Analysis Of Higher-order Aberration Changes And Visual Quality After Corneal Topography-guided Trans-PRK And SBK

Objective: To study the refractive regression,changes in higher-order aberrations and subjective visual quality scale analysis after corneal topography-guided plus smart pulse technique-assisted trans-epithelial excimer laser keratomileusis versus anterior Sub-Bowman keratomileusis.Methods: A prospective cohort study was used to collect data from patients with low to moderate myopia with or without astigmatism in a non-randomized controlled design.Patients who met the inclusion and exclusion criteria attending Jining No.1 People’s Hospital were divided into two groups according to individual preference: the case group underwent SBK and the control group underwent Trans-PRK,with 32 eyes in the SBK group and 30 eyes in the Trans-PRK group.The results of best corrected visual acuity(BCVA),uncorrected distance visual acuity(UDVA),columnar refraction,spherical refraction and equivalent spherical refraction(SE),as well as higher order aberrations including spherical aberration,coma aberration,root mean square of higher order aberrations and subjective visual quality scale were compared before and1 week,1 month and 3 months after surgery.Results: Both refractive procedures had good effectiveness and safety.The equivalent spherical refraction,column refraction,and equivalent spherical refraction were significantly improved in both groups after surgery,and the equivalent spherical refraction in the Trans-PRK group was higher than that in the SBK group at 1 week after surgery and the Trans-PRK group at 1 month after surgery(P≤0.05).(In the SBK group,corneal spherical aberration and total corneal higher-order aberration were significantly higher at 1 week postoperatively,while corneal wise-difference was not statistically significantly different(P ≤ 0.05).In the Trans-PRK group,corneal wise-difference,corneal spherical aberration,and total corneal higher-order aberration were higher at 1 week postoperatively than before surgery(P ≤ 0.05).In both groups,corneal wise-difference,corneal spherical aberration,and total corneal higher-order aberration were higher than those before surgery at 1 month and 3 months postoperatively,and there was no significant difference between the two groups at 1 month postoperatively and 3 months postoperatively(P ≤ 0.05).In the Trans-PRK group,corneal spherical aberration was lower than that in the SBK group at 1 week,1 month,and 3 months postoperatively,and was statistically different(P ≤ 0.05).The change of postoperative corneal spherical aberration in the SBK group was related to the preoperative spherical lens,preoperative equivalent spherical lens and intraoperative central zone cutting corneal depth.On the subjective visual quality scale,both groups showed significantly better symptoms of blurred near vision at 1 month postoperatively than at 1 week postoperatively(P≤0.05).At 1month postoperatively,the Trans-PRK group showed statistically less symptoms of blurred near vision and ocular dryness and fatigue relative to the SBK group(P≤0.05).At 3 months postoperatively,the Trans-PRK group showed fewer symptoms of dry eyes relative to the SBK group(P≤0.05).Conclusion: In the correction of low to moderate myopia,both Transepithelial Photorefractive Keratectomy(Trans-PRK)and anterior Sub-Bowman keratomileusis(SBK)assisted by corneal topography guidance plus smart pulse technology have good refractive correction results after surgery.In this study,we found that Trans-PRK resulted in better quality of vision than SBK.In terms of elevated postoperative higher-order aberrations,corneal wisps,corneal spherical aberration and total corneal higher-order aberrations were higher in both groups at 1month and 3 months postoperatively than before surgery,but corneal spherical aberration was significantly lower in the Trans-PRK group than in the SBK group at 1 week,1 month and 3 months postoperatively.In the SBK group,the changes in postoperative corneal spherical aberration were related to the preoperative spherical lens,preoperative equivalent spherical lens,and intraoperative central zone cutting depth.In terms of subjective visual quality,patients in the Trans-PRK group had better near visual acuity and less eye fatigue and dryness at 1 month postoperatively,and patients in the Trans-PRK group had less frequent eye fatigue and dryness than those in the SBK group at 3 months postoperatively.