波前像差引导与波前像差优化LASIK治疗近视散光疗效的对比观察

Comparison the effectiveness of wavefront-guided and wavefront-optimized LASIK for myopia and myopic astigmatism

目的:观察波前像差引导LASIK与波前像差优化LASIK对全眼高阶像差在0.3μm以下近视散光眼的疗效差异。方法:前瞻性病例系列研究。收集在我院就诊拟行LASIK手术的近视散光患者30例60眼。每位患者随机选取一眼接受波前像差引导的LASIK,对侧眼接受波前像差优化的LASIK。术后6mo观察患者的视力、屈光度、全眼高阶像差及暗光下对比敏感度。采用配对样本t检验和χ2检验进行统计学分析。结果:术后6mo,波前像差引导组与波前像差优化组分别有93%及90%的术眼裸眼视力≥5.0,两组术后等效球镜值在±0.50D范围内的比例分别为87%及83%,差异无统计学意义(P>0.05)。两组术后均未出现最佳矫正视力丢失2行或以上的情形。两组术后总高阶像差、球差、彗差均较术前增大(P<0.01),但增幅在两组间无统计学差异(P>0.05)。两组术后6mo暗光下对比敏感度在各个空间频率均恢复至术前水平,差异无统计学意义(P>0.05)。结论:对术前全眼高阶像差小于0.3μm的近视散光眼,波前像差引导LASIK与波前像差优化LASIK对术后视力、屈光度、全眼高阶像差及对比敏感度的影响无明显差异。

AIM：To compare the clinical outcomes of wavefront-guided and wavefront-optimized laser in situ keratomileusis（LASIK） to correct myopia and myopic astigmatism in patients with a preoperative total ocular higher-order aberrations（HOAs） lower than 0.3pm.METHODS：In this prospective study,60 eyes of 30 patients with myopia with or without astigmatism in our department were included.One eye of each patient was randomized to undergo wavefront-guided LASIK,and the fellow eye received wavefront-optimized LASIK.Postoperative outcome measures at 6mo included visual acuity,refraction,ocular HOAs,and contrast sensitivity under mesopic condition.Paired t-test and x test were used to analyze the data.RESULTS：Six months postoperatively,93% of eyes in the wavefront-guided group and 90%in the wavefrontoptimized group had uncorrected visual acuity of 5.0 or better;87%and 83%,respectively,had a postoperative spherical equivalent refraction of ±0.50 D diopter.The differences were not statistically significant（P〉0.05）.No eye in either group lost 2 lines or more BCVA.Total HOAs,spherical aberration and coma increased in both groups postoperatively（P〈0.01）,with no statistical differences in HOA changes between groups（P〉0.05）.Contrast sensitivity under mesopic conditions in both groups recovered to preoperative levels at all spatial frequencies at 6mo postoperative（P〉0.05）.CONCLUSION：For eyes with preoperative HOAs lower than 0.3μm,wavefront-guided LASIK and wavefront-optimized LASIK can provide similar results in terms of visual acuity,refraction,HOAs,and contrast sensitivity.