近视及近视散光眼高阶像差的研究

A study of higher order aberrations in myopia and myopic astigmatism

目的分析近视及近视散光眼高阶像差的分布特点,探讨高阶像差的相关因素,为个体化切削术前病例合理筛选提供客观依据。方法利用Allegretto Wavelight Ana-lyzer像差仪对来我中心欲行准分子激光原位角膜磨镶术(laser situ in keratomileusis,LASIK)的142例(273眼)近视及近视散光患者进行波阵面像差检测并分析结果。结果①4mm瞳孔直径下垂直像差C7与最佳矫正视力(best correctivevision acuity,BSCVA)呈负相关(r=-0.147,P=0.05)。水平彗差C8在不同瞳孔直径下与BSCVA无明显相关性。球差C12在6 mm瞳孔直径下与BSCVA呈负相关(r=-0.151,P=0.044)。②左右眼之间高阶像差比较差异无显著性(P>0.05),男女性别之间高阶像差RMS 3-6比较差异无显著性(P>0.05)。③C7与年龄呈明显负相关(P<0.01),C8与年龄无明显相关性(P>0.05),C12与年龄呈明显正相关(P<0.01)。④RMS3、RMSh与柱镜呈明显正相关(P<0.05),RMS4与球镜无明显相关性(P>0.05)。RMS5在瞳孔大于6mm时与柱镜呈明显正相关(P<0.05),RMS6在瞳孔大于6mm时与球镜呈明显正相关(P<0.05)。结论①眼别与性别对近视及近视散光眼的高阶像差无明显影响。②C7主要受散光和年龄影响,C12主要受年龄影响。③对欲行个体化角膜切削的近视患者,术前除了要考虑总的高阶像差、角膜的不规则性,大瞳孔和再次手术修补等适应证外,还应考虑C7、C12和年龄等因素,综合制订切削方案。

Objective To analyze higher order aberrations in myopia and myopic astigmatism, investigate the relevant factors of higher order aberrations, and present the data for clinical consideration when customized LKSIK can reasonably be performed. Methods To check and analyze the data from volunteers who would like to have LASIK surgery. These patients were diagnosed with myopia and myopic astigmatism and there were no indications of any other ocular diseases. These were 142 cases （273 eyes）, 40 males （80 eyes）, and 102 females （ 193 eyes）. The average age was （29 ± 9.50）years, with a range of 19 - 40 y. Spberical refraction was （ - 5.36 ± 1.57）DS （range of -2.25 to -7.00 DS） and cylindrical refraction was （ -0.72± 0.47）DC （range from - 0.25 to - 2.75 DC）. Best corrected visual acuity （BSCVA） was 0.99±0.11 （0.8 - 1.2）. Aberration analysis was basd on the tscherning theory, from the wave light company of germany. Results ① There was a negative relationship between C7 and BCVA （ r = - 0. 147, P = 0.05） in the 4 mm pupil, but there was no significant relationship between C8 and BCVA. There was a negative relationship between C12 and BSCVA （ r = - 0. 151, P = 0.044） in the 6 mm pupil. ②There was no significant difference between the left and right eyes for higher order aberrations in myopia （ P 〉 0.05） nor was there a significant difference between males and females （ P 〉 0.05）. ③There was a significant negative relationship between C7 and age （ P 〈 0.01 ）, but there was no relationship between C8 and age （ P 〉 0.05 ）. However, there was a positive relationship between C12 and age （ P 〈 0.01 ）. ④There was a positive relationship between RMS3/RMSh and astigmatism （ P 〈 0.05 ） and between RMS5 and astigmatism when the pupil was larger than 6 mm（ P 〈 0.05 ）. There was also a positive relationship between RMF6 and sphere, when the pupil was larger than 6 mm （ P 〈 0.05 ）. Conclusion ①For higher order aberrations, there are no significant differences between the left and fight eyes; there is also no significant difference between genders. ②With an increase in age, higher order spherical aberrations become larger while the value of vertical coma becomes smaller. With an increase in refractive astigmatism, the values of the coma and geaeral higher order aberrations become larger. Coma is mainty affected by astigmatism, and spherical aberration （C12） is mainly affected by age. ③Complex factors such as C7, C12 and age, etc. should be analyzed before customized corneal laser ablation surgery, is performed. Eyes with higher order aberration values, corneal irregularity, a larger pupil or enhancement are other factors that should also be taken into consideration.