PDF(Pubmed)
Abstract：
Background/Objectives: To compare the epithelial thickness changes and the changes in epithelial wavefront aberrometry following spherical versus astigmatic myopic small incision lenticule extraction (SMILE). Methods: Eighty-six eyes of 86 patients who underwent SMILE were included in this retrospective study. A total of 43 eyes underwent myopic spherical correction (spherical group) and 43 eyes underwent myopic cylindrical correction (cylindrical group). The groups were matched according to the spherical equivalent of surgically corrected refraction. Subjective manifest refraction as well as high-resolution anterior segment optical coherence tomography (MS-39; CSO; Florence, Italy) were obtained preoperatively as well as 3 months postoperatively. The latter was utilized for computing epithelial wavefront aberrometry in addition to epithelial thickness mapping. Results: Epithelial thickness increased significantly in both groups after SMILE (p < 0.01). In the cylindrical group, epithelial thickening was more pronounced on the flat meridian compared to the steep meridian (p = 0.04). In both groups, epithelial wavefront aberrometry showed a significant postoperative increase in the epithelium\'s spherical refractive power, causing a myopization of -0.24 ± 0.42 diopters (D) in the spherical group (p < 0.01) and -0.41 ± 0.52 D in the cylindrical group (p < 0.0001). While no significant changes in epithelial cylindrical refractive power were observed in the spherical group, a significant increase was noted in the cylindrical group from -0.21 ± 0.24 D to -0.37 ± 0.31 D (p = 0.01). In both groups, epithelial higher-order aberrations increased significantly (p < 0.001). Conclusions: Postoperative epithelial remodeling after SMILE alters lower-order (sphere and cylinder) and higher-order aberrations of the corneal epithelial wavefront and might contribute to refractive undercorrection, especially in astigmatic corrections. Epithelial wavefront aberrometry can be used to quantify the refractive effect of epithelial remodeling processes after keratorefractive surgery.
摘要：
背景/目的：比较球形和散光性近视小切口微透镜摘除（SMILE）后上皮厚度的变化和上皮波前像差的变化。方法：本回顾性研究包括86例接受SMILE治疗的患者的86只眼。共有43只眼进行了近视球面矫正（球面组），43只眼进行了近视圆柱矫正（圆柱组）。根据手术矫正屈光的球面当量对各组进行匹配。主观明显屈光以及高分辨率眼前段光学相干断层扫描（MS-39；CSO；Florence，意大利）在术前和术后3个月获得。除了上皮厚度映射外，后者还用于计算上皮波前像差。结果：SMILE后两组上皮厚度均显著增加（p<0.01）。在圆柱形组中，与陡峭子午线相比，平坦子午线的上皮增厚更为明显（p=0.04）。在这两组中,上皮波前像差仪显示术后上皮的球面屈光力显著增加，在球形组中引起-0.24±0.42屈光度（D）（p<0.01），在圆柱形组中引起-0.41±0.52D（p<0.0001）。虽然在球形组中没有观察到上皮圆柱屈光力的显着变化，圆柱组中从-0.21±0.24D显着增加至-0.37±0.31D（p=0.01）。在这两组中,上皮高阶像差显著增加(p<0.001)。结论：SMILE术后上皮重塑改变了角膜上皮波前的低阶（球体和圆柱体）和高阶像差，并可能导致屈光矫正不足，尤其是在散光矫正中.上皮波前像差法可用于量化角膜屈光手术后上皮重塑过程的屈光效应。
