目的:利用光学相干断层扫描血管成像技术(OCTA)对比飞秒激光小切口角膜基质透镜取出术(SMILE)与飞秒激光制瓣准分子激光原位角膜磨镶术(FS-LASIK)术中负压吸引对浅层视网膜血流密度、视网膜厚度和视网膜神经纤维层的影响.方法:前瞻性非随机对照研究.选取2017年11月至2018年3月于首都医科大学附属北京同仁医院屈光手术中心就诊且双眼等效球镜度(SE)＜-6.00 D患者(45例).根据手术方式不同分为FS-LASIK组22例(22眼),SE为(-8.10±1.20)D,SMILE组23例(23眼),SE为(-7.34±1.90)D.所有患者除行常规检查外,由同一人进行术前、术后1周、术后1个月、术后3个月OCTA检查.应用重复测量方差分析、独立样本t检验对数据进行分析.结果:术后3个月时,FS-LASIK组和SMILE组裸眼视力均达到术前最佳矫正视力,SE分别为(0.14±0.82)D和(-0.23±0.56)D,差异无统计学意义(t=1.696,P=0.098).FS-LASIK组和SMILE组术前浅层视网膜血流密度、视网膜厚度和视盘旁视网膜神经纤维层厚度差异无统计学意义(均P＞0.05),且术后1周、术后1个月、3个月2组间比较差异无统计学意义(均P＞0.05).结论:FS-LASIK和SMILE术中负压吸引对高度近视眼底微结构无显著影响.高度近视眼选择2种手术方式均是安全可行的.%Objective: To compare the effect of suction on the retinal superficial vascular networks's flow density, macular retinal thickness, and retinal nerve fiber layer thickness during small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) surgery using optical coherence tomagraphy angiography (OCTA). Methods: This was prospective, non-randomized, controlled study. From November 2017 to March 2018, 45 patients with a binocular spherical equivalent (SE) ＜-6.00 D were treated at the same refractive surgery center of Beijing Tongren Hospital. The study included 22 patients (22 eyes) who had undergone FS-LASIK and 23 patients (23 eyes) who had undergone SMILE surgery, and the SE was -8.10±1.20 D, and -7.34±1.90 D, respectively. Besides the routine examinations, all patients were examined with OCTA by the same operator. OCTA was performed at 1 week, 1 month and 3 months after surgery. Repeated measures analysis of variance and independent sample t-tests were used to analyze and compare the collected data from the two surgical groups. Results: All patients had uncorrected and best corrected visual acuity assessed preoperatively. The FS-LASIK and SMILE groups had SE values of 0.14±0.82 D and -0.23±0.56 D, respectively, at 3 months postoperatively. The difference was not statistically significant (t=1.696, P=0.098). There were no significant differences in the preoperative retinal superficial vascular networks's flow density, macular retinal thickness, and retinal nerve fiber layer thickness between the FS-LASIK group and SMILE group (all P＞0.05), and there were no statistical differences between the follow-up times at 1 week, 1 month and 3 months after surgery in each group (all P＞0.05). Conclusions: The suction during SMILE and FS-LASIK surgery has no effect on the microstructural parameters of the fundus in high myopic eyes. It is safe and feasible to choose either surgical methods for high myopia.
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