多种验光模式在LASIK术前检查中的应用

Comparison of different optometric tests to measure refraction before LASIK

目的比较准分子激光原位角膜磨镶术（LASIK）前多种验光模式的差异性和相关性。方法前瞻性临床研究。拟接受LASIK手术122例（241眼），近视球镜度为-0．75- -13．25D，平均（-5．57±2．40）D；柱镜度为-0．25- -5．50D，平均（-0．96±66）D。术前分别进行检影验光、电脑验光、主觉验光以及Orbscan Ⅱ检查；术后1年进行主觉验光，对获得数据进行分析。检影验光、电脑验光与主觉验光结果的差异性采用单因素方差分析，OrbscanⅡ结果与主觉验光结果的差异性采用配对t检验。不同验光结果的相关性采用Pearson相关分析。结果通过检影验光、电脑验光和主觉验光获得的球镜度分别为（-5．20±2．61）D、（-5．64-±2．71）D和（-5．57-±2．40）D，差异具有统计学意义（F=38．586，P〈0．01）：检影验光、电脑验光和主觉验光获得的柱镜度分别为（-0．99±0．66）D、（-1．03±0．73）D和（-0．96±0．66）D．差异具有统计学意义（F=15．147，P〈0．01），OrbscanⅡ获得的柱镜度为（-1．16±1．84）D，与主觉验光的差异具有统计学意义（t=3．190，P〈0．01）；检影验光、电脑验光和OrbscanⅡ提示的散光轴向与主觉验光结果差异均无统计学意义。不同验光模式所得的验光结果均具有密切的线性相关（r均〉0．9．P〈0．01）。结论应采取多种验光手段对预进行LASIK手术患者的屈光状态进行综合评估，以确保手术效果。

Objective To compare the accuracy and reliability of refraction with different optometric tests before laser in situ keratomileusis （LASIK）. Methods It was a prospective clinical study. Two hundred and forty one eyes of 122 myopes with a spherical range of -0.75±13.25 D, average, -5.57±2.40 D and cylinder range of -0.25--5.50 D, average, -0.96±0.66 D. Four different optometric tests were used before the exeimer laser surgery： cycloplegic retinoscopy, autorefraction, subjective refraction and Orbsean Ⅱ. Subjective refraction was performed on the patients 1 year postoperatively. Data were analyzed using one-way ANOVA, a paired samples t test and Pearson correlation. Results The mean spherical results with cycloplegic retinoscopy, autorefraction and subjective refraction were -5.20±2.61 D, -5.64±2.71 D and -5.57±2.40 D, respectively. These were significantly different （F=38.586, P〈0.01）. The mean cylinder results with cycloplegic retinoscopy, autorefraetion and subjective refraction were -0.99±0.66 D, -1.03±0.73 D and -0.9_±0.66 D. These were significantly different （F=15.147, P〈0.01）. The cylinder measured by Orbscan Ⅱ was -1.16±1.84 D, which was significantly different from the result by subjective refraction （t=3.190, P〈0.01）. A Pearson correlation showed a high correlation for the results from the different optometric tests （r〉0.9 for all, P〈0.01 for all）. Conclusion It is important to note in clinical practice, comprehensive optometric tests are necessary for the success of exeimer laser surgery.