Correlation between Functional Optical Zone and Corneal Epithelial Remodeling after Small Incision Lenticule Extraction for Correcting Myopia
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目的： 探究飞秒激光小切口角膜基质透镜取出术（SMILE）后功能性光学区（FOZ）的大小，分析其与角膜上皮厚度（CET）变化和角膜形态变化的相关性。 方法： 前瞻性临床研究。连续性选取2021年6—12月在中国医科大学附属盛京医院接受SMILE手术的近视散光患者69例（135眼）。根据手术预计矫正的等效球镜度（SE）分为高度近视组（<-6.00 D，69眼）和中低度近视组（≥-6.00 D，66眼），分别于术前和术后3个月时应用Pentacam三维眼前节分析系统对患者进行检查并评估术后3个月时患者的FOZ，应用眼前节光学相干断层扫描仪（AS-OCT）测量角膜0~2 mm、>2~5 mm、>5~7 mm、>7~9 mm范围内的上皮厚度。采用独立样本t检验、Pearson线性相关性分析、多重线性回归分析对数据进行分析。 结果： 所有患者手术前透镜光学区直径均设计为6.5 mm。术后3个月时，高度近视组和中低度近视组的FOZ直径分别为（5.10±0.17）mm、（5.26±0.24）mm，2组患者术后FOZ均较术前设计的透镜光学区缩小，高度近视组缩小更明显，2组间FOZ变化量比较差异有统计学意义（t=-4.44，P<0.001）。2组患者术后0~2 mm、>2~5 mm、>5~7 mm区域内CET较术前增加，>7~9 mm区域内较术前略减少，且高度近视组0~2 mm、>2~5 mm区域内CET变化量比中低度近视组大，2组间变化量差异有统计学意义（t=2.43，P=0.016；t=2.71，P=0.008）。2组患者术前角膜曲率（Km）、角膜Q值比较差异均无统计学意义（t=0.79，P=0.430；t=0.13，P=0.894），术后3个月时，2组患者Km较术前明显减少，角膜Q值较术前明显增加，高度近视组比中低度近视组变化更大，2组间Km变化量、角膜Q值变化量比较差异有统计学意义（t=-6.26，t=10.86；均P<0.001）。术后3个月FOZ的大小与手术预计矫正的SE呈正相关（r=0.51，P<0.001），与手术前后Km的变化量、角膜Q值的变化量呈负相关（r=-0.48、r=-0.39；均P<0.001），与手术前后CET的变化量呈负相关（r0~2mm=-0.37，r>2~5mm=-0.32；均P<0.001）。术后3个月时，2组间总高阶像差（HOA）、球差（SA）、垂直彗差（V-Coma）比较差异有统计学意义（t=6.46，t=5.04，t=-4.91；均P<0.001），且△HOA、△SA、△V-Coma与FOZ的大小呈负相关（r=-0.59，r=-0.59，r=-0.59；均P<0.001）。 结论： SMILE术后FOZ较术前预计光学区缩小，术前近视度数越大，术后角膜上皮重塑越明显，术后FOZ越小,角膜高阶像差增加越多。SMILE术后角膜上皮重塑效应和角膜非球面形态和曲率的改变均影响术后FOZ的大小。 Objective: To explore the size of functional optical zone (FOZ) and the relationship between the FOZ and the change in corneal epithelial thickness and corneal shape after small incision lenticule extraction (SMILE). Methods: In this prospective clinical study. A total of 69 myopic patients (135 eyes) who underwent SMILE in Shengjing Hospital of China Medical University were selected consecutively from June 2021 to December 2021. According to the predicted spherical equivalent (SE), treated eyes were divided into two groups: a high myopic group (<−6.00 D, 69 eyes) and a mild to moderate myopic group (≥−6.00 D, 66 eyes). FOZ and corneal epithelial thickness were measured using a Scheimpflug camera and AS-OCT preoperatively and 3 months postoperatively. Statistical analyses were performed byt test, Pearson correlation, multiple linear regression. Results: All of the optical zones were programmed 6.5 mm. The average FOZ of the patients in the high myopia group and the moderate and low myopia group were 5.10±0.17 mm and 5.26±0.24 mm at 3 months after operation. The FOZ of the two groups were reduced, and the reduction in the high myopia group was more obvious. The difference between two groups was statistically significant (t=-4.44, P<0.001). The corneal epithelial thickness in the 0-2 mm, >2-5 mm, >5-7 mm areas of the two groups increased and the corneal epithelial thickness in the 7-9 mm area was slightly decreased compared with preoperative ones. The change of corneal epithelial thickness in the 0-2 mm and >2-5 mm area of the high myopia group were larger than that of the moderate and low myopia group, and the difference between two groups was statistically significant (t=2.43, P=0.016 t=2.71, P=0.008). There was no significant difference in corneal curvature and corneal Q value between two groups before surgery (t=0.79, P=0.430 t=0.13, P=0.894). Three months after surgery, the corneal curvature of two groups was significantly decreased and the corneal Q value was significantly higher than that before surgery. The changes in the high myopia group were greater than those in the moderate and low myopia group, and the difference between two groups was statistically significant (t=-6.26, t=10.86 both P<0.001). Three months after the operation, the size of the FOZ was positively correlated with the expected SE by surgery (r=0.51, P<0.001), and was negatively correlated with the change of corneal curvature and corneal Q value (r=-0.48, r=-0.39 both P<0.001), and negative correlated with the change of corneal epithelial thickness (r0~2 mm=-0.37, r>2~5 mm=-0.32 both P<0.001). Three months after surgery, there were statistically significant differences in total high-order aberration, spherical aberration and vertical Coma between the two groups (t=6.46, t=5.04, t=-4.91 both P<0.001), and FOZ was significantly negatively correlated with ∆HOA, ∆SA, ∆V-Coma (r=-0.59, r=-0.59, r=-0.59 both P<0.001). Conclusions: The FOZ after SMILE was lower than that expected before operation, the larger the preoperative SE, the more obvious postoperative corneal epithelial remodeling, and the smaller the postoperative FOZ, the more the increase of corneal high-order aberration. Corneal epithelial remodeling and changes in corneal aspheric morphology and curvature can affect the size of postoperative FOZ after SMILE.
Objective: To explore the size of functional optical zone (FOZ) and the relationship between the FOZ and the change in corneal epithelial thickness and corneal shape after small incision lenticule extraction (SMILE). Methods: In this prospective clinical study. A total of 69 myopic patients (135 eyes) who underwent SMILE in Shengjing Hospital of China Medical University were selected consecutively from June 2021 to December 2021. According to the predicted spherical equivalent (SE), treated eyes were divided into two groups: a high myopic group (<−6.00 D, 69 eyes) and a mild to moderate myopic group (≥−6.00 D, 66 eyes). FOZ and corneal epithelial thickness were measured using a Scheimpflug camera and AS-OCT preoperatively and 3 months postoperatively. Statistical analyses were performed byt test, Pearson correlation, multiple linear regression. Results: All of the optical zones were programmed 6.5 mm. The average FOZ of the patients in the high myopia group and the moderate and low myopia group were 5.10±0.17 mm and 5.26±0.24 mm at 3 months after operation. The FOZ of the two groups were reduced, and the reduction in the high myopia group was more obvious. The difference between two groups was statistically significant (t=-4.44, P<0.001). The corneal epithelial thickness in the 0-2 mm, >2-5 mm, >5-7 mm areas of the two groups increased and the corneal epithelial thickness in the 7-9 mm area was slightly decreased compared with preoperative ones. The change of corneal epithelial thickness in the 0-2 mm and >2-5 mm area of the high myopia group were larger than that of the moderate and low myopia group, and the difference between two groups was statistically significant (t=2.43, P=0.016 t=2.71, P=0.008). There was no significant difference in corneal curvature and corneal Q value between two groups before surgery (t=0.79, P=0.430 t=0.13, P=0.894). Three months after surgery, the corneal curvature of two groups was significantly decreased and the corneal Q value was significantly higher than that before surgery. The changes in the high myopia group were greater than those in the moderate and low myopia group, and the difference between two groups was statistically significant (t=-6.26, t=10.86 both P<0.001). Three months after the operation, the size of the FOZ was positively correlated with the expected SE by surgery (r=0.51, P<0.001), and was negatively correlated with the change of corneal curvature and corneal Q value (r=-0.48, r=-0.39 both P<0.001), and negative correlated with the change of corneal epithelial thickness (r0~2 mm=-0.37, r>2~5 mm=-0.32 both P<0.001). Three months after surgery, there were statistically significant differences in total high-order aberration, spherical aberration and vertical Coma between the two groups (t=6.46, t=5.04, t=-4.91 both P<0.001), and FOZ was significantly negatively correlated with ∆HOA, ∆SA, ∆V-Coma (r=-0.59, r=-0.59, r=-0.59 both P<0.001). Conclusions: The FOZ after SMILE was lower than that expected before operation, the larger the preoperative SE, the more obvious postoperative corneal epithelial remodeling, and the smaller the postoperative FOZ, the more the increase of corneal high-order aberration. Corneal epithelial remodeling and changes in corneal aspheric morphology and curvature can affect the size of postoperative FOZ after SMILE.
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