Comparison and Observation of Higher-Order Aberrations after SMILE,TPRK and FS-LASIK
Objective:This study aims to observe and analyze the changes and trends in higher-order aberrations within 6 months postoperatively following three distinct refractive surgeries:small incision lenticule extraction(SMILE),femtosecond laser-assisted in situ keratomileusis(FS-LASIK),and transepithelial photorefractive keratectomy(TPRK).Additionally,this study aims to compare the differences among these surgeries and explore the potential correlations between these changes and patient outcomes.Methods:This prospective nonrandomized clinical study consecutively enrolled 55 patients(55 eyes)with myopia or myopic astigmatism who underwent SMILE,FS-LASIK or TPRK at the Refractive Surgery Center,Eye Hospital,Wenzhou Medical University from July 2020 to June 2021.Only the right eye of each participant was selected,and patients were categorized into three groups based on the surgical intervention:the SMILE group(16 eyes),the FS-LASIK group(19 eyes),the TPRK group(20 eyes).In addition to routine examinations,preoperative and postoperative wavefront aberrations were measured at 1,3,and 6 months.Corneal anterior surface Q value and central corneal thickness(CCT)were obtained from Pentacam anterior segment analyzer.The actual stromal ablation depth was derived from the difference in CCT values between preoperative and postoperative assessments.Effective optical zone diameter was determined using the tangential difference map.Preoperative baseline data,postoperative Q-values,and CCT were compared among the three groups using one-way analysis of variance(ANOVA).Wavefront aberrations across the groups were analyzed using two-way repeated measures ANOVA,with LSD-t tests for further intragroup and intergroup comparisons.The correlation between postoperative aberration and various influencing factors was assessed using Pearson correlation analysis.Results:Within each group,the total higher-order aberrations(HOAs),spherical aberrations,and coma aberrations of the cornea significantly increased postoperatively at all follow-up time points compared to preoperative values in all three groups(all P＜0.05).The total eye HOAs of FS-LASIK group at 3 and 6 months post-surgery and in the TPRK group at all follow-up time points were significantly higher than preoperatively(all P＜0.05).Spherical aberrations in the total eye for both the FS-LASIK and TPRK groups significantly increased after surgery(P＜0.001).The internal HOAs for the SMILE and FS-LASIK groups,internal spherical aberrations for the TPRK group,internal coma aberrations for the SMILE group,and internal trefoil aberration for the FS-LASIK group significantly decreased postoperatively(all P＜0.05).Between groups,corneal spherical aberrations in the FS-LASIK group were significantly higher than those in the SMILE group at 1 month post-surgery(P=0.013),and those in the FS-LASIK and TPRK groups were significantly higher than the SMILE group at 3 and 6 months post-surgery(all P＜0.05).The effective optical zone diameters in the SMILE group were significantly larger than those in the FS-LASIK and TPRK groups(all P＜0.05).The 6 mm Q value of SMILE group was significantly lower than those of the FS-LASIK and TPRK groups(all P＜0.05).The effective optical zone diameters of the three groups were significantly negatively correlated with spherical aberration of the whole eye,HOAs,and cornea spherical aberration(all P＜0.05).The actual ablation depths and Q values of the three groups were positively correlated with corneal HOAs and spherical aberration(all P＜0.05).The absolute value of spherical equivalent was positively correlated with total eye aberration,corneal HOAs,and spherical aberration(all P＜0.05).There was a significant negative correlation between central corneal thickness and corneal spherical aberration(all P＜0.05).Conclusions:After SMILE,FS-LASIK,and TPRK,there is a notable increase in higher-order aberrations(HOAs)of the cornea,predominantly spherical aberration and coma.Among the three procedures,SMILE induces fewer spherical aberrations postoperatively.The induction of postoperative HOAs in all three surgical techniques is associated with the effective optical zone diameter,corneal thickness,asphericity,ablation depth,and the magnitude of refractive correction.
myopiafemtosecond laserkeratomileusiskeratectomyhigh-order aberrationrefractive surgery
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