目的 观察在大光学区透镜设计条件下暗瞳孔直径大小对飞秒激光小切口角膜基质内透镜取出术(SMILE)后患者视觉质量的影响.方法 回顾性病例研究.分析2021年12月至2022年4月在广州医科大学附属第五医院行SMILE手术患者28例(56只眼).各患者手术均采用大光学区(直径≥6.5 mm),其中根据手术光学区与暗瞳孔的关系分为两组,A组(光学区小于暗瞳孔直径)30只眼,B组(光学区大于或等于暗瞳孔直径)26只眼,所有患者分别在术前和术后1个月及3个月测量球镜度、柱镜度、等效球镜(SE)、裸眼视力(UCVA)、最佳矫正视力(BCVA)、各级像差、点扩散函数(PSF),其中参数变化量用△表示(术后参数数值-术前参数数值),填写主观视觉质量问卷,对测得指标进行统计学分析.结果 术前两组间角膜中央厚度(CCT)、球镜度、柱镜度、SE、BCVA、总高阶像差、球差、慧差、三叶草差、PSF差异均无统计学差异(均P>0.05),而光学区和暗瞳孔直径、光学区减去暗瞳直径的差值、UCVA有统计学意义(均P<0.01);术后1个月A组球镜度、△球差大于B组(均P<0.05),术后3个月两组间△球差A组大于B组(P<0.05),而球镜度数、柱镜度数、等效球镜数、UCVA、BCVA差异均无统计学意义(均P>0.05).术后3个月两组间主观视觉质量问卷各参数(夜间眩光、雾视、光晕、夜间视力、干涩、异物感、视力波动、重影、满意度)评分差异均无统计学意义.结论 SMILE手术使用大光学区(直径≥6.5 mm)时,当暗瞳孔直径大于光学区仅会出现术后球差变化量增加,对屈光度数及视力及术后主观视觉质量无明显影响,仍能获得较好的术后视觉质量.
Objective To observe the influence of scotopic pupil diameter on visual quality after small incision lenticule extraction(SMILE)under large optical zone lens design.Methods Retrospective analysis of 28 patients(56 eyes)who underwent SMILE surgery in the Fifth Affiliated Hospital of Guangzhou Medical University from December 2021 to April 2022.Large optical zone(diameter ≥6.5 mm)was used in all patients.According to the relationship between the surgical optical zone and the scotopic pupil,30 eyes in group A(the optical zone is smaller than the diameter of the scoto-pic pupil)and 26 eyes in group B(the optical zone is larger than or equal to the diameter of the scotopic pupil).All pa-tients were measured for spherical degree,cylindrical degree,spherical equivalent(SE)degree,uncorrected distance visu-al acuity(UCVA),best corrected visual acuity(BCVA),all levels of high-order corneal aberration,point scatter function(PSF)before and at 1 and 3 months after the surgery.Results There were no significant differences in central corneal thickness(CCT),spherical degree,cylindrical degree,spherical equivalent degree,BCVA,total higher-order aberration,spherical aberration,coma,trefoil and point scatter function(PSF)between the two groups preoperative(all P>0.05).However,the optical zone and scotopic pupil diameter,optical zone minus scotopic pupil diameter value differences were statistically significant(all P<0.05).The spherical degree and △ spherical aberration in group A were higher than those in group B at 1 month after the operation(P<0.05),and the △ spherical aberration in group A was higher than that in group B at 3 months after the operation(P<0.05).However,there were no significant differences in spherical degree,cylindrical degree,spherical equivalent degree,UCVA and BCVA(P>0.05).There was no significant difference in sub-jective visual quality parameters(night glare,fog,halo,night vision,dryness,foreign body sensation,vision fluctuation,double vision and satisfaction)among three groups at 3 months after the opertion.Conclusions When a large optical zone(diameter≥6.5 mm)is used in SMILE surgery,the scotopic pupil diameter is larger than the optical zone,which will only increase the change of postoperative spheri-cal aberration,and has no obvious influence on refractive power,vision and subjective visual quality after surgery,but still a good visual quality after surgery can be obtained.