飞秒激光与机械角膜刀制瓣准分子激光原位角膜磨镶术后视觉质量对比分析

Comparison of visual quality after laser in situ keratomileusis flap creation with a femtosecond laser and a mechanical microkeratome

目的对比分析FEMTOLDV飞秒激光与Hansatome机械角膜刀制瓣辅助准分子激光原位角膜磨镶术（LASIK）后高阶像差和对比敏感度（CS）。方法前瞻性临床对照研究。接受飞秒激光制瓣46例（92眼）作为观察组，同期用Hansatome微型角膜刀制瓣52例（104眼）作为对照组，制瓣后均行波前像差引导的准分子激光切削术。对术后高阶像差、CS及眩光CS进行比较。采用卡方检验、方差分析、独立样本t检验进行数据分析。结果视力：术后1周，观察组裸眼视力（UCVA）达到或高于术前最佳矫正视力（BCVA）59眼（64．1％），对照组76眼（73．1％）；术后1个月2组分别为82眼（89．1％）、96眼（92．3％），术后3个月时分别为86眼（93．5％）和96眼（92．3％）。各时间点2组比较差异均无统计学意义（X2=1．423、1．112、0．183，P〉0．05）。屈光度：术后1周观察组为（＋O．49±0．24）D，对照组为（＋0．35±0．32）D；术后3个月观察组为（＋0．10±0．18）D，对照组为（0-．14±0．22）D；2组差异均无统计学意义（t=0．566、1．178，P〉0．05）。高阶像差：术后1周及3个月时全眼球总高阶像差及彗差的均方根值观察组低于对照组（t1周=-2．422、-2．295．t3个月=1．957、-1．926，P〈0．05），球差及三叶草2组间差异均无统计学意义。CS：明视下2组术后各时间点差异无统计学意义。暗视下观察组CS值术后1周时最低，但对比术前差异无统计学意义（P〉0．05），1个月时CS值已达到术前水平，尤其1个月和3个月时3．0和18．0c／d处CS值高于术前（F=3．602、3．216．P〈0．05）。术后1周时6．0c／d处观察组高于对照组（t=2．326，P〈0．05），术后1、3个月时2组间差异无统计学意义。眩光CS：明视下术后1周时3．0、12．0c／d处观察组显著高于对照组（t=2．173、2．327，P〈0．05），术后1、3个月时2组间差异无统计学意义。暗视下眩光CS值术后1周时在空间频率为3．0、6．0c／d处观察组高于对照组（t=2．124、2．691，P〈0．05）；术后3个月时，在中低空间频率为1．5、3．0、6．0c／d处观察组高于对照组（t=2．428、2．416、2．507，P〈0．05）。结论飞秒激光辅助LASIK手术后CS结果优于机械角膜刀制瓣LASIK。

Objective To compare and analyze the higher-order aberrations （HOA）, contrast sensitivity （CS） and CS under the glare after FEMTO LDV femtosecond laser flap and mechanical microkeratome Hansatome flap in laser in sitn keratomileusis （LASIK）. Methods This was a prospective clinical controlled study. Ninety-two eyes of 46 patients were treated with FEMTO LDV as the observation group, and 104 eyes of 52 patients were treated with Hansatome as the control group. Wavefront-guided LASIK （Zyoptix） was performed on each of these eyes after the flap preparation. HOA, CS and CS under the glare were evaluated before surgery and 1 week, 1 month, 3 months after treatment. Data were analyzed using chi-square test, ANOVA, independent t test. Results At 1 week after the surgery, 59/92（64.1%） patients in the observation group had uncorrected visual acuity （UCVA） levels reaching or surpassing the preoperative best corrected visual acuity （BCVA）, while in the control group, this rate was 76/104（73.1%）. At 1 month after the surgery, the rate of UCVA〉preoperative BCVA was 82/92 （89.1%） in observation group and 96/104 （92.3%） in control group. At 3 months after the surgery, the rate of UCVA〉preoperative BCVA was 86/92（93.5%） in observation group and 96/104（92.3%） in control group. The two groups were not significantly different after the surgery （X2=1.423, 1.112, 0.183, P〉0.05）. The refraction was ＋0.49＋0.24 D in the observation group and ＋0.35±0.32 D in the control group at 1 week after surgery, while at 3 months, it was ＋0.10±0.18 D in the observation group and ＋0.14±0.22 D in the control group. The differences between the 2 groups were insignificant （t=0.566, 1.178, P〉0.05）. Higher-order aberration. At 1 week and 3 months, the HOA and coma in the observation group were all lower than in the control group （t1 w=-2.422, -2.295, t3,,=-1.957, -1.926, P〈0.05）. There were no difference in spherical aberration and trefoil between the 2 groups （t1w w=-1.395, -0.779, t3m=-1.205, -0.922, P〉0.05）. The 2 groups photopic CS was not significantly different after the surgery. The observation group mesopic CS decreased to the lowest level at 1 week postoperation, and returned to preoperative level at 1 month after operation. At 1 month and 3 months, the CS were higher than preoperation at 3.0, 18.0 c/d （F=3.602, 3.216, P〈0.05）. At 1 week after surgery, the mesopic CS of the observation group was better than the control group at 6.0 c/d （t=2.326, P〈0.05）. The 2 groups mesopic CS was not significantly different at 1 month and 3 months after operation. At 1 week after surgery, the photopic CS under the glare stimulus of the observation group was significantly higher than the control group at 3.0, 12.0 c/d （t=2.173, 2.327, P〈0.05）. At 3 months, the medium to low spatial frequencies （1.5, 3.0, 6.0 e/d） the mesopic CS of observation group was higher than the control group （t=2.428, 2.416, 2.507, P〈0.05）. Conclusion Patients undergoing femtosecond laser-assisted LASIK have better quality of vision after surgery than hansatome patients.