波前像差引导个体化切削治疗高度近视视觉质量评价

Evaluation of the vision qualiy following wavefront-guided laser in situ keratomileusis for high myopia

目的观察波前像差引导的个体化切削治疗高度近视患者手术前后视力、对比敏感度、眩光以及波前像差的变化，评价其对视觉质量的影响。方法回顾性病例研究。对2007年10月至2008年10月在武警河南总队医院眼科就诊，选取屈光度为-6．0≤球镜≤-10．0D，柱镜≤-2．0D的高度近视患者200例（380只眼）行波前像差引导的个体化切削，手术治疗区直径均〉6．0mm。检查术前及术后1周、1月、3月及6月患者的裸眼视力、屈光度、对比敏感度和波前像差。统计分析使用SPSSl1．0软件包的独立样本进行t检验。结果波前像差引导的个体化切削患者术后裸眼视力均达到术前矫正视力，部分患者比术前矫正视力提高2行；术后I周高阶像差增加，术后1月和3月逐渐降低，术后3月和术前比较差异仍有统计学意义（P〈0．05）；术后1周各空间频率的对比敏感度及眩光敏感度与术前比较均明显下降，差异有统计学意义（P〈0．05），术后3月时各空间频率对比敏感度和眩光敏感度均有恢复，低频率段恢复至接近术前水平，中、高频率段恢复较慢，和术前比较差异仍有统计学意义（P〈0．05）。结论波前像差引导的个体化切削有效地提高高度近视患者的远视力，部分患者可以获得超常视力，但是术后仍有高阶像差的增加和对比敏感度的下降。

Objective To observe the pre and postoperative changes of visual quality, contrast sensitivity （CS）, glare contrast sensitivity （GCS） and wavefront aberration in high myopic patients who received wave-front guided customized ablation （WAGCA）. Methods It was a retrospective case series. High myopic patients were collected in Henan peoples armed police corps hospital from October, 2007 to October, 2008. A total of 380 eyes in 200 high myopic patients with preoperative spherical refraction of-6.0 D to -10.0 D and astigmatism 〈2 D received WAGCA. The ablation zone was 〉6. 0mm. The uncorrected visual acuity （UCVA）, CS, GCS and corneal wave-front aberrations were ana- lyzed before surgery and at 1 week, 1 month and 3 months postoperatively. Results After WAGCA, uncorrected visual acuity （UCVA） in all of the patients recovered to or better than the preoperative best spectacled-corrected visual acuity （BSCVA）. High order aberrations （HOA） increased at 1 week and then decreased slowly at 1 month and 3 months postoperatively. But the statistical difference was still significant at 3 months （P 〈0.05）. The postoperative CS and GCS of every space frequency de- creased after WAGCA. The difference between the preoperative and 1 week after operation was significant （P 〈0.05）. At 3 months postoperatively, the low space frequency recovered nearly to preoperative level, but the differeflee of the medium and high space frequency was still statistically significant （P 〈0.05）. Conclusions WAGCA is effective on correcting high myopia and some patients can gain super visual acuity, but the HOA increases and the CS and GCS decrease after WAGCA. The wave-front aberration, CS and GCS measurements combined with usual examination can more effectively evaluate the changes of visual function after WAGCA.