近视及近视散光眼手术前高阶像差的分析

Higher Order Ocular Aberrations in Eyes with Myopia and Myopic Astigmatism

目的了解近视及近视散光患者眼高阶像差的特征,探讨近视度数、散光度数等对高阶像差的影响。方法随机选取欲行准分子激光手术的161只眼进行检查,按近视度数分为高、中、低近视组,按散光度数分为Ⅰ、Ⅱ组,像差数据由Hartmann-Shack原理设计的德国WASCA波阵面像差仪测得。提取当瞳孔直径为4.0、5.0和6.0mm时每眼的高阶相差值,使用方差分析以及简单直线相关分析,探讨瞳孔大小、近视度数、散光度数对高阶像差的影响及最佳矫正视力与高阶像差的关系。结果各高阶像差值均随瞳孔直径的增大而增大;高、中、低度近视组的高阶像差值差异均无显著意义(P>0.05);在瞳孔直径为5和6mm时,两个散光组的总高阶像差和垂直彗差差异有显著意义(P<0.05),垂直彗差和最佳矫正视力正相关(r=0.542,0.685,P<0.05),球差和最佳矫正视力负相关(r=-0.573,-0.758,P<0.05)。结论瞳孔大小影响近视及近视散光患者眼的高阶像差;近视度数不影响眼的高阶像差;散光度数影响垂直彗差和总高阶像差;在行波阵面像差引导的个体化切削手术时应充分考虑垂直彗差和球差对视觉质量影响。

Objective To analyze the characteristics of higher order ocular aberrations in eyes with myopia and myopic astigmatism, and determine the effects of myopia and astigmatism on higher order aberrations. Methods One hundred and sixty one myopic astigmatism eyes were evaluated before refractive surgery by using a Hartmann-Shack method. According to the degree of myopia and astigmatism, it is divided into high myopia, moderate myopia, low myopia and groups Ⅰand Ⅱ The values of higher-order aberrations for each subject with pupil diameters of 4. 0, 5.0 or 6. 0 mm were calculated . The correlations between higher order aberrations and myopia, astigmatism, and best corrective vision acuity （ BSCVA）, respectively, were analyzed using analysis of variance and linear regression method. Results All types of higher order aberrations were increased significantly with increasing pupil size. However, they were not affected by the degree of myopia. In 5.0 mm and 6. 0 mm pupil, astigmatism affected total higher order aberrations and vertical primary coma, but horizontal primary coma and spherical aberration. In 5.0 mm and 6. 0 mm pupil, there was a positive relationship between vertical primary coma and BSCVA （ r = 0. 542, 0. 685, P 〈 0. 05 ）, a negative relationship between spherical aberration and BSCVA （ r = -0.573, -0.758,P〈0.05）. Conclusions All types of higher order aberrations are affected by pupil diameters, but not the degree of myopia. Astigmatism affects total higher order aberrations and vertical primary coma. Maintaining smaller vertical primary coma aberration and correcting spherical aberration completely for myopia and myopic astigmatism may be the best choice for customized cornea laser ablation surgery.