常规LASIK与波前像差引导的LASIK治疗中高度近视散光的对比研究

The comparison of standard LASIK and wavefront aberration guided LASIK in treatment of high myopia a- stigmatism

目的比较常规准分子激光原位角膜磨镶术(简称常规LASIK)和波前像差引导的个体化LISIK(简称波前像差引导LASIK)矫正中高度近视散光后的视觉质量。方法随机选取2011年1月至2012年12月在我院行准分子激光手术者,其中散光度数≥-2.00 DC作为入选对象共82例(163只眼)。其中选择行波前像差引导的LASIK术者42例(83只眼),散光(-3.55±1.09)DC;接受常规LASIK术者40例(80只眼),散光(-3.47±1.23)DC。所有患者术前与术后7 d、1个月、6个月分别进行视力、角膜地形图、波前像差的检查和视疲劳满意度调查,比较两组的差别。结果 (1)术后7 d、1个月、6个月波前像差引导的LASIK术者视力分别优于常规LASIK术者(P<0.05)。(2)角膜地形图查残余角膜散光度:波前像差组7 d、1个月、6个月分别为(-0.35±0.24)DC、(-0.42±0.13)DC、(-0.51±0.19)DC;常规组7 d、1个月、6个月分别为(-0.75±0.28)DC、(-0.92±0.23)DC、(-1.21±0.21)DC,两组差异有统计学意义(P<0.05)。(3)波前像差组和常规组高阶像差均呈增加趋势,以彗差和球差增加为主。波前像差组在总高阶像差(HOAROM)、30°三叶草(Z6)、垂直彗差(Z7)和水平彗差(Z8)高阶像差的改变显著优于常规组(P<0.05)。(4)视疲劳满意度调查:波前像差组明显优于常规组。结论波前像差引导的个性化LASIK较常规LASIK能更好地矫正中高度近视散光,使患者术后角膜残余散光更少,高阶像差的增加更少,视力恢复更理想,视觉质量更佳,患者的满意度更好。

Objective To compare the visual quality outcomes of the standard LASIK and wavefront aberration guided LASIK surgery in high myopia astigmatism patients. Methods Totally 82 patients （ 163 eyes ） of high myopia astigmatism （ 92.00 D） who received excimer laser surgeries in our hospital between January 2011 and December 2011 were involved in this .study. Among these subjects, forty-two patients （ 83 eyes） were treated with wavefront aberration guided LSAIK, and forty patients were treated with standard LASIK. The average preoperative astigmatism was -3.55 ± 1.09 DC and -3.47± 1.23 DC respectively. Visual acuity, wavefront corneal topographic map, and visual fatigue were surveyed before and 7 days, 1 month, 6 months after surgery. Results （ 1 ） Visual acuity was significantly better in patients received wavefront guided LASIK than in patients received standard LASIK at 7 days, 1 month and 6 months （ P 〈 0.05 ）. Residual astigmatism was - 0.35 ± 0.24 DC, - 0.42 ± 0.13 DC, and - 0.51 ±0. 19 DC in patients received wavefront aberration guided LASIK at 7 days, 1 month and 6 months, respectively. In contrast, residual astigmatism was much higher （ P 〈 0. 05 ） in patients received standard LASIK at the same time points （ - 0.75 ± 0.28 DC at 7 days, - 0.92 ± 0.23 DC at 1 month, and - 1.21 ±0.21 DC at 6 months, respectively）. （3） Higher order aberrations, particularly, spherical and coma aberrations were found to be increased in beth groups. Total higher order aberrations （ HOAROM）, 30°clover （ Z6）, vertical coma （Z7） and level of coma （ Z8 ） aberrations were significantly smaller in wavefront aberration guided LASIK group （P 〈0.05 ）. 4. The visual fatigue survey returned better responses in wavefront aberration guided IASIK group. Conclu- sion Wavefront aberration guided LASIK was relatively superior to standard LASIK in terms of correcting high myopia astigmatism, less residual astigmatism, less higher-order aberrations, better visual acuity, better visual quality, and better patient satisfaction.