目的：观察飞秒激光小切口角膜基质透镜取出(SMILE)术后角膜光密度(CD)及高阶像差的变化，并探讨其相关性及影响因素。方法：前瞻性研究。收集2022年12月至2023年11月在乌鲁木齐爱尔眼科医院接受SMILE手术的高度近视和高度近视复合散光患者62例62眼(为避免双眼相关性，所有患者均取右眼进行分析)。分别于术前，术后1 d，1 wk，1、3、6 mo测量患者的角膜CD值、角膜高阶像差均方根(RMS HOA)、球差、垂直彗差、水平彗差及角膜上皮厚度(CET)。结果：随访期间共4例患者均因未能按时复查失访，完整有效病例58例58眼。术后1 d角膜前层、中间层、全层的中央区和旁中央区CD值较术前显著增加(均P<0.003)； 术后6 mo时前层的中央区、旁中央区和总前层CD值出现下降(均P<0.003)。术后6 mo时RMS HOA、球差、垂直彗差均较术前增加(均P<0.003)，水平彗差无变化。术后6 mo时角膜中央区、旁中央区、外周区CET及角膜0-7 mm范围总平均CET均较术前增加(均P<0.003)。术后1 d角膜前层和全层的中央区CD值与中央区的CET呈正相关(rs=0.327、0.250，均P<0.05)。术后6 mo角膜中间层、后层中央区的CD值与术前等效球镜度和ΔRMS HOA均呈负相关(均P<0.05)。结论：SMILE矫正高度近视患者术后6 mo角膜前层光密度降低，光密度变化与部分临床参数之间有一定的相关性。

AIM: To observe the changes of corneal densitometry(CD)and higher-order aberrations after small incision lenticule extraction(SMILE), and to explore their correlations and influencing factors.METHODS: Prospective study. A total of 62 high-degree myopia and compound myopic astigmatism patients(62 eyes)who underwent SMILE in Urumqi Aier Eye Hospital from December 2022 to November 2023 were collected. The CD, root mean square of corneal higher-order aberrations(RMS HOA), spherical aberration, vertical coma, horizontal coma, and corneal epithelial thickness(CET)of the patients were measured before surgery, and at 1 d, 1 wk, 1, 3, and 6 mo after surgery, respectively.RESULTS:There were 4 patients lost to follow-up during the period, all due to failure to attend scheduled reexaminations. The number of complete and valid cases was 58 eyes. The CD in the central and paracentral regions of the anterior, middle, and total layer of the cornea increased significantly on the first day after surgery(all P<0.003). At 6 mo after surgery, there was a slight but statistically significant decrease in the CD of the central and paracentral regions of the anterior and the total anterior layer(all P<0.003). Compared with the preoperative baseline values, the RMS HOA, spherical aberration, and vertical coma significantly increased at 6 mo after surgery(all P<0.003), while the change in horizontal coma was not statistically significant. Compared with the preoperative baseline values, the CET in the central, paracentral, and peripheral regions of the cornea, as well as the total average CET in the 0-7 mm range of the cornea increased at 6 mo after surgery(all P<0.003). At 1 d after surgery, CD of the anterior layer and total layer in the central region of the cornea were positively correlated with the CET in the central region(rs=0.327, rs=0.250, all P<0.05). At 6 mo after the surgery, the CD of the middle layer and posterior layer in the central corneal region were negatively correlated with the preoperative spherical equivalent and the change of RMS HOA(all P<0.05).CONCLUSION:The anterior CD decreases at 6 mo after SMILE for high myopia correction, and there is a certain correlation between the changes in CD and some clinical parameters.

乌鲁木齐市卫生健康委科技计划项目(No.202370)