准分子激光多焦点非球面切削模式治疗远视型老视术后2年临床评价

Clinical evaluation of biaspheric multifocal central presby LASIK treating hyperopic presbyopia 2 years postoperation

目的 评价准分子激光多焦点非球面切削模式治疗远视型老视的安全性、有效性和可预测性.方法 前瞻性自身对照研究.对36例（72眼）远视型老视患者采用飞秒激光制瓣后用准分子激光SUPRACORTM老视矫正技术矫正远视后在角膜中央区进行老视矫正,检测手术前后患者的裸眼远、近视力,屈光度,角膜形态学数据,眼压（IOP）,中央角膜厚度,角膜变形指数及患者术后主观感受,术后随访24个月.计量资料正态分布采用配对t检验及重复测量方差分析,非正态分布资料手术前后比较采用Friedman秩和检验,两两比较用配对Wilcoxon符号秩和检验.结果 手术均顺利,术后24个月裸眼远视力为0.1 （0.5～-0.1）logMAR,与术前[0.2（1.0～0.0）logMAR]相比,差异有统计学意义（Z=-2.59,P＜0.01）;术后24个月裸眼近视力为0.2 （0.8 ～-0.1） logMAR,较术前[0.55 （1.3～0.3）logMAR]提高（6.75±1.81）行,差异有统计学意义（Z=-7.14,P＜0.01）.术后24个月球镜度为-0.25（-1.25～＋1.25）D,柱镜度为-0.24（-1.25～0.00）D,与术前比较差异有统计学意义（Z=-12.14、-3.87,P＜0.01）,术眼屈光度由术前的远视状态变为轻度近视漂移.术后24个月角膜中央3 mm区屈光力（43.97±1.67）D,较术前的[（43.33±1.51）D]有所提高（t=16.85,P＜0.01）,角膜中央5 mm屈光力及后表面屈光力与术前比较差异无统计学意义.手术前后IOP、中央角膜厚度差异无统计学意义,角膜变形指数术后大于术前（F=4.88,P＜0.01）,术后各时间点差异无统计学意义.术后6个月采用生活质量调查表对患者主观感受进行量化评价,得分为（80±16）分.结论 准分子激光多焦点非球面模式切削治疗远视型老视术后能提高患者远、近视力,有较好的安全性、有效性和稳定性。

Objective To evaluate safety and efficacy of SUPRACORTM technique in treating hyperopic presbyopia.Methods It was a retrospective case-series study.Seventy-two eyes of 36 patients with hyperopic presbyopia a new centered multifocal aspheric Presby LASIK, and followed 24 months postoperatively.Uncorrected distance visual acuity （UDVA）, uncorrected near visual acuity （UNVA）, diopter, central corneal curvature, intraocular pressure, central corneal thickness,corneal deformation amplitude and patient satisfaction （questionnaire） were measured.Data were analyzed using paired t test, repeat measured ANOVA, Friedman rank sum test.Results The UDVA of 24 months postoperative improved compared with preoperation [0.1 （0.5--0.1）logMAR vs.0.2（1.0-0.0）logMAR, Z=-2.59, P〈0.01].The UNVA of 24 months postoperative improved compared with preoperation [0.2（0.8--0.1）logMAR vs.0.55（1.3-0.3）logMAR, Z=-7.14, P〈0.01].The spherical dioptor and cylindrical dioptor were-0.25（-1.25-＋1.25）D and-0.24（-1.25-0.00）D respectively postoperative.Mean power of the 3 mm corneal central increased （43.97±1.67 D vs.43.33±1.51 D, t=16.85, P〈0.01）.Postoperative corneal deformation amplitude is greater than the preoperation （F=4.88, P〈0.01）.The score of life quality questionnaire was 80±16 with at 6 months postoperation.Conclusion SUPRACORTM Presby LASIK could decrease the presbyopic symptoms and correct far distance refraction, offering spectacle-free vision in daily life in most of the treated patients.