Q值引导及Kappa角调整后SBK和飞秒LASIK术后高阶象差的对比

A clinical study comparing the changes in higher-order aberrations following SBK and femtosecond laser LASIK with a customized Q-factor and Kappa adjustment

目的 比较在Q值引导及Kappa角调整的准分子切削模式下,机械刀制瓣SBK（OUP-SBK）和飞秒制瓣LASIK（FS-LASIK）2种手术方式对术眼的高阶像差的影响.方法 回顾性病例对照研究.43例患者（86眼）根据制瓣方式不同分为2组：SBK组（23例46眼）和FS组（20例40眼）,均采用Q值引导及Kappa角调整的准分子切削模式手术,分别于术前、术后1个月、术后3个月测量术眼的总高阶像差及各单项高阶像差.应用方差分析和独立样本t检验分析高阶像差在不同时间点的变化以及2组间的差异.结果 SBK组和FS组的总高阶像差均方根（RMS）值在术后1个月和3个月时均较术前增加（F=14.935、6.498,P＜0.01）;SBK组C40、C42、C4较术前有增加（F=8.326、3.202、6.195,P＜0.01）.FS组只有球差C40较术前有增加（F=9.045,P＜0.01）.2组的比较：术后1个月、3个月时SBK组和FS组的总高阶像差RMS值（t=0.26、0.88,P＞0.05）以及RMS增加量（t=0.74、1.24,P＞0.05）比较差异均无统计学意义,但在1个月时C44（t=3.08,P＜0.0l）,在3个月时C4-2（t=-2.34,P＜0.05）、C44（t=2.78,P＜0.01）2组间差异有统计学意义.结论 Q值引导及Kappa角调整后,SBK和FS制瓣的LASIK手术后术眼总高阶像差均有增加,但高阶像差的增加量两者并无差异,但个别的单项高阶像差存在差异.

Objective To compare the changes in higher-order aberrations following microkeratome SBK （OUP-SBK） and femtosecond laser LASIK （FS-LASIK） with customized Q-factor and Kappa adjustment.Methods This was a retrospective clinically controlled study.Forty-three patients （86 eyes）were divided into two groups：one group （46 eyes of 23 cases） was treated with the Moria One Use-Plus SBK and the other group （40 eyes of 20 cases） with a VisuMax FS-LASIK.Both groups had customized Q-factor and Kappa adjustment during laser ablation.Higher-order aberrations were measured preoperatively and 1 month and 3 months postoperatively.An analysis of variance and independent t test were used to analyze the changes in higher-order aberrations after FS-LASIK and SBK.Results At the 1st and 3rd month postoperatively,there was an increase in all higher-order aberrations in both groups （F=14.935,6.498,P〈0.01）.In the SBK group,spherical aberrations （C40） and 4th order aberrations （C42,C44） had increased on the 1st and 3rd months （F=8.326,3.202,6.195,P〈0.01）.The C40 in the FS-LASIK group had increased on the 1st and 3rd months （F=9.045,P〈0.01）.A comparison of the SBK and FS-LASIK groups showed there were no significant differences when higher-order aberration （t=0.26,0.88,P〉0.05） and changes （t=0.74,1.24,P〉0.05） were compared postoperatively at 1 and 3 months.There were significant differences in aberration C44 in the 1st month （t=3.08,P〈0.01） and C4-2 and C44 in the 3rd month （t=-2.34,2.78,P〈0.05）.Conclusion With customized Q-factor and Kappa adjustment during laser ablation,higher-order aberrations increase with both mechanical microkeratome and VisuMax femtosecond flap creation.There is no significant difference in the total change in higher-order aberrations,but there is a difference in some single higher-order aberrations.