波前像差引导FS-LASIK治疗近视合并中高度散光患者术后高阶像差变化

Changes in higher order aberrations after wavefront guided FS-LASIK for myopia combined with moderate to high astigmatism

目的:评估波前像差引导飞秒激光辅助LASIK(femtosecond laser assisted LASIK,FS-LASIK)治疗近视合并中高度散光患者术后高阶像差变化。方法:纳入我院于2016-07/2017-02收治的近视合并中度至高度散光患者50例88眼。术前51眼散光≥-1.50D且<-3.00D(中度散光),37眼散光≥-3.00D(高度散光),所有患者均接受波前像差引导FS-LASIK手术。术前和术后3mo评估未矫正视力(uncorrected distance visual acuity,UDVA)、矫正视力(corrected distance visual acuity,CDVA)、角膜曲率、角膜中心厚度(central corneal thickness,CCT)和部分高阶像差(higher order aberrations,HOAs)。结果:术后3mo所有术眼的UDVA均达到20/20以上,均较术前提高且差异有统计学意义(P<0.05),而CDVA和术前相比差异无统计学意义(P=0.36)。术后85眼(97%)散光在-1.00D以下,70眼(80%)散光在-0.50D以下,差异有统计学意义(P<0.05)。较术前相比,术后平均角膜曲率降低约为3.81±1.97D,CCT减少约78.66±37.22μm,差异有统计学意义(P<0.05)。术后3mo彗差与三叶草较术前无明显变化(P=0.078、0.065);而球面像差、二次散光及高阶像差均方根(HOA-root mean square,HOA-RMS)术后较术前均有所增加,分别从术前的0.19±0.06、0.05±0.02和0.42±0.12增加至术后的0.32±0.17、0.26±0.08和0.78±0.28,差异有统计学意义(P<0.05)。结论:波前像差引导FS-LASIK术后虽然产生部分高阶像。

AIM： To assess the changes in higher order aberrations after wavefront guided femtosecond laser assisted laser in situ keratomileusis（FS-LASIK）for moderate to high astigmatism.METHODS： Eighty-eight eyes of 50 myopia patients with moderate to high astigmatism were included in this prospective study. There were 51 eyes with moderate astigmatism（≥-1.50D and 〈-3.00D）and 37 eyes with high astigmatism（≥-3.00D）. All patients underwent wavefront guided FS-LASIK. Uncorrected distance visual acuity（UDVA）, corrected distance visual acuity（CDVA）, keratometry, central corneal thickness（CCT）and higher order aberrations（HOAs）were evaluated before operation and 3mo postoperatively.RESULTS： At the 3mo after operation, the mean UDVA of all eyes was above 20/20, better than before operation（P〈0.05）, but CDVA remained unchanged（P=0.36）and no eyes lost ≥2 lines of CDVA. Mean astigmstism of 85 eyes（97%）was reduced below -1.00D, mean astigmatism of 70 eyes（80%）was reduced below -0.50D（P〈0.05）. The average corneal curvature was flatter by 3.81±1.97D and CCT was reduced by 78.66±37.22μm, postoperatively（P〈0.05）. Coma and trefoil aberrations remained unchanged（P=0.078, 0.065）. The spherical aberration, secondary astigmatism and the HOA root mean square（RMS）increased from 0.19±0.06, 0.05±0.02 and 0.42±0.12, preoperatively to 0.32±0.17, 0.26±0.08 and 0.78±0.28（P〈0.05）, postoperatively. CONCLUSION： Wavefront-guided FS-LASIK is a safe and effective option for the patients with moderate to high astigmstism although parts of HOAs increased.