波阵面像差引导下个体化LASIK治疗近视的早期分析

Wavefront aberrametor guided Lasik on myopia

目的探讨波阵面差引导下准分子激光角膜原位磨镶术(个体化)治疗近视的术后疗效,为指导临床合理治疗提供客观依据。方法随机选取2002年12月~2004年12月在我院欲行手术治疗者386例678眼,排除手术禁忌症后,行术前常规检查及波阵面差检查,从中选取高阶相差均方根值(RMSh)超过或等于0.25;或RMSh在0.20~0.25之间,而RMS3和RMS4大于0.15者39例68眼。均为女性,年龄20~38岁,平均31岁。术前平均视力0.10±0.09;最佳矫正视力1.00±0.08。术前球镜度数:-4.57±1.58D(-2.25^-6.25D)/柱镜度数:-0.68±0.39D(0^-1.25D)。手术方法为波阵面差引导下鹰式准分子激光角膜原位磨镶术(个体化切削),采用WAVE-LIGHT公司的波阵面差仪和ALLEGRETTO鹰式准分子激光机,法国MORIA-2自动角膜板层刀。结果①术后1周裸眼视力1.20±0.21;最佳矫正视力1.30±0.19。屈光度术后1周球镜度数+0.38±0.40D/柱镜度数+0.09±0.19DC。术后1月裸眼视力1.13±0.29/最佳矫正视力1.4±0.31;屈光度术后1月球镜度数+0.33±0.13D/柱镜度数+0.04±0.10D。术后3月裸眼视力1.12±0.25/最佳矫正视力1.39±0.34;术后3月球镜度数+0.25±0.12D/柱镜度数+0.05±0.12D。②术后一周波阵面差值(总均方根值)较术前明显降低;术后一个月较术后一周有所增高(部分超过术前)。但各阶均方根值变化不同。③术后无一例出现眩光,光晕,夜间暗视力下降等并发症。结论波阵面差引导下个体化准分子激光角膜原位磨镶术治疗近视散光,安全可靠,临床疗效佳,提倡在临床屈光手术中推广。但是此项个体化手术术前适应证的选择一定要严格谨慎。

Objective To investigate the clinical results with wavefront aberrametor- guided Lasik on myopia. Methods 386 cases （678 eyes） who were operated in our myopia laser correction center from Dec 2002 to Dec 2004 were selected randomly. After contraindications were excluded, conventional examination and wavefront aberration examination were performed on these patients. The 39 patients （68 eyes） whose values of RMS of high - order aberration were above or equal to 0.25, or the value of RMSh was ranged from 0.20 to 0.25, while the value of RMS 3 and RMS4 were above 0.15, were included. They were all females and aged from 18 to 38 years. （The average age was 31 years）. The average visual acuity was 0.10± 0.09, and the BCVA of preoperation was 1.00± 0.08. The spherical diopter preoperation was -4.57±1.58D （ 2.25～6.27D）, and the cylindrical diopter was -0.68±0.39D （0～1.25D）. The operative method was wavefront aberration guded Lasik （customized ablation） with Allegretto wavelight （Germany） and Moria 2 keratome （France）. Results 1. The outcome of wavefront aberration 1 week [xxstoperation： UCV： 1.20 ± 0.21, BCVA： 1.30 ± 0.19, mean of spherical diopter： ＋ 0.38 ± 0.40D and mean of cylindrical diopter： ＋ 0.09 ± 0.19D. The outcome of wavefront aberration 1 month postoperation： UCV- 1.13 ± 0.29, BCVA： 1.40 ± 0.31, mean of spherical diopter： ＋ 0.33 ± 0.13D and mean of cylindrical diopter： ＋ 0.04 ± 0.10D; 1.12 ± 0.25/1.39 ± 0.34 at 3 months; ＋ 0.25 ± 0.12D/＋ 0.05 ±0.12D at 3 months. 2. The general value of wavefront lW lmstoperation decreased significantly than that of preoperation, and the value of wavefront aberration 1M postoperation increased slightly than that of 1W postoperation （A part of valus was above those of preoperation）. There are different changes in the value of each order RMS. 3. No complication was found （such as glare, halo and night VA decreasing）. Conclusions The correction of myopia with wavefront aberrametor- guided Lasik is safe and reliable, and the clinical results are better than before. So we advocate that it should be popularized in clinical refractive surgery. But the indications of this customized surgery should be selected strictly.