| Objective:To evaluate the difference of visual quality at different time points after small incision extraction(SMILE)and implantable collamer lens(ICL)implantation in patients with high myopia.Methods:This is a prospective non-randomized study.From September 2017 to March 2019,48 patients(86 eyes in total)with high myopia,19 males(34 eyes)and 29females(52 eyes),aged 18-49 years(mean age29±9years),were selected from the Department of refractive surgery,Eye Hospital of China Academy of CMS,which required refractive surgery and eye examination at the same time suitable for SMILE and ICL implantation.According to the patients' wishes,the patients were divided into two groups:the smile group(32 eyes),13 men(23 eyes),19 women(33 eyes),with an average age of 28±9years,SE of-7.90±0.87D,astigmatism of-1.25±0.47D;the ICL group(16 eyes),6 men(11 eyes),10 men(19 eyes),with an average age of 30±9years,SE of-8.28±1.11D,astigmatism of-1.18±0.44D.Uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),diopter and spherical equivalent were performed in both groups before operation Equivalency,SE),astigmatism,intraocular pressure,ocular axis,white to white,anterior chamber depth,lens thickness,corneal endothelial count,anterior segment,fundus and corneal topography were examined,and the visual quality parameters of patients were measured by the optical quality analysis system(OQASTM ?),including the modulation transfer function cut off frequency Function cut off frequency,MTF cut off,objective scattering index(OSI),visual activity(VA).The differences of UCVA,residual SE,residual astigmatism,MTF cut off,OSI,daytime contrast visual acuity(VA100%),nighttime contrast visual acuity(VA20%)and nighttime contrast visual acuity(VA9%)between the two groups were observed.Spss25.0 software was used to test the age,preoperative BCVA and SE of the two groups;x2 test was used to test the sex composition ratio of the two groups;univariate analysis of variance was used to compare the UCVA and preoperative BCVA in March and June after operation;univariate analysis of variance was used to compare the ratio of residual astigmatism and preoperative astigmatism in March and June after operation;UCVA,residual SE,residual astigmatism and MTF cut were used in the two groups Matched t-test was used for off,OSI,VA100%,VA20%and VA9%;two independent samples t-test was used for UCVA,residual SE,residual astigmatism,MTF cut off,OSI,VA100%,VA20%and VA9%between the two groups.With ?=0.05 as the test level,P<0.05 as the difference was statistically significant..Result:1.There was no significant difference in age,sex ratio,preoperative BCVA and preoperative SE between smile group and ICL group(P>0.05).2.Comparison of operation effectiveness and accuracy:before operation,smile and BCVA were 1.08±0.10 and 1.04±0.13 respectively:after 3 months,UCVA of smile group and ICL group were 1.15±0.15 and 1.19±0.20 respectively;after 6 months,UCVA of smile group and ICL group were 1.16±0.16 and 1.18±0.20 respectively.Comparison between groups:there was no significant difference between the two groups(P>0.05)in the preoperative BCVA and the postoperative UCVA in March and June(P>0.05);comparison within groups:there was significant difference between the postoperative UCVA and the preoperative BCVA in the smile group(F=7.448,P<0.05);there was significant difference between the postoperative UCVA and the preoperative BCVA in the ICL group(F=6.379.P<0.05),and there was no significant difference between the two groups in the postoperative UCVA in March and June(F=6.379.P<0.05)The difference between the two groups shows that UCVA is better than BCVA,and the two methods have good effectiveness and accuracy in the treatment of high myopia.Before operation,the astigmatism of smile group and ICL group were-1.25±0.47D and-1.1 8±0.44D,respectively;after 3 months,the residual astigmatism of smile group and ICL group were-0.11±0.19D and-0.21±0.15D,respectively;after 6 months,the residual astigmatism of smile group and ICL group were-0.18±0.22D and-0.25±0.20D,respectively.There was no significant difference in preoperative astigmatism and postoperative residual astigmatism between the two groups(P>0.05);intra group comparison:there was significant difference in postoperative astigmatism between smile group and preoperative astigmatism(F=9.267,P<0.05);there was significant difference in postoperative UCVA and preoperative BCVA in ICL group(F=8.134,P<0.05),which indicated that the two kinds of surgical methods were better than each other The correction of astigmatism has good effectiveness and accuracy.3.Comparison of predictability and stability of operation:the residual SE of smile group and ICL group were-0.18±0.55D and-0.15±0.30D respectively at 3 months after operation,and the residual SE of smile group and ICL group were-0.24±0.51D and-0.14±0.37D respectively at 6 months after operation.There was no significant difference in SE between the two groups(P>0.05).Three months after operation,the proportion of SE in the range of±1.0d was 87.5%(49 eyes),93.3%(28 eyes),in the range of±0.50D was 80.3%(45 eyes),90.0%(27 eyes),and in the range of±1.0D was 89.2%(50 eyes),93.3%(28 eyes),in the range of±0.50D was 75.0%(42 eyes)and 93.3%(28 eyes),respectively?There was no significant difference between the two groups(P>0.05).This shows that the two methods have good predictability and stability in the treatment of high myopia.4.Comparison of operation safety:in the smile group,there were no complications.In the early postoperative period,two patients had decreased night vision,one had night glare,and the adaptation gradually improved and the patients could accept it.In ICL group,there were no postoperative complications except transient intraocular pressure rise in 3 eyes after operation and normal treatment with anterior chamber drainage.In the early postoperative two patients,one eye had a diaphragm,one eye disappeared in 3 months,the other eye gradually adapted in 6 months and the patient was acceptable.It is suggested that the two methods are safe in the treatment of high myopia.5.Comparison of objective visual quality parameters:Within group comparison:in smile group,the MTF cut off value was 33.576±10.376,33.065±9.771,OSI value was 1.161±0.892,1.045±0.700,VA100%was 1.098±0.370,1.102±0.317,VA20%was 0.791±0.292,0.773±0.262,VA9%was 0.473±0.182,0.454±0.158,respectively.There was no significant difference in the objective visual quality of smile group at all time points(P>0.05).In ICL group,the MTF cut off value was 33.795±8.443,34.248±8.512,OSI value was 1.130±0.743,1.137±0.689,VA100%was 1.127±0.278,1.137±0.289,VA20%was 0.800±0.270,0.820±0.250,VA9%was 0.500±0.166,0.4800±0.165,respectively.There was no significant difference in the objective visual quality of all time points in ICL group(P>0.05).Comparison between groups:there was no significant difference in the objective visual quality parameters between the two groups(P>0.05).The results showed that the two kinds of operation can bring good objective visual quality to patients.Conclusion:1.SMILE and ICL implantation have good refractive correction effect on high myopia patients,and can maintain good safety,predictability,stability,effectiveness and accuracy in the short term.2.Good postoperative visual quality can be achieved in patients with high myopia after SMILE and ICL implantation. |
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