【摘要】 目的 比较SMILE与波前像差引导的个体化角膜切削（WASCA）LASIK治疗近视的短期临床效果。方法 对照研究。随机选取于浙江眼科中心行SMILE术的近视患者17例（34眼，SMILE组）和WASCA术的患者20例（39眼，WASCA组）。随访3个月，比较2组术后1个月和术后3个月UCVA、BCVA、等效球镜度和高阶像差的变化。组内手术前后比较采用配对样本t检验，组间比较采用独立样本t检验及卡方检验。结果 术后3个月UCVA达到或超过术前BCVA的百分比2组均达到100%；术后3个月无一例BCVA较术前下降；比较术后1个月和3个月等效球镜度，2组2个时间点差异均无统计学意义，术后3个月等效球镜度在±0.50 D范围内的百分比，SMILE组为97%，高于WASCA组（90%），但差异没有统计学意义（χ2=1.524，P>0.05），2组无一眼术后等效球镜度在±1.00 D以外，术后残留柱镜度2组比较差异无统计学意义（χ2=2.359，P>0.05）；2组术后1个月、3个月总高阶像差和球差与术前相比均增大，并且差异有统计学意义（P＜0.05），术后1个月、3个月总高阶像差引入量2组比较差异无统计学意义；术后1个月、3个月球差引入量SMILE组小于WASCA组，2组比较差异有统计学意义（t=-6.23、-6.98，P<0.01）。结论 SMILE手术与WASCA LASIK手术治疗近视有效、安全、稳定和预测性佳。前者比后者引入的术后球差更少，准确性和疗效更佳。
【关键词】 飞秒激光； 飞秒激光小切口基质透镜取出术； 波前像差引导的个体化角膜切削； 高阶像差
DOI：10.3760/cma.j.issn.1674-845X.2014.07.010
作者单位：325000 温州眼科（董海曙）；310000 杭州，浙江临床医学（眼科学）（林芳宇）；310000 杭州，眼科中心（杨亚波）
通信作者：杨亚波，Email：yabyang@hotmail.com
Comparison of visual quality of SMILE surgery and wavefront-guided LASIK surgery in treating myopia Dong Haishu*， Lin Fangyu， Yang Yabo. * Department of Ophthalmology， the First Affiliated Hospital， Wenzhou Medical University， Wenzhou 325000， China
Corresponding author：Yang Yabo，Email：yabyang@hotmail.com
【Abstract】 Objective To compare the outcomes of small incision lenticule extraction surgery （SMILE） and wavefront supported corneal ablation （WASCA） LASIK surgery in treating myopia. Methods In this cases control study， 34 eyes of 17 patients who underwent SMILE and 39 eyes of 20 patients who underwent WASCA LASIK were included. Before surgery there were no significant differences between the two groups in spherical equivalent， age， gender and scotopic pupil diameter. All patients were followed up for more than 3 months. UCVA， BCVA， spherical equivalent and higher order aberrations before surgery and 1 month and 3 months after surgery were compared between the two groups. Results There were no statistically significant differences in uncorrected or best corrected visual acuity and spherical equivalence after the two surgical procedures （P>0.05）. Three months after surgery， the SMILE group had a significantly higher percentage of eyes whose SE range was -0.50 D to +0.50 D compared with the WASCA group （P<0.05）. There were no statistically significant differences in higher-order aberrations induced by SMILE and WASCA 1 month and 3 months after surgery （P>0.05）. However， SMILE induced far fewer spherical aberrations than WASCA LASIK （P<0.01）. Conclusion Both SMILE and WASCA LASIK have good efficacy， safety， stability and predictability in treating myopia. However， SMILE induces far fewer spherical aberrations and results in better visual quality.
【Key words】 Femtosecond laser； Small incision lenticule extraction； Wavefront supported corneal ablation； Higher order aberration
