Q值优化Micro-Monovision矫正近视合并老视的短期临床效果

A Short-Term Clinical Analysis of Q-Value-Guided Micro-Monovision LASIK for Myopic Astigmatism and Presbyopia

目的:探讨Q值优化Micro-monovision准分子激光手术矫正近视合并老视的安全性、有效性及预测性。方法:前瞻性临床研究。收集2017年8月至2018年5月在青岛大学附属医院行Q值优化Micro-monovision准分子激光手术的近视合并老视患者35例(70眼)。术后3个月观察单眼和双眼的远、近视力(logMAR视力)、屈光状态、对比敏感度(CS)及立体视,并进行近距离工作视觉疲劳问卷及满意度调查。采用配对t检验对手术前后数据进行分析。结果:35例患者术前双眼视远最佳矫正视力(BCVA)为0.01±0.06,术后3个月为-0.04±0.21,且术后无一眼BCVA下降1行及以上。术后主视眼裸眼视力(UCVA)为-0.04±0.19,非主视眼UCVA为0.04±0.13。所有患者主视眼视近UCVA均达20/25及以上,非主视眼均达20/20。所有术眼实际获得等效球镜度(SE)与预期切削SE的差值均在±1.00D以内,而差值在±0.50D以内为60眼(86%)。术后3个月CS在昼+周边眩光条件下18.0c/d频段较术前显著提高(t=-2.504,P=0.017);在昼1.5、6.0、18.0c/d频段,昼+周边眩光6c/d频段,夜1.5c/d频段,夜+周边眩光18.0c/d频段CS均较术前显著下降(P<0.05),其他各条件频段CS均恢复至术前水平。立体视术后3个月与术前比较差异均无统计学意义。所有患者术后均未出现近距离工作后头痛、恶心、阅读模糊及视近困难。所有患者对手术效果均表示满意,满意度为100%。结论:Q值优化Micro-monovision准分子激光手术矫正近视合并老视,可同时获得较好的双眼远、近视力及双眼视功能,是一种安全、有效且预测性好的手术方法。

Objective: To evaluate the safety, effectiveness and predictability of Q-value-guided micro-monovision laser in situ keratomileusis (LASIK) in the treatment of myopia and presbyopia. Methods: A prospective study was performed based on 35 patients (70 eyes) with myopia and presbyopia, who underwent Q-valueguided micro-monovision LASIK in the Affiliated Hospital of Qingdao University from August 2017 to May 2018. At the 3-month postoperative visit, examinations were performed that included binocular and monocular distance and near visual acuity (logMAR), manifest refraction, contrast sensitivity (CS) and stereopsis. In addition, questionnaires of asthenopic symptoms due to near-distance work were also included for all the patients 3 months postoperatively. The data before and after surgery were analyzed using a paired t test. Results: Binocular distance best-corrected visual acuity (BCVA) was 0.01±0.06 before surgery and was -0.04±0.21 at 3 months after surgery. Thus, none of the eyes lost one line after the operation. Uncorrected visual acuity (UCVA) of the dominant eye and the non-dominant eye were -0.04±0.19 and 0.04±0.13, respectively. In all patients, near distance UCVA of the dominant eye was equal to 20/25 or above, and that of the non-dominant eye was 20/20. In addition, the difference between the actually obtained spherical equivalent (SE) and target SE was in the range of ±0.50 D and ±1.00 D for 60 eyes (86%) and 75 eyes (100%), respectively. At 3 months after surgery, CS had a significant improvement of 18.0 c/d spatial frequency under day+peripheral glare (t=-2.504, P=0.017). The spatial frequencies for day 1.5 c/d, 6.0 c/d and 18.0 c/d, day+peripheral glare 6 c/d, night 1.5 c/d and night+peripheral glare 18.0 c/d had significantly decreased compared to that before surgery (P<0.05). All other conditions were restored to preoperative levels. There was no significant difference in stereopsis before and after surgery. No patients suffered from headache, nausea, blurred reading or difficulty with nearsightedness after near-distance work at 3 months postoperatively. All patients (100%) were satisfied with the results of the operation. Conclusions: The Q-value-guided micro-monovision LASIK protocol is a safe, effective and predictable method for the treatment of myopic patients with presbyopia. Patients can obtain better binocular distance, near vision and visual function simultaneously.