准分子激光原位角膜磨镶术术中一眼激光切削延迟时双眼波阵面像差的分析

Analysis of wavefront aberrations in myopic eyes when ablation of one eye with an excimer laser is delayed

目的利用波阵面像差检测仪探讨准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)中角膜瓣制作与激光扫描切削在时间上有延迟时对手术效果的影响。方法30例(60眼)近视患者自愿接受LASIK手术。手术方式基本同常规LASIK术,不同点为:用角膜刀先后制作左、右眼带蒂上方角膜瓣,再分别对右、左眼角膜基质层行激光切削。于术前、术后第1周、第1个月、第3个月进行双眼波阵面像差的检测和分析。结果术前双眼波阵面像差均方根值(root means squares,RMS)检测各组值比较差异无显著性(P>0.05)。术后第1周在中小瞳孔直径下,右、左眼RMS2和RMSg比较差异有显著性(P<0.05)。术后第1个月仅在小瞳孔直径下,右、左眼RMS2比较差异有显著性(P<0.05)。RMS1、RMS3-6、RMSg及RMSh各组值比较差异均无显著性(P>0.05)。术后第3个月双眼RMS各组值比较差异均无显著性(P>0.05)。术后各时期双眼裸眼视力、最佳矫正视力、平均屈光度比较差异均无显著性(P>0.05)。结论该手术方式步骤衔接紧密,省出有效时间消毒显微角膜板层刀和相关器械,对术后稳定效果无影响,适宜于对大批患者集中进行手术,易于推广应用。

Objective To investigate the effectiveness of surgery with a wavefront aberrametor after LASIK when corneal flap making and laser ablation were not performed at the same time. Methods Thirty patients with myopia who were scheduled to have LASIK surgery in our center were included in the shady. Among these patients, 14 patients （28 eyes） were males and 16 patients （32 eyes） were females. The average age was （27.78 ± 6.07） years （range, 19 to 38 years）. The spherical equivalent of the right eyes was （ -5.51 ± 1.63）D （range, -2.50 D to - 10.00 D）and the spberical equivalent of the left eyes was （ - 5.41 ± 1.55）D （range, - 2.50 D to -9.00 D）. The surgical procedure was almost identical to conventional LASIK. The only difference was that the corneal flaps of left eyes and right eyes were made successively with a microkeratome before laser ablation was performed on the corneal stroma. The wavefront aberrations of both eyes were measured and compared before surgery and 1 week, 1 month and 3 months after surgery. Results The wavefront aberration values for both eyes showed no significant differences among groups of RMS1-6, RMSg, and RMSh before. surgery （P〉0.05）. The significant results appeared at 1 week （values of RMS2 and RMSg for moderate pupil size） and 1 month （values of RMS2 for small pupil size） after surgery （P 〈 0.05）, while the values of RMSI, RMS3-6 and RMSh showed no significant differences （ P 〉 0.05）. All of the RMS values did not differ significantly between the right and left eyes at 3 months after surgery （ P 〉 0.05 ）. There were no significant differences for UCVA, BCVA and SE when measured at the three different follow-up times after surgery. Conclusion This proedure saves time and proved to be no different in visual quality from the conventional procedure.