Q值调整的个体化准分子激光原位角膜磨镶术治疗近视临床疗效

Clinical efficacy of the Q-value adjusted customized laser in situ keratomileusis for myopia correction

目的探讨Q值调整的个体化切削准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)治疗近视的安全性、有效性、可预测性和稳定性。方法应用美国雷赛Astramax三维角膜地形图仪、Astrapro个体化切削设计程序和Astrascan XL准分子激光系统,对33例(66眼)近视患者行Q值调整的个体化LASIK手术。30例(59眼)近视患者作为对照组行标准切削方式的LASIK手术。随访6个月,评价手术疗效。结果标准组和Q值组术后第6个月结果:"!安全性:两组均无一眼下降2行及以上,下降一行的各仅为2眼。"#有效性:术后裸眼视力分别为5.04±0.06和5.05±0.07,5.0以上分别为89.8%和90.9%,5.1以上为49.2%和50.0%。"$可预测性:术后平均等效球镜分别为(-0.11±0.44)D和(-0.07±0.44)D,在目标值±0.50D以内分别为83.1%和80.3%,±0.25D以内均为57.6%。"%稳定性:术后第1、第3和第6个月的平均等效球镜为-0.02966D和0.096591D,-0.09746D和0.003788D,-0.11441D和-0.07197D,变化均小于0.25D。上述4种指标均未见统计学差异。&"术后Q值分别为0.42±0.21和0.107±0.23,两者差异有显著性。结论6个月的随访结果显示,两组具有较高的安全性、有效性、可预测性和稳定性;Q值调整的个体化切削比标准切削更有助于维持角膜生理性的非球面性。其远期效果仍需更多病例、更全面的评价指标和更长时间的随访和研究。

Objective To evaluate the efficacy, safety, predictability and stability of the Q-value adjusted customized laser in situ keratomileusis （LASIK） using the Lasersight platform for the treatment of myopia. Methods Thirty-three patients were enrolled in a controlled study in which thirty-three patients were treated with the Q-value customized ablation （Q-value adjusted study group） and thirty patients were treated with standard ablation （control group）. The procedures for both groups were done with a Lasersight Astrascan XL excimer laser system. Q-value customized ablation was prepared with an Astramax topographer and Astrapro ablation planning software. The efficacy, predictability, safety, and stability were evaluated for a period of 6 months following surgery. Results The evaluation at 6 months showed the following results for the standard group and Q-value adjusted group： （1.）Safety： No eye lost more than 2 lines of best spectacle-corrected visual acuity （BSCVA） in either group, and only 2 eyes lost 1 line of BSCVA;（2） Efficacy：UCVA was 5.04±0.06 and 5.05±0.07, with 5.0 or better in 89.8% and 90.9%; 5.l or better in 49.2% and 50.0%, respectively; （3）Predlctability： Postoperative mean spherical equivalent of the manifest refraction （SE） was （-0.11±0.44） D and （-0.07±0.44） D, 83.1% and 80.3% of eyes were within ±0.5D of the intended correction, respectively; 57.6% of eyes were within ±0.25 D of the intended correction for both groups;（4）Stability： SE was -0.02966 D and 0.096591 D, -0.09746 D and 0.003788 D, -0.11441D and -0.07197D at 1, 3 and 6 months, respectively, and the change was less than 0.25 D over 6 months for both groups. There was no statistical difference between the two groups in terms of the above 4 indices;（5）Q-value： Postoperative Q-value for the Q-adjusted group was 0.107±0.23, which required significantly less oblation when compared to the standard ablation group （0.42±0.21）. Conclusion Both Q-value adjusted customized ablation and standard ablation LASIK surgeries show very good safety, efficacy, stability and predictability after 6 months of follow-up. The Q-value adjusted group appears to exceed those of standard treatment in terms of maintaining anterior corneal asphericity.