角膜波前像差引导的个性化LASIK手术后角膜像差变化的临床研究

Corneal Aberrations Changes after Corneal Wavefront Aberrations Guided Laser in situ Keratomileusis:A Clinical Study

目的观察角膜波前像差引导的个性化准分子激光原位角膜磨镶术(LASIK)手术治疗近视后角膜像差变化情况及其与术前预矫屈光度的相关性。方法按自愿选择非随机原则,将行准分子激光手术治疗的55例101只眼分为两组,其中22例40只眼接受常规小光斑飞点扫描LASIK手术(常规组),另33例61只眼接受基于ORK-CAM软件角膜波前像差引导的个性化LASIK手术(个性化组)。记录两组患者术前和术后7d的裸眼视力、最佳矫正视力、残留屈光度;Optikon 2000角膜地形图仪测量术前和术后7 d球差、彗差、总体像差均方根值(RMS)。结果术前常规组平均屈光度等效球镜值为(-5.27±2.04)D,个性化组为(-4.48±1.92)D;术后7 d常规组裸眼视力为0.96±0.21,平均残留屈光度为(0.97±0.63)D;个性化组视力为1.02±0.20,平均残留屈光度为(0.86±0.71)D,两组之间差异无显著意义。术前两组角膜球差、彗差和RSM值差异均无显著意义。术后7 d球差、彗差值增加量在两组间差异有显著意义(P<0.05,P<0.01),RMS差异无显著意义(P>0.05),术后球差、彗差值增加量个性化组均低于常规组。两组术后球差增加量与术前屈光度数呈显著负相关(相关系数分别为r=-0.823、-0.876,P<0.01),彗差值增加量与术前屈光度数亦呈负相关(相关系数分别为r=-0.310、-0.345,P<0.05)。总像差RMS与术前屈光度数在常规切削组呈正相关(相关系数为r =0.348,P<0.05),而在个性化组呈显著正相关(相关系数为r=0.787,P<0.01)。结论角膜波前像差引导的个性化切削LASIK手术后球差、彗差值增加量均小于常规组,与术前预矫屈光度数相关性亦较常规组为佳,具有良好的稳定性和可预测性。

Objective To observe the effect after corneal wavefront aberrations guided laser in situ keratomileusis on correcting myopia, to present the changes in root mean square （ RMS）, comatic and spherical aberrations and analyze the relationship among diopter and the changes in comatic aberrations, spherical aberrations and RMS.Methods The pratients were divided into LASIK group （22 cases, 40 eyes） and corneal wavefront aberrations guided LASIK group （33 cases, 61 eyes）. All procedures were performed with the Esiris excimer laser system and Moria microkeratome. The Optikon- 2 000 Keratron Scout device was used for topography and corneal wavefront measurements. Preoperation and 1 day and 7days postoperation the UCVA, BCVA and remained diopter were recorded. Preoperation and 7 days postoperation corneal root mean square（RMS） , comaatic and spherical aberrations were analyzed.Results （1） Before surgery, the diopter, comatic and spherical and abertations and RMS were similar between two groups [ （ -5.27±2.04） D versus （ -4.48 ± 1.92） D,P =0. 052; 0.21 ±0. 11 versus 0. 23 ±0. 12,P =0. 286; 0. 30 ±0. 09 versus 0. 32 ±0. 08,P =0. 243 ;6. 72±2.49 versus 7. 29 ±2.63 ,P =0. 274） ]. （2） At 7 days postoperation,between the UCVA and remained diopter the differences were without statistical significance （ P 〉 0. 05 ）, but there were statistically significances in the changes in comatic and spherical aberrations（ P 〈 0. 05 and P 〈 0. 01 ）. （3）There was negative correlation between diopter and spherical aberrations increment （r = - 0. 823 and - 0. 876, P 〈 0. 01 ）, and so between diopter and coma aberrations increment （r = - 0. 310 and - 0. 345, P 〈 0. 01 ） in two groups ;there was postive correlation between diopter and all aberrations RMS changes in two groups （r = 0. 348 versus0. 787, P 〈0.05 versus P〈0. 01）.Conclusions Corneal wavefront aberrations guided LASIK is effective, stable and predictable, the corrected myopia, and the comatic and spherical aberrations increment are lower than LASIK group, and the relationship between aberrations changes and diopter is all better than the latter group.