民航飞行员角膜屈光术后远期视觉质量的评估分析

Evaluation of distant visual fnnctions in the civil aviation pilots after corneal refractive surgery

目的 评估角膜屈光术后民航飞行员的视觉质量和视功能,探讨角膜屈光手术的安全性和远期稳定性. 方法 对四川大学华西医院眼科就诊的297名飞行员进行视力、屈光度、角膜地形图、对比敏感度、泪膜破裂时间（break-up time,BUT）检查及主观问卷调查.根据等效球镜度（spherical equivalent,SE）分组,屈光正常组：任一眼的SE≤＋0.50 D或≥-0.50 D;屈光不正组：任一眼的SE为-0.75～-6.00 D;屈光术后组：有角膜屈光手术史的飞行员.比较3组飞行员视力情况、视觉质量和生活质量结果. 结果 屈光正常组99例（198眼）,SE（0.00±0.50）D;屈光不正组90例（180眼）,SE（-2.06±1.75）D;屈光术后组108例（216眼）,SE（0.00±0.74）D,±0.50 D范围内占68.1％±1.00 D范围内占90.3％.屈光术后组飞行员裸眼视力≥1.0的眼有185只（85.6％）,≥0.5的眼有213只（98.6％）.3组飞行员仅BUT、空间频率为12时的眩光对比敏感度、角膜散光、角膜表面非对称性指数（surface asymmetry index,SAI）差异有统计学意义（H=6.910～26.075,P＜0.05）;屈光正常组与屈光术后组的BUT、SAI差异有统计学意义（H=2.465、4.449,P＜0.017）,其他视觉质量指标差异均无统计学意义（P＞0.017）.屈光术后飞行员在症状、社会活动、精神心理3个模块的评分与屈光正常飞行员差异均无统计学意义（P＞0.017）. 结论 屈光术后飞行员的远期视觉质量和视功能比较稳定,可以达到屈光正常飞行员的标准.

Objective To evaluate the visual quality and functions of the civil pilots after corneal refractive surgery （CRS） and to explore the safety and long-term stability of CRS. Methods Two hundred and ninety-seven pilots, who were treated in Ophthalmology Department of West China Hospital, Sichuan University, were selected as subjects in this study. Their visual acuity, refraction, corneal topography, contrast sensitivity and break-up time （BUT） were detected and the subjective questionnaires were surveyed. The pilots were divided by spherical equivalent （SE） into emmetropia group： the SE of any eye was ≤＋0.50 D or ≥-0.50 D, refractive error group： the SE of any eye was--0.75--6.00 D and CRS group the pilots had the history of CRS. ResuRs （1） There were 99 pilots （198 eyes） in emmetropia group [-SE （0.00±0.50） D]; 90 pilots （180 eyes） in refractive error group [-SE （-2.06±1.75） D]; 108 pilots （216 eyes） in CRS group [SE （0.00±0.74） D]. The SE of 68.1% pilots in CRS group was within 4-0.50 D, 90.3% pilots was with in 4-1.00 D. （2）The uncorrected visual acuity of 85.6% pilots （185 eyes） of CRS group was ≥1.0 while 98.6% pilots （213 eyes） achieved ≥0.5. （3）There were significant differences on BUT, glare contrast sensitivity function-12, corneal astigmatism, surface asymmetry index （SAD among 3 groups （H = 6. 910-26.075, P 〈 0.05）. There were no significant differences in the index of visual quality between emmetropes and CRS group except BUT and SAI （H = 2.465, 4.449, P〈0.017）. There were no significant differences in symptom, social activity, mental and psychology domains between emmetropes and CRS group （P〉0.017）. Conclusions The long-term visual quality and functions of the pilots by CRS show stable effects and compatible to the criteria of emmetropie pilots.