuity improved after all surgeries and there were no significant differences among the results. ②OSI： there was no statistically significant difference between SBK and FS-SBK. When compared with pre-operative OSI， there was a statistically significant difference between moderate and high myopia groups one week after SMILE surgery. ③MTF cut-off： there were no statistically significant differences before and after surgery in the FS-SBK group， but there was a statistically significant difference from both SBK and SMILE surgeries in the moderate myopia group 1 week postoperatively compared with the preoperative period and 1 month postoperatively. However， there were no significant differences for the remaining time points. No significant differences were found between the different myopia groups. Conclusion Postoperative visual quality improves after the three surgical procedures discussed above. Due to a raised OSI after SMILE surgery， LASIK is the better option for high and moderate degrees of myopia. While the MTF cut-off did not vary significantly between pre- and postoperative FS-SBK， it decreased one week later after SBK and SMILE surgeries but recovered after one month in the moderate myopia group， even reverting to pre-operative levels.
【Key words】 Femtosecond laser； Small incision lenticule extraction； Keratomileusis，sub-Bowman； Opposite sector index； Modulation transfer function cut-off； Visual quality
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中华眼视光学与视觉科学