伴不全纽扣瓣的准分子激光原位角膜磨镶术后屈光状态和手术效果分析

An assessment of refraction and visual acuity after LASIK with a partial button hole

目的观察伴有不全纽扣瓣的准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)后屈光状态、视力和角膜地形图情况。方法选取出现不全纽扣瓣并继续激光切削的患者13例,不全纽扣瓣均出现在左眼,故以右眼为对照,分为不全纽扣瓣组和对照组,对两组病例术后第1天、第1周、第1个月、第3个月的裸眼视力(uncorrected visual acuity,UCVA)、球镜度数、柱镜度数和术后第1个月的角膜散光值(cylinder,CYL)、表面非对称性指数(surface asymme-tryindex,SAI)、不规则散光指数(irregular astigmatism index,IAI)进行配对t检验。结果不全纽扣瓣组的UCVA稍低于对照组,但在术后各时间点差异均无显著性(P>0.05)。两组柱镜度数比较差异无显著性(P>0.05),术后第3个月时,均在0.50D以内。不全纽扣瓣组术后第1天、第1周、第1个月、第3个月的球镜度数分别为(1.7±0.4)D、(1.2±0.7)D、(1.1±0.7)D、(0.7±0.7)D;对照组分别为(0.9±0.4)D、(0.6±0.7)D、(0.7±0.5)D、(0.7±0.6)D,其中术后第1天、第1周和第1个月两组比较差异有显著性(P<0.05),术后第3个月差异无显著性(P>0.05)。不全纽扣瓣组术后第1个月的CYL和SAI与对照组比较差异无显著性(P>0.05),IAI稍高于对照组(P<0.05)。结论本组伴有不全纽扣瓣的LASIK术后早期过矫偏多,但屈光度变化幅度大,其术后UCVA、散光度数和角膜地形图受影响不大。

Objective To assess refraction, visual acuity and corneal topography after laser in situ keratomileusis （LASIK） with a partial button hole. Methods This retrospective study included 13 LASIK cases with partial button holes that had occurred in the left eyes and continued to ablate. The eyes were divided into two groups：the partial button hole group （including all left eyes） and a contrast group （including all right eyes）. Uncorrected visual acuity （UCVA） and sphere and cylinder measurements for the two groups were compared at 1 day, 1 week, 1 month and 3 months after surgery. At the same time, some corneal topographic indices such as the cylinder （CYL）, surface asymmetry index （SAI） and irregular astigmatism index （IAI） for the two groups were separately compared at 1 month after surgery. Results The UCVA of the partial button hole group was slightly lower than for the contrast group, but there was no statistical difference at any time-point （P〉0.05）. Cylinder measurements for the two groups were also similar （P〉0.05） and were within 0.50 D at 3 months after surgery. Sphere measurements were （1.7±0.4）D, （1.2±0.7）D, （1.1±0.7）D, and （0.7±0.7）D, respectively, at 1 day, 1 week, 1 month and 3 months after surgery for the partial button hole group and were （0.9±0.4）D, （0.6±0.7）D, （0.7±0.5）D, and （0.7±0.6）D, respectively, for the contrast group. The sphere measurements for the two groups were statistically different （P〈0.05） at 1 day, 1 week and 1 month after surgery, but there was no statistical difference （P〉0.05） at 3 months. The IAI of the partial button hole group was slightly higher than that for the contrast group （P〈0.05）, but there were no statistical differences for CYL and SAI （P〉0.05）. Conclusion The over-correction sphere of the partial button hole group was initially higher than that of the contrast group after surgery and was more unstable, but the UCVA, cylinder and corneal topography of the partial button hole group was only slightly worse than that of the contrast group.