Q值引导与标准LASIK治疗近视临床疗效的Meta分析

Comparison of Q-value guide LASIK and standardized LASIK for the treatment of myopia ：a meta-analysis

背景当前，临床上正广泛开展各种个体化的准分子激光角膜屈光手术。其中，Q值引导的个体化切削准分子激光原位角膜磨镶术（Q—LASIK）是目前的研究热点之一。目的系统评价Q值引导LASIK和标准LASIK治疗近视的临床疗效。方法检索MEDLINE、中国期刊全文数据库（CNKI）、Cochrane图书馆、EMbase，对有关比较Q值引导LASIK和标准LASIK临床疗效的临床试验文献进行Meta分析。Meta分析的内容包括术后裸眼视力、角膜前表面的Q值、高阶像差、残余屈光不正的等效球镜度。统计学分析采用ReviewManager5．0，连续性变量以加权均数差（WMD）（95％CI）或标准均数差（SMD）（95％cI）为疗效分析统计量，计数资料则用优势比OR（95％CI）。按照Jadad评分量表对有效检索文献的证据等级进行评价。结果共14篇文献，1617例患者2956眼（等效球镜为0—-10D）纳入研究，包括临床随机对照试验6篇和病例对照试验8篇。其中2篇按Jadad量表评分法为3分，质量较好，其余12篇为1～2分，质量欠佳。Meta分析显示，Q值引导LASIK组术后裸眼视力达20／20以上的跟数与标准LASIK组相比差异无统计学意义[OR=1．16，95％CI（0．61～2．19），P=0．65]，Q值引导LASIK术后裸眼视力较标准LASIK组好，差异有统计学意义[WMD=0．04，95％CI（0．00～0．08），P〈0．05]。术后Q值引导组的Q值较标准组小，差异有统计学意义[SMD=-1．52，95％CI（-2．23—-0．81），P=0．00J。术后Q值引导组的总高阶像差较标准组小，差异有统计学意义[SMD=-1．58，95％CI（-2．38，-0．77），P〈0．05]，术后Q值引导组的球差较标准组小，差异有统计学意义[SMD=-1．25，95％CI（-2．07，-0．43），P〈0．05]，而术后2组慧差的差异无统计学意义[WMD=-0．10，95％CI（-0．29～0．09），P=0．31]。术后Q值引导组残余屈光不正的等效球镜度以及残余屈光不正的等效球镜度在±O．5D以内的眼数与标准LASIK组相比差异均无统计学意义[WMD=0．10，95％CI（-0．11～0．31），P=0．34]、[OR=1．01，95％CI（0．52～1．96），P=0．99]。结论与标准LASIK相比，Q值引导LASIK治疗近视术后裸眼视力更好，Q值更小，术后总高阶像差和球差更小，而术后彗差及残余屈光不正的等效球镜度两者基本相同。在评价Q值引导LASIK与标准LASIK的临床疗效方面，还需要更多高质量的临床随机对照研究文献。

Background Nowadays, customized ablation is widely used in the excimer laser corneal refractive surgery. And the Q-value guide LASIK is one of the research hotspots. Objective Present study was to evaluate and compare the effectiveness of Q-value guide LASIK and standardized LASIK for myopia. Methods A systematic literature retrieval from 2003 through 2010 was conducted in the MEDLINE, CNKI, Coehrane Library, EMBASE. The literature examine possible differences in uncorrected visual acuity （UCVA） , Q-value, higher order aberrations（HOAs）, and spherical equivalent （SE） between Q-value guide LASIK and standardized LASIK for correcting myopia. Statistical analysis was performed using a Review Manager 5.0 software. The data was extracted, and the methodological quality was evaluated by two reviewers independently. The quality of included literature was scored according to the Jadad Scale. Results A total of 14 studies involving 1617 patients （2956 eyes） was included in the meta-analysis. Of these fourteen studies,six studies were randomized trials and the other eight studies were retrospective cohort studies. According to the Jadad Scale,2 studies scored 3 points, and the other 12 studies scored 1 ~ 2 points. The results showed that the Q-value guide LASIK group had a better postoperative effectiveness in uncorrective visualaeuity（UCVA） （WMD=0.04,95% CI0.00to0.08,P〈0.05）,Q-value （SMD=-1.52,95% CI -2.23 to-0.81,P=0.00）,total HOAs （SMD=-1.63,95% CI -2.57 to -0.69,P〈0.05） and spherical-like aberrations （SMD =-1.49,95% CI -2.22 to -0.76 ,P〈O. 00） after surgery. However, the number of eyes achieved UCVA≥20/20 （OR=1.16,95% CI0.61 to 2. 19,P=0.65）,coma-like aberrations （SMD=-1.02,95% CI-0.36 to0. 11,P=0.29） and SE （WMD=0.10,95% CI -0.11 to 0.31,P=0.34） after surgery were comparable. Conclusion The effectiveness of Q-value guide LASIK is superior to standardized LASIK for treatment of myopia. High-quality clinical randomized-controlled study should be performed to further evaluate the comparable outcome of Q-value guide LASIK with standard LASIK.