飞秒激光小切口角膜基质透镜取出术(Small incision lenticule extraction, SMILE)凭借微创、无瓣和高精准度的特点,受到越来越多近视患者的青睐。研究表明,SMILE手术在矫正近视及近视散光方面具有较好的安全性、有效性、稳定性和可预测性,并且术后能够获得较好的视觉质量。然而,现有研究指出SMILE在矫正近视散光方面总体上存在欠矫趋势,影响SMILE矫正散光的因素包括术前散光大小、散光轴位、角膜上皮重塑、术中眼球旋转、眼内散光等因素。本文就SMILE在矫正近视散光中的影响因素以及现有补偿措施方法进行综述。Small incision lenticule extraction (SMILE) has gained increasing popularity among myopic patients due to its minimally invasive, flapless, and high-precision features. Studies have demonstrated that SMILE exhibits favorable safety, efficacy, stability, and predictability in correcting myopia and myopic astigmatism, with satisfactory postoperative visual quality. However, current evidence indicates a general trend of undercorrection in astigmatism treatment with SMILE. Key influencing factors include preoperative astigmatism magnitude, astigmatic axis, corneal epithelial remodeling, intraoperative cyclorotation, and ocular residual astigmatism (ORA) among others. This review systematically summarizes the critical factors affecting astigmatism correction accuracy in SMILE and discusses existing compensatory strategies.
