智慧型光斑LASIK治疗近视临床分析

Clinical observation of varied size spot laser for the treatment of myopia

目的:探讨智慧型光斑LASIK治疗近视或近视散光可预测性、稳定性、有效性及术后残留屈光度危险因素分析。方法:回顾性分析2008-10/2009-10在我中心行LASIK病例,术前最佳矫正视力(BCVA)≥0.8,随访时间>1mo,球镜<-10.00D纳入统计分析病例,共768例。按激光切削模式及屈光度分组,对术后裸眼视力,术后1,3,6mo;1a残留等效球镜,屈光回退患者术前术后数据行统计学分析。结果:10例BCVA术后未达术前;预测性:术后常规组98.0%SE<0.50D,99.2%SE<1.00D;波前组97.4%SE<0.50D,99.3%SE<1.00D;术后残留屈光度,常规组:1mo:-0.01±0.10D;3mo:-0.02±0.20D;6mo:-0.07±0·31D;1a:-0.15±0.38D。波前组:1mo:-0.01±0.08D;3mo:-0.01±0.09D;6mo:-0.03±0.15D;1a:-0.08±0.19D;视力改变,常规组:0±0.05,波前组:0.01±0.04。23例术后残留屈光度危险因素分析,术后残留球镜与年龄,术前球镜有关,术后球镜=1.355-0.034年龄+0.142术前球镜;术后残留柱镜与术前柱镜,术前中央角膜厚度有关,术后柱镜=3.489+0.238术前柱镜-0.007术前中央角膜厚度。结论:智慧型光斑LASIK预测性,稳定性,有效性均较好,波前像差引导LASIK在预测性及有效性方面更优,两种术式均有较好的稳定性;术后残留球镜危险因素:年龄、术前球镜,术后残留柱镜危险因素:术前柱镜、术前中央角膜厚度。

AIM： To evaluate the predictability, stability, efficacy of laser in situ keratomileusis （LASIK） using varied size spot laser for the treatment of myopia and compound myopic astigmatism. And analyse risk factors in residual refrac-tion after LASIK. METHODS： A total of 768 samples （eyes） were enrolled in this retrospective study in our surgery center from Oct. 2008 to Oct. 2009. The inclusion criteria were spherical equivalent （SE） no more than -10.00D, follow-up periods more than one month and BCVA no less than 0.8. The samples were divided by surgery mode and power of SE. The uncorrected visual acuity （UCVA）, residual refraction of one month, three months, six months, one a after surgery and the preoperative and postoperative data of regression samples were used for statistics. RESULTS： Ten samples lost the BCVA; 98.0% samples were within 0.50D of emmetropia and 99.2% of the samples were within 1.00D of conventional LASIK（conven-tional group）, 97.4% and 99.3% of wavefront-guided LASIK（wavefront-guided group） respectively; the residual refraction was - 0.01±0.10D at one month, - 0.02±0.20D at three months, - 0.07±0.31D at six months, - 0.15±0.38D at one year postoperatively in conventional group and the residual refraction was -0.01±0.08D at one month, - 0.01±0.09D at three months, - 0.03±0.15D at six months, - 0.08±0.19D at one year postoperatively in conventional group. The change in visual acuity （posto-perative UCVA preoperative BCVA） was 0±0.05 and 0.01±0.04 of the two groups respec-tively. Analysis of the residual refractive error of the 23 samples of residual refraction： residual spherical （RS） was related to age and preoperative spherical, residual spherical = 1.355- 0.034 age ＋ 0.142 preoperative spherical; residual cylinder was related to preoperative cylinder and preoperative center corneal thickness, residual cylinder =3.489＋0.238 preoperative cylinder -0.007 preoperative center corneal thickness. CONCLUSION： Varied size spot LASIK is predictable, stable, and effective for the treatment of myopia and compound myopic astigmatism, wavefront-guided LASIK was better than conventional LASIK on the aspect of predictability and efficacy, both surgery modes have a good stability; age and preoperative spherical power were risk factors for residual spherical, preoperative cylinder and preoperative center corneal thickness were risk factors for residual cylinder.