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Abstract：
This study compares postoperative visual outcomes and optical aberrations after Small Incision Lenticule Extraction (SMILE) in patients with both small (S-Kappa: Kappa angle < 0.2 mm) and large Kappa (L-Kappa: Kappa angle ≥ 0.2 mm) angles. The evaluated aberrations include total higher-order aberrations (HOAs), horizontal coma (HC), vertical coma (VC), and spherical aberrations (SA), with procedures incorporating intraoperative Kappa angle adjustments. We retrospectively analyzed patient records undergoing SMILE utilizing linear mixed models (LMM). We assessed adjusted mean uncorrected distance visual acuity (UDVA), Strehl ratio (SR), total HOAs, VC, and SA at pupils of 3 mm and 6 mm for both S-Kappa and L-Kappa. The disparities between S-Kappa and L-Kappa were evaluated by LMM\'s adjusted mean differences. The differences in optical metrics were also assessed in eyes grouped by myopia levels: low, moderate, and high. A sensitivity analysis was conducted on a threshold of Kappa angle at 0.3 mm. Eight-five patients (169 eyes) were analyzed, and no significant pre-operative difference was found in UDVA (p = .222) or spherical equivalent (p = .433). Post-operative differences were found in SR at 3 mm pupil size (-0.06, p = .022), total HOA 3 mm (0.15, p = .022), HC 3 mm (0.04, p = .042), VC 3 mm and 6 mm (-0.08, p = .041; 0.04, p = .041). The stratified analysis for high myopia revealed significant differences in UDVA (-0.04, p = .037), HC 3 mm (0.07, p = .03), VC 6 mm (-0.21, p = .001), and SA 3 mm and 6 mm (0.07, p = .037; -0.09, p = .037). Sensitivity analysis showed no significant difference using a 0.3 mm Kappa threshold. While some optical aberrations exhibited statistical differences between S-Kappa and L-Kappa, their clinical significance is limited. Thus, a large Kappa angle might not substantially influence post-operative optical aberrations when intraoperative Kappa angle adjustments are implemented.
摘要：
这项研究比较了小切口透镜摘除（SMILE）后的视觉结果和光学像差小（S-Kappa：Kappa角<0.2mm）和大Kappa（L-Kappa：Kappa角≥0.2mm）角度的患者。评估的像差包括总高阶像差(HOA)，水平昏迷(HC),垂直昏迷(VC),和球面像差(SA)，手术包括术中Kappa角度调整。我们使用线性混合模型（LMM）回顾性分析接受SMILE的患者记录。我们评估了调整后的平均未矫正视力(UDVA)，斯特雷尔比率(SR)，总HOA,VC,S-Kappa和L-Kappa的3mm和6mm瞳孔处的SA。S-Kappa和L-Kappa之间的差异通过LMM调整的平均差异进行评估。还评估了按近视水平分组的眼睛的光学指标差异：低，中度,和高。对0.3mm的K角阈值进行灵敏度分析。对85例患者(169只眼)进行了分析，在UDVA（p=.222）或球形等效（p=.433）中没有发现显着的术前差异。术后在3mm瞳孔大小的SR中发现差异（-0.06，p=0.022），总HOA3mm(0.15,p=.022),HC3mm(0.04,p=.042),VC3毫米和6毫米（-0.08，p=.041；0.04，p=.041）。高度近视的分层分析显示，UDVA存在显着差异（-0.04，p=0.037），HC3mm(0.07,p=.03),VC6mm(-0.21,p=.001),和SA3mm和6mm(0.07,p=.037;-0.09,p=.037)。敏感性分析显示使用0.3mmKappa阈值没有显著差异。虽然一些光学像差表现出S-Kappa和L-Kappa之间的统计差异，其临床意义有限。因此，在进行术中Kappa角度调整时,较大的Kappa角度可能不会对术后光学像差产生实质性影响.
