散光标记下SMILE矫正中高度顺规散光的长期矢量结果

评估在散光轴标记状态下行SMILE矫正中高度近视散光的矢量结果。

在本前瞻性，纵向，干预性研究中，中山眼科中心使用VisuMax矫正了术前顺规散光超过1.50 D的71眼（71例患者）。于术前及术后1、3、6和30个月评估屈光结果和散光轴向。

术后30个月，有效性和安全性指数分别为1.04 ± 0.18和1.15 ± 0.17。手术引入散光（SIA）的大小（1个月: 2.13 ± 0.71 D, P= .018; 3个月: 2.12 ± 0.72 D, P= .006;6个月:2.13±0.69 D, P= .010;30个月:2.19 ± 0.72 D, P<.001]）略高于目标引入散光（TIA）（2.07 ± 0.69 D）。与TIA矢量相比，仅SIA矢量的y坐标有过矫，差异有统计学意义（P_{1个月-术前}= .033，P_{3个月-术前}= .011，P_{6个月-术前}= .012，P_{30个月-术前}<.001）。矫正指数（| SIA | / | TIA |）从1个月时的1.03±0.07变为30个月时的1.06±0.10，且术后30个月时中度散光组中矫正指数较高度组大（P= .041）。

▲图1术后屈光效果九连图

▲图2 手术引入散光在术后1，3，6，30月时的矢量分布。TIA =目标引入散光；SIA =手术引入散光。

散光标记下SMILE矫正中高度近视散光时具有长期安全性，有效性，可预测性和稳定性。同时，y轴方向的散光过矫导致了整体的散光过矫，这提示了散光矫正时需考虑合适的nomogram。

To evaluate the vector outcomes of small incision lenticule extraction (SMILE) in correcting moderate to high myopic astigmatism under astigmatic axis marked condition.

In a prospective, longitudinal, interventional study, 71 eyes (71 patients) that had with-the-rule preoperative cylinder refraction exceeding 1.50 diopters (D) were corrected with the VisuMax femtosecond laser (Carl Zeiss Meditec AG) at Zhongshan Ophthalmic Center. Refractive outcomes and astigmatic vector were evaluated preoperatively and at 1, 3, 6, and 30 months postoperatively.

At 30 months postoperatively, the efficacy and safety indexes were 1.04 ± 0.18 and 1.15 ± 0.17, respectively. The magnitude of the surgically induced astigmatism (SIA) (2.13 ± 0.71 D at 1 month [P_1m-pre = .018], 2.12 ± 0.72 D at 3 months [P_3m-pre = .006], 2.13 ± 0.69 D at 6 months [P_6m-pre = .010], and 2.19 ± 0.72 D at 30 months [P_30m-pre < .001]) was slightly higher than that of the target induced astigmatism (TIA) (2.07 ± 0.69 D). Only the y-coordinate of the SIA vector had a significant overcorrection compared to that of the TIA vector (P_1m-pre = .033, P_3m-pre = .011, P_6m-pre = .012, P_30m-pre< .001). The corrected index (CI = |SIA|/|TIA|) varied from 1.03 ± 0.07 at 1 month to 1.06 ± 0.10 at 30 months, which was higher when correcting moderate astigmatism than when correcting high astigmatism (P = .041) at 30 months postoperatively.

SMILE had long-term safety, efficacy, predictability, and stability when correcting moderate to high myopic astigmatism under astigmatism axis marked condition. Meanwhile, a cylinder overcorrection was observed due to the overcorrection of y-coordinate astigmatic power, which implied that the vector adjustment of the cylinder refraction nomogram should be considered.