多焦点准分子激光原位角膜磨镶术治疗老视眼术后早期视觉质量的研究

Evaluation of vision quality in presbyopic patients after multifocal LASIK

目的探讨多焦点准分子激光原位角膜磨镶术(LASIK)矫治老视眼术后随访6个月的视觉质量。方法有老视症状者42例84眼,应用模拟调节角膜(PAC)软件计算激光切削形态后进行角膜中央视远周边渐进性视近的多焦点切削,术前及术后1、3、6个月检测,指标为裸眼远近视力、对比敏感度(CS)、球差(C12)、垂直慧差(C7)、水平慧差(C8)及斯特列尔比(SR)等。结果术后6个月42例(100%)患者远视力达到0.8及以上,30例(71%)患者近视力达到0.5及以上。双眼各空间频率CS与术前比较,仅在1.5cpd较术前升高(P<0.05),术后所有眼的C12减小,C7和C8增加,SR值与术前比较减小,但差异无统计学意义(P>0.05)。术后1个月38例(91%)患者比较满意或特别满意,7例(17%)主诉有眩光、幻影、星爆等症状,术后6个月不适症状比例为7%。结论多焦点LASIK矫治老视有效性高,并发症少,但同时应重视其造成的视觉质量的下降。

Objective Different approaches have been reported to treat presbyopic patients. Muhifocal laser in situ keratomileusis（LASIK） is capable of compensating for presbyopia. This study was to analyze the quality of vision at postoperative 6 months after muhifocal LASIK for correction of presbyopic symptoms. Methods Multifocal LASIK was performed on 84 eyes of 42 patients with presbyopia. The follow-up time was 6 months. The ablation pattern of pseudo-accommodative cornea software was selected to design a muhifocal ablation with a peripheral nearzone. The observation index in preoperation and postoperative 1 month,3 and 6 months were as follows： uncorrected distance and near visual acuity, contrast sensitivity （CS）, spherical aberration, vertical coma, horizontal coma, strehl ratio and a questionnaire. Results At 6 months postoperatively,42 （ 100% ） patients achieved an uncorrected visual acuity of≥0. 8 and 30 （71% ）patients showed the uncorrected near visual acuity of≥0. 5. After 6 months, the significant change in contrast sensitivity was noted only in 1.5 cpd （ P 〈 0.05 ）. The spherical coefficients were decreased and the coma coefficients were increased at 6 months postoperatively, however, the changes were not significant（P 〉 0. 05 ）. A indistinctive decrease was also noted in strehl ratio at 6 months postoperatively（ P 〉 0. 05 ）. Thirty-eight（91% ）patients were either very satisfied or satisfied with this surgery at postoperative 1 month and 7 （17%）patients complained glare,ghost and starburst. Three patients complained these symptoms at postoperative 6 months. Conclusion Peripheral muhifocal presby LASIK is a safe and predicted procedure for correction of presbyopia. Howerev,the change of vision qulity following surgey should be concerned.