准分子激光角膜中央多焦点非球面切削模式治疗老视的疗效及其对角膜生物力学的影响

Effect of excimer laser excimer laser biaspheric multifocal central corneal ablation on presbyopia and corneal biomechanics

目的探讨准分子激光角膜中央多焦点非球面切削模式(老视消融术)治疗老视的疗效及其对角膜生物力学的影响。方法选取2016年5月至2018年7月医院收治的老视患者共150例,以随机数表分为常规组(75例,准分子激光原位角膜磨镶术治疗)、研究组(75例,准分子激光SUPRACOR技术治疗)。对比治疗前与术后1 d、7 d、1个月、3个月、6个月、1年裸眼近、远视力及像差情况治疗1年后裸眼近、远视力情况,临床疗效,治疗前与治疗1年后角膜生物力学参数变化情况及并发症发生情况。结果两组术后1 d、7 d、1个月、3个月、6个月、1年裸眼近视力、远视力均高于治疗前(P<0.05),术后7 d、1个月、3个月、6个月、1年裸眼近视力、远视力均高于术后1 d(P<0.05),两组间术后不同时刻比较,研究组裸眼近视力、远视力均高于常规组(P<0.05),两组患者术后1 d、术后7 d、术后1个月3阶慧差、5阶像差均高于治疗前,术后1个月研究组有6.67%出现星芒、光晕,常规组有10.67%出现星芒、光晕,两组对比无显著性差异(P>0.05),且术后3个月两组患者上述症状均消失;两组临床疗效分布差异显著(P<0.05),研究组总有效率高于常规组(P<0.05);两组治疗后最大压陷时变形幅度均提高(P<0.05),研究组更高(P<0.05),两组治疗后最大压陷时曲率半径均降低(P<0.05),研究组更低(P<0.05);研究组总并发症发生率低于常规组(P<0.05)。结论采用准分子激光角膜中央多焦点非球面切削模式治疗老视可显著提高裸眼近、远视力,增强疗效,改善角膜生物力学参数且减少并发症发生。

Objective To investigate the effect of excimer laser biaspheric multifocal central corneal ablation on presbyopia and corneal biomechanics.Methods A total of 150 presbyopia patients who underwent excimer laser treatment in our hospital from May 2016 to July 2018 were selected and randomly divided into the conventional group(75 cases treated by excimer laser in-situ keratectomy)and the study group(75 cases treated by excimer laser SUPRACOR technique).The near and distant visual acuity(VA)and aberration of the naked eye before and at 1 day,7 days,1 month,3 months,6 months and 1 year after the treatment were compared.The clinical efficacy,changes of corneal biomechanical parameters and complications before and after treatment were compared.Results The near and distance VA of the two groups at 1 day,7 days,1 month,3 months,6 months and 1 year after the surgery were higher than those before the treatment(P<0.05),and the near and distant VA at 7 days,1 month,3 months,6 months and 1 year after the surgery were higher than those at 1 day after the surgery(P<0.05).The near and distant VA of naked eyes in the study group were higher than those in the conventional group at different follow-uP visits(P<0.05).In both groups,at 1 day,7 days and 1 month after the surgery,the third-order aberration and the fifth-order aberration were higher than those before the treatment.At one month after the surgery,6.67%of the patients in the study group experienced starlight and halo,as compared to 10.67%of the patients in the conventional group and without significant inter-group difference(P>0.05).These symptoms disappeared within 3 months after the treatment in both groups.There was significant difference in the distribution of clinical efficacy between the two groups(P<0.05),and the total effective rate in the study group was higher than the conventional group(P<0.05).After treatment,the deformation amplitude of maximum collapse increased in both groups(P<0.05),and was higher in the study group(P<0.05);and the curvature radius of maximum collapse decreased in both groups(P<0.05),and was lower in the study group(P<0.05).The incidence of complications in the study group was lower than that in the conventional group(P<0.05).Conclusions The excimer laser excimer laser biaspheric multifocal central corneal ablation technology for the treatment of presbyopia can significantly improve the near and far VA of naked eye,enhance the curative effect,improve the corneal biomechanical parameters and reduce the incidence of complications.