SMILE与FS-LASIK术后角膜生物力学变化的Meta分析

Meta-Analysis of Corneal Biomechanics after SMILE and FS-LASIK

摘要: 目的：探讨飞秒激光小切口透镜取出术(small incision lenticule extraction, SMILE)和飞秒激光制瓣的准分子激光角膜原位磨镶术(femtosecond laser-assisted laser in situ keratomileusis, FS-LASIK)治疗近视术后角膜生物力学的差异。方法：进行荟萃分析，使用MEDLINE、EMABASE、中国知网、Cochrane图书馆检索有SMILE和FS-LASIK术后角膜生物力学的报告。分析内容包括术前和术后3个月角膜滞后量CH和角膜阻力因子CRF。使用Newcastle-Ottawa Scale (NOS)文献质量评价量表评价报告的质量。采用RevMan5进行统计学分析。结果：在这项荟萃分析中，最终只包括6项研究，771只眼，并使用随机效应模型。术前SMILE组和FS-LASIK组相比较CH和CRF差异均无统计学意义(WMD, −0.12; 95% CI, −0.31~0.06; P, 0.19; WMD, −0.05; 95% CI, −0.29~0.19; P, 0.69)。术后3个月CH，国外组，两种手术方式差异无统计学意义(WMD, 0.19; 95% CI, −1.02~1.41; P, 0.75)。中国组，两种手术方式CH差异无统计学意义(WMD, 0.13; 95% CI, −0.16~0.41; P, 0.75)。术后3个月CRF，国外组，两种手术方式差异无统计学意义(WMD, −0.11; 95% CI, −2.53~−2.31; P, 0.93)。中国组，两种手术方式差异有统计学意义(WMD, 0.26; 95% CI, 0.06~0.47; P, 0.01)。结论：这一荟萃分析表明，SMILE和FS-LASIK术后CH差异无统计学意义；CRF国外组差异无统计学意义，国内组SMILE优于FS-LASIK。

Abstract: Objective: To evaluate and compare corneal biomechanics after small-incision lenticule extraction and femtosecond laser-assisted laser in situ keratomileusis. Methods: We conducted a me-ta-analysis and searched for reports concerning corneal biomechanical effects after small-incision lenticule extraction and femtosecond laser-assisted laser in situ keratomileusis using Medline, EMbase, CNKI, and the Cochrane Library. The quality of the reports was evaluated using the New-castle-Ottawa Scale (NOS). Results: Only six studies with a total of 771 eyes were ultimately in-cluded in this meta-analysis and the random-effects model was used. CH and CRF after SMILE and FS-LASIK were compared by meta-analysis, including pre-operation and 3 months post-operation. There was no difference in CH and CRF between SMILE and FS-LASIK before surgery (WMD, −0.12；95% CI, −0.31~0.06; P, 0.19; WMD, −0.05; 95% CI, −0.29~0.19; P, 0.69). There was no significant difference between the two surgical methods in CH at 3 months after operation and in the foreign group (WMD, 0.19; 95% CI, −1.02~1.41; P, 0.75). In the Chinese group, there was no significant difference in CH between the two surgical methods (WMD, 0.13; 95% CI, −0.16~0.41; P, 0.75). There was no significant difference between the two surgical methods in CRF at 3 months after operation and in the foreign group (WMD, −0.11; 95% CI, −2.53~−2.31; P, 0.93). In the Chinese group, the difference between the two surgical methods was statistically significant (WMD, 0.26; 95% CI, 0.06~0.47; P, 0.01). Conclusion: This meta-analysis showed that there was no significant difference in CH between SMILE and FS-LASIK; there was no significant difference in CRF in the foreign group, but in the domestic group, SMILE was better than FS-LASIK.