| Objective: To evaluate and compare the clinical effect of marking on corneal in small incision lenticule extraction(SMILE)operation,unmarking on corneal in SMILE operation and wavefront aberration guided femtosecond laser assisted laser-assisted in situ keratomileusis(FS-LASIK)surgery in the treatment of high myopia astigmatism,so as to provide the clinical evidence for improving the safety and effectiveness of intrastromal corneal operation.Methods: A prospective non-randomized control method was used.41 patients(82 eyes)of high myopia astigmatism(spherical mirror ? 1.0 D,cylindrical mirror ? 1.5 D)intends to SMILE operation and wavefront aberration guided FS-LASIK surgery in our myopia laser treatment center between December 2018 to October 2019 were collected,and were divided into 3 groups according to the surgical treatment.Among these subjects,17 cases(34 eyes)were treated with SMILE of corneal marker,12 cases(24 eyes)were treated with SMILE of non-corneal marker,and 12 cases(24 eyes)were treated with wavefront aberration guided FS-LASIK.Uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),diopter,intraocular pressure,slit lamp microscope,Pentaca manterior segment analysis,Wavescan wavefront aberrations(total higher order aberrations,spherical aberrations,coma and clover)were examined before and 1 day,1 week,1 month and 3 months after the surgery,and the differences among the three groups were compared.Alpins' s vector analysis was used to calculated the target induced astigmatism(TI A),surgically induced astigmatism(SIA),difference vector(DV),correct ion index(CI),index of success(IOS),angle of error(Aof E),and flattening index(FI).Using spss 26.0 statistical software,all data were analy zed with t test or Mann-Whitney nonparametric test,Pearson or Spearman correlation analysis and other statistical methods.Results:1.UCVA(log MAR): at 3 months after operation,the SMILE of corneal marker group was-0.040 ± 0.020,the SMILE of non-corneal marker group was-0.062 ± 0.043,and the wavefront aberration guided FS-LASIK group was 0.054 ± 0.038.No significant difference of refraction was found between follow-ups(P > 0.05).2.Diopter: at 3 months after operation,postoperative sphere,spherical power and cylinder power was-0.02 ± 0.51 D,0.158 ± 0.291 D,-0.056 ± 0.349 D in the SMILE of corneal marker group,-0.07 ± 0.38 D,0.229 ± 0.375 D,-0.068 ± 0.439 D in the SMILE of non-corneal marker group and-0.06 ± 0.48 D,0.091 ± 0.358 D,-0.25 ± 0.555 D in the wavefront aberration guided FS-LASIK group.No significant diff erence of refraction was found between follow-ups(P > 0.05).3.Mean residual astigmatism: at 3 months after operation,the SMILE of corneal marker group was-0.06 ± 0.35 D,the SMILE of non-corneal marker group was-0.07 ± 0.44 D,the wavefront aberration guided FS-LASIK group was-0.25 ± 0.56 D.No significant difference of ref raction was found between follow-ups(P > 0.05).4.Vector analysis results:(1)There was significant positive correlation between IOS and |Aof E|,DV and|Aof E|(P < 0.05).(2)At 3 months after operation,the|Aof E|was 1.39 ± 3.03 in the SMILE of corneal marker group,2.24 ± 4.13 in the SMILE of non-corneal marker group and 1.81 ± 4.88 in the wavefront aberration guided FS-LASIK group.The SMILE of non-corneal marker group was higher than the SMILE of corneal marker group and the wavefront aberration guided FS-LASIK group(P < 0.05).There was no significant difference between the SMILE of corneal marker group and the wavefront aberration guided FS-LASIK group(P > 0.05).(3)There was no significant difference in CI,IOS and FI between the three groups(P > 0.05).5.Pentacam anterior segment analysis(1)The Q-value of corneal anterior surface: before operation,the SMILE of corneal marker group was-0.362 ± 0.040,the SMILE of non-corneal marker group was-0.362 ± 0.040,the wavefront aberration guided FS-LASIK group was-0.385 ± 0.141.At 3 months after operation,the SMILE of corneal marker group was 0.474 ± 0.230,the SMILE of non-corneal marker group was 0.604 ± 0.276,and the wavefront aberration guided FS-LASIK group was 0.805 ± 0.331.The Q-value of 3 months after operation turned to positive value compared with that before operation,which was statistically significant(P < 0.05).The FS-LASIK group guided by the Q-value of the anterior surface of the cornea at 3 months after surgery was significantly higher than the corneal marked and noncorneal marked SMILE groups(P <0.05).The corneal marked and noncorneal marked SMILE groups There was no statistically significant difference between the groups(P> 0.05).(2)The optical density of the central cornea(the wavefront aberration guided FS-LASIK group is 100?m under the corneal flap,and 120?m under the corneal cap)was 14.335 ± 1.484,17.091 ± 0.812,16.827 ± 0.649,16.082 ± 0.527,15.178 ± 0.424 in the SMILE of corneal marker group before operation,1 day,1 week,1 month and 3 months after operation,respectively.One day and one week after the operation were higher than that before the operation(P < 0.05).There was no significant difference between 1 month and 3 months after operation and before operation(P > 0.05).There was no significant difference between the two groups at 3 months after operation and before operation(P > 0.05).6.Wavefront aberration results(1)There was no significant difference in total higher-order aberrations,spherical aberrations,coma and clover among the three groups before operation(P > 0.05).(2)At 3 months after operation,the total higher-order aberrations,spherical aberrations,coma and clover was 0.531 ± 0.136 um?0.192 ± 0.224 um?0.254 ± 0.162 um?0.198 ± 0.132 um in the SMILE of corneal marker group,0.615 ± 0.179 um?0.216 ± 0.137 um?0.427 ± 0.186 um?0.213 ± 0.125 um in the SMILE of non-corneal marker group,and 0.662 ± 0.121 um?0.363 ± 0.120 um?0.421 ± 0.146 um?0.170 ± 0.070 um the wavefront aberration guided FS-LASIK group.The total higher-order aberrations,spherical aberrations and coma in the SMILE of corneal marker group were lower than that in the wavefront aberration guided FS-LASIK group(P < 0.05).The total higher-order aberrations,and coma in the SMILE of corneal marker group were lower than that in the SMILE of non-corneal marker group(P < 0.05).The difference in spherical aberration between the two groups was not statistically significant(P > 0.05).The spherical aberrations in the SMILE of non-corneal marker group was lower than that in the wavefront aberration guided FS-LASIK group(P < 0.05).There was no statistical difference in other cases(P > 0.05).7.Significance positive correlation between the Q-value of corneal anterior surface and spherical aberration(r = 0.428,P = 0.037)in the wavefront aberration guided FS-LASIK group at 3 months after operation.There was no correlation between the Q-value and the spherical aberration in the remaining two groups(P > 0.05).There was no correlation between the optical density of the central cornea and the total higher-order aberrations,spherical aberrations,coma and clover(P > 0.05).Conclusions:1.Compared with the SMILE of non-corneal marker,the accuracy of the SMILE of corneal marker and the wavefront aberration guided FS-LASIK group is better in controlling the error of incorrect astigmatis maxis,which can improve the correction effect of astigmatism.2.The higher-order aberrations after the SMILE of corneal marker are significantly lower than those of the SMILE of non-corneal marker and the wavefront aberration guided FS-LASIK group,and the one have better accuracy and predictability.3.All of the three methods are safe and effective,while the SMILE of corneal marker has more advantages. |
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