波前像差引导与波前像差优化LASIK对视力及全眼高阶像差影响的比较研究

Effect of wavefront-guided and wavefront-optimized laser in situ keratomileusis on visual acuity and higher-order aberrations

目的观察波前像差引导激光原位角膜磨镶术(LASIK)与波前像差优化LASIK对于全眼高阶像差在0.3μm以上的近视散光眼患者术后视力及全眼高阶像差的影响。方法收集拟行LASIK手术的近视散光患者30例(60眼)。采用随机数字表法将患者一眼随机纳入波前像差引导组,对侧眼纳入波前像差优化组,每组30眼。术后6个月观察患者的视力、屈光度及全眼高阶像差的变化。结果术后6个月,波前像差引导组与波前像差优化组分别有27眼(90%)及26眼(87%)患者术眼裸眼视力≥5.0,术后等效球镜值在±0.5D范围内者分别为25眼(83%)及24眼(80%),2组比较差异均无统计学意义(P均>0.05)。2组术后均未出现最佳矫正视力丢失2行或以上的情形。2组术后总高阶像差、球差、慧差均较术前明显增大(P均<0.05),但波前像差引导组增幅显著低于波前像差优化组(P<0.05)。结论波前像差引导LASIK与波前像差优化LASIK治疗术前全眼高阶像差大于0.3μm的近视散光眼患者具有同样的安全性、有效性及可预测性,但波前像差引导LASIK可更好地降低术后高阶像差的增幅。

Objective It is to observe the influence of wavefront-guided and wavefront-optimized laser in situ keratomileus- is （LASIK） to correct myopia and myopic astigmatism on visual acuity and higher-order aberrations （HOAs） in patients with a preoperative total ocular HOAs higher than 0.3 μm. Methods Sixty eyes of thirty patients with myopia with or without astigmatism were selected. One eye of each patient was randomized to undergo wavefront-guided LASIK, and the fellow eye received wavefront-optimized LASIK. Postoperative outcome were observed at 6 months included visual acuity, refraction and ocular HOAs. Results 6 months postoperatively, there were 27 eyes （90%） in the wavefront-guided group and 26 eyes （87%） in the wavefront-optimized group with uncorrected visual acuity of 5.0 or better; and 25 eyes （83%） and 24 eyes （80%） with a postoperative spherical equivalent refraction of ± 0.5D diopter respectively, there was no significant differences between the two groups （ all P 〉 0.05 ）. No eye in either group was lost 2 lines or more of best-corrected visual acuity （ BCVA）. Post- operatively total HOAs, spherical aberration and coma were increased in both groups （ all P 〈 0.05 ） , but the changes in wav front-guided group were significant fewer than those in wavefront-optimized group （ all P 〈 0.05 ）. Conclusion For eyes with preoperative HOAs higher than 0.3 μm, both wavefront-guided and wavefront-optimized LASIK has excellent safety, efficacy, and predictability. However, wavefront-guided platform can induce less HOAs than wavefront-optimized platform.