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Abstract：
OBJECTIVE: To compare the subjective and objective visual quality between small incision lenticule extraction (SMILE) and transepithelial photorefractive keratectomy (tPRK) in patients with low and moderate myopia.
METHODS: Patients undertaking SMILE or tPRK for the correction of low and moderate myopia were consecutively recruited in this prospective cohort study with a 3-month follow-up period. Objective evaluation [visual acuity test, manifest refraction, wavefront aberrations, the total cut-off value of the total modulation transfer function (MTFcut-off), and Strehl ratio (SR)] and subjective evaluation of visual quality (quality-of-life questionnaire) were conducted before surgery and at days 1, 7, 30, and 90 after surgery.
RESULTS: A total of 47 patients (94 eyes) with SMILE and 22 patients (22 eyes) with tPRK were enrolled. The uncorrected visual acuity (UCVA) was better in SMILE patients on day 7 after surgery (1.13±0.13 vs 0.99±0.17, t=4.85, P<0.001) but was comparable at days 30 and 90. At day 90, the SMILE group had a lower spherical equivalent (SE) than the tPRK group (0.04±0.31 vs 0.19±0.43, t=2.08, P=0.042). Total higher order aberrations (HOAs) were induced in both surgical types, which were more evident in the tPRK group with 3-mm pupil diameter (0.16±0.07 vs 0.11±0.05, t=4.27, P<0.001) and 5-mm pupil diameter (0.39±0.17 vs 0.36±0.11, t=2.33, P=0.022). The MTFcut-off and SR showed a trend of improvement in both SMILE and tPRK patients but were statistically better in the SMILE group with both pupil diameters. There was a significant improvement of contrast sensitivity (CS) over baseline levels at the spatial frequency of 18 cycles/degree (c/d) in the SMILE group (F=2.72, P=0.033) and at 3 c/d (F=3.03, P=0.031), 12 c/d (F=3.72, P=0.013), and 18 c/d (F=4.62, P=0.004) in the tPRK group. The subjective quality of life questionnaire showed a steady improvement in the SMILE group (F=8.31, P<0.001) but not the tPRK group.
CONCLUSIONS: SMILE and tPRK are both safe and effective ways to correct low and moderate myopia. A generally better and quicker recovery of visual quality favors the application of SMILE in qualified patients.
METHODS: Patients undertaking SMILE or tPRK for the correction of low and moderate myopia were consecutively recruited in this prospective cohort study with a 3-month follow-up period. Objective evaluation [visual acuity test, manifest refraction, wavefront aberrations, the total cut-off value of the total modulation transfer function (MTFcut-off), and Strehl ratio (SR)] and subjective evaluation of visual quality (quality-of-life questionnaire) were conducted before surgery and at days 1, 7, 30, and 90 after surgery.
RESULTS: A total of 47 patients (94 eyes) with SMILE and 22 patients (22 eyes) with tPRK were enrolled. The uncorrected visual acuity (UCVA) was better in SMILE patients on day 7 after surgery (1.13±0.13 vs 0.99±0.17, t=4.85, P<0.001) but was comparable at days 30 and 90. At day 90, the SMILE group had a lower spherical equivalent (SE) than the tPRK group (0.04±0.31 vs 0.19±0.43, t=2.08, P=0.042). Total higher order aberrations (HOAs) were induced in both surgical types, which were more evident in the tPRK group with 3-mm pupil diameter (0.16±0.07 vs 0.11±0.05, t=4.27, P<0.001) and 5-mm pupil diameter (0.39±0.17 vs 0.36±0.11, t=2.33, P=0.022). The MTFcut-off and SR showed a trend of improvement in both SMILE and tPRK patients but were statistically better in the SMILE group with both pupil diameters. There was a significant improvement of contrast sensitivity (CS) over baseline levels at the spatial frequency of 18 cycles/degree (c/d) in the SMILE group (F=2.72, P=0.033) and at 3 c/d (F=3.03, P=0.031), 12 c/d (F=3.72, P=0.013), and 18 c/d (F=4.62, P=0.004) in the tPRK group. The subjective quality of life questionnaire showed a steady improvement in the SMILE group (F=8.31, P<0.001) but not the tPRK group.
CONCLUSIONS: SMILE and tPRK are both safe and effective ways to correct low and moderate myopia. A generally better and quicker recovery of visual quality favors the application of SMILE in qualified patients.
摘要：
目的：比较小切口微透镜摘除术（SMILE）和经上皮屈光性角膜切削术（tPRK）对低度和中度近视患者的主观和客观视觉质量。
方法：这项前瞻性队列研究连续招募接受SMILE或tPRK治疗低度和中度近视的患者，随访3个月。客观评价[视力测试，明显的折射，波前像差,总调制传递函数的总截止值(MTFcut-off)，和Strehl比率（SR）]和视觉质量的主观评估（生活质量问卷）在手术前以及手术后第1、7、30和90天进行。
结果：共纳入47例（94只眼）SMILE患者和22例（22只眼）tPRK患者。术后第7天，SMILE患者的未矫正视力（UCVA）较好（1.13±0.13vs0.99±0.17，t=4.85，P<0.001），但在第30天和第90天具有可比性。在第90天，SMILE组的球形当量（SE）低于tPRK组（0.04±0.31vs0.19±0.43，t=2.08，P=0.042）。两种手术类型均诱发了总高阶像差(HOAs)，在3mm瞳孔直径（0.16±0.07vs0.11±0.05，t=4.27，P<0.001）和5mm瞳孔直径（0.39±0.17vs0.36±0.11，t=2.33，P=0.022）的tPRK组中更为明显。MTFcut-off和SR在SMILE和tPRK患者中均显示出改善的趋势，但在两种瞳孔直径的SMILE组中统计学上更好。在SMILE组（F=2.72，P=0.033）和在3c/d（F=3.03，P=0.031）的空间频率下，对比敏感度（CS）比基线水平显着改善。12c/d（F=3.72，P=0.013），tPRK组18c/d(F=4.62,P=0.004)。主观生活质量问卷显示SMILE组（F=8.31，P<0.001）有稳定的改善，但tPRK组无改善。
结论：SMILE和tPRK都是矫正低度和中度近视的安全有效方法。通常更好，更快的视觉质量恢复有利于SMILE在合格患者中的应用。
方法：这项前瞻性队列研究连续招募接受SMILE或tPRK治疗低度和中度近视的患者，随访3个月。客观评价[视力测试，明显的折射，波前像差,总调制传递函数的总截止值(MTFcut-off)，和Strehl比率（SR）]和视觉质量的主观评估（生活质量问卷）在手术前以及手术后第1、7、30和90天进行。
结果：共纳入47例（94只眼）SMILE患者和22例（22只眼）tPRK患者。术后第7天，SMILE患者的未矫正视力（UCVA）较好（1.13±0.13vs0.99±0.17，t=4.85，P<0.001），但在第30天和第90天具有可比性。在第90天，SMILE组的球形当量（SE）低于tPRK组（0.04±0.31vs0.19±0.43，t=2.08，P=0.042）。两种手术类型均诱发了总高阶像差(HOAs)，在3mm瞳孔直径（0.16±0.07vs0.11±0.05，t=4.27，P<0.001）和5mm瞳孔直径（0.39±0.17vs0.36±0.11，t=2.33，P=0.022）的tPRK组中更为明显。MTFcut-off和SR在SMILE和tPRK患者中均显示出改善的趋势，但在两种瞳孔直径的SMILE组中统计学上更好。在SMILE组（F=2.72，P=0.033）和在3c/d（F=3.03，P=0.031）的空间频率下，对比敏感度（CS）比基线水平显着改善。12c/d（F=3.72，P=0.013），tPRK组18c/d(F=4.62,P=0.004)。主观生活质量问卷显示SMILE组（F=8.31，P<0.001）有稳定的改善，但tPRK组无改善。
结论：SMILE和tPRK都是矫正低度和中度近视的安全有效方法。通常更好，更快的视觉质量恢复有利于SMILE在合格患者中的应用。
