Q值优化角膜地形图引导的准分子激光原位角膜磨镶术临床研究

Clinical study of corneal topography-guided LASIK with Q value

目的观察Astrapro个性化软件Q程序引导准分子激光原位角膜磨镶术（Laser insitukeratomileusis，LASIK）的临床效果，评价该软件应用于手术的安全性和有效性。方法对2007年3～6月行LASIK手术的患者92例（184只眼）随机分为两组。标准化92只眼为Ⅰ组，应用传统模式；个性化92只跟为Ⅱ组，以Astrapro2．2Q程序引导。记录术前及术后3个月的数据，以术后最佳矫正视力、角膜切削深度、激光切削时间为手术安全性指标；以术后裸眼视力与术前最佳矫正视力之比、手术前后Q值的变化、术后实际光学区（OZ）大小、术后对比敏感度的恢复作为手术有效性指标。结果两组术后裸眼视力与术前最佳矫正视力之比无统计学差异（P〉0．05）；两组切削深度、激光切削时间无统计学差异（P〉0．05）；个性化组手术前后Q值的变化较标准手术组小（P〈0．001）；个性化组术后实际光学区较标准手术组大（P〈0．001）；两组术后1个月各个空间频率的平均对比敏感度均低于术前，3个月时个性化组对比敏感度全部恢复，标准手术组尚未恢复。结论Astrapro2．2个性化软件Q治疗程序引导的LASIK手术具有良好的临床效果和安全性。术后角膜地形图提示：角膜前表面形态虽未达到预设的目标Q值-0．26，但较标准化手术更接近术前Q值，更有效地维持了术前横椭圆非球面形态（Prolate）。

Objective To observe and access the clinical effect and safety of corneal topography-guided LASIK with Astrapro-Q.Methods Total of 92 patients （ 184 eyes）were randomly divided into two groups： 46 patients （92 eyes）of standard LASIK were assigned to Group I and 46 patients （92 eyes）of corneal topography-guided LASIK with Astrapro-Q were assigned to Group Ⅱ .Inspect and record the data of before and after the surgery. Whether loss the best corrected visual acuity after surgery or not, laser ablation time and real ablation depth was regard as safety. The ratio of the best corrected visual acuity of preoperation and the best naked viaual acuity of postoperation, the difference of Q value of before and after surgery, the optics zone and the recovery of contrast sensitivity after surgery was regard as effectivity. The two data were analyzed with statistics.Results There were no siginificant difference between two groups at the ratio of the best corrected visual acuity ofpreoperation and the best naked viaual acuity ofpostoperation, laser ablation time and real ablation depth （P〉0.05）.All patients visual acuity were not decreased after surgery.The difference of Q value in Group Ⅱ were smaller than that in Group Ⅰ （P 〈0.001 ）.The optics zone after surgery in Group Ⅱ were lager than that in Group Ⅰ （P 〈0.001 ）.The contrast sensitivity after surgery in two qraps Ⅰ were docrease than that in before surgery at one months after surgery.It can almost recover at three months after surgery in ffoup Ⅱ. But the contrast sensitivity can not recover in Groupi after surgery ar the sanetime.Conelutions The LASIK guided by corneal topography with Astrapro-Q is effective and safe.The topography shows that comeal superficial profile do not become anticipated Q value-0.26, but was more near preoperational level than after surgery and attained better prolate ellipse than stardard LASIK.