[摘要]目的：分析飛秒激光小切口角膜基质透镜取出术（Small incision lenticule extraction，SMILE）和飞秒制瓣激光辅助原位角膜磨镶术（Femtosecond assisted laser in situ keratomileusis，FS-LASIK）对近视患者角膜厚度和角膜知觉的影响。方法：回顾性收集2017年7月-2019年12月笔者医院眼科收治的行SMILE治疗的25例近视患者临床资料为SMILE组，另择同期行FS-LASIK治疗的25例近视患者临床资料为FS-LASIK组。比较两组术前和术后1周等效球镜度、角膜曲率、角膜厚度、不同位置角膜知觉，两组术后1周中央区角膜帽厚度、全区角膜帽厚度和并发症发生情况。结果：术后1周，两组等效球镜度较术前升高，SMILE组高于FS-LASIK组，差异有统计学意义（P<0.05）;角膜曲率、角膜厚度较术前降低，SMILE组角膜曲率低于FS-LASIK组，角膜厚度高于FS-LASIK组，差异有统计学意义（P<0.05）。术后1周，SMILE组中央区角膜帽厚度、全区角膜帽厚度均低于FS-LASIK组，差异有统计学意义（P<0.05）。术后1周，两组中央、上方、下方、鼻侧角膜知觉均降低，FS-LASIK组低于SMILE组，差异有统计学意义（P<0.05）。术后1周，SMILE组并发症发生率为6.00%，与FS-LASIK组（12.00%）比较，差异无统计学意义（P>0.05）。结论：与FS-LASIK相比，SMILE治疗近视能显著改善患者视力、角膜曲度和角膜厚度，其制作的角膜帽厚度更薄，对患者角膜知觉损伤更小，同时并发症较少。

[关键词]近视;飞秒激光小切口角膜基质透镜取出术;飞秒制瓣激光辅助原位角膜磨镶术;角膜帽;角膜瓣厚度;角膜知觉

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）05-0008-04

Effect of SMILE and FS-LASIK on Corneal Thickness and Corneal Perception in Myopia Patients

XIAO Chun-xia

（Department of Ophthalmology，Qinzhou District Ophthalmic Hospital，Tianshui 741000，Gansu，China）

Abstract： Objective  To analyze the effects of small incision lenticule extraction （SMILE） and femtosecond assisted laser in situ keratomileusis （FS-LASIK） on corneal thickness and corneal perception of myopia patients. Methods  Between July 2017 and December 2019， the clinical data of 25 myopia patients treated with SMILE were collected retrospectively as SMILE group， and the clinical data of 25 myopia patients treated with FS-LASIK in our hospital at the same period were selected as FS-LASIK group. The equivalent sphericity， corneal curvature， corneal thickness， corneal perception at different positions， central corneal cap thickness， whole corneal cap thickness and complications were compared between the two groups before and one week after operation. Results  One week after operation， the spherical equivalent diopter of the two groups was higher than that before operation， the spherical equivalent diopter of the SMILE group was higher than that of the FS-LASIK group， and the difference was statistically significant （P<0.05）. Corneal curvature and corneal thickness were lower than those before operation， the corneal curvature of SMILE group was lower than that of FS-LASIK group， and the corneal thickness was higher than that of FS-LASIK group （P<0.05）. One week after operation， the thickness of central corneal cap and whole corneal cap in SMILE group were lower than those in FS-LASIK group （P<0.05）. One week after operation， the central， upper， lower and nasal corneal perception decreased in both groups， which was lower in FS-LASIK group than in SMILE group （P<0.05）. One week after operation， the incidence of complications in SMILE group was 6.00%， and there was no significant difference compared with FS-LASIK group （12.00%， P>0.05）. Conclusion  Compared with FS-LASIK， SMILE can significantly improve patients' vision， corneal curvature and corneal thickness. The corneal cap made by Smile has thinner thickness， less damage to patients' corneal perception and fewer complications.

Key words： myopia; small incision lenticule extraction （SMILE）; femtosecond assisted laser in situ keratomileusis （FS-LASIK）; the corneal cap; corneal flap thickness; corneal perception

近视患者由于视力降低，眼睛经常会出现疲劳、干涩等不良状况，对患者生活和工作产生较大影响，据相关数据统计，目前我国近视人数已高达6亿[1]。近年来，随着现代角膜屈光手术的迅速发展，涌现了大量的近视激光治疗技术，飞秒激光应用最为广泛且相较于其他治疗方法，其效果更好，其中飞秒激光小切口角膜基质透镜取出术（Small incision lenticule extraction，SMILE）和飞秒制瓣激光辅助原位角膜磨镶术（femtosecond assisted laser in situ keratomileusis，FS-LASIK）是临床应用较为广泛的两种术式[2-3]。SMILE实现了真正微创化，对于高度近视治疗具有较大潜力，而FS-LASIK具有良好的稳定性和可预测性，两种术式在近视治疗方面各有千秋。……