有效切削光学区的差异对经上皮准分子激光屈光性角膜切削术后高阶像差的影响

The observation and analyses of higher order aberrations of cornea for corneal topography guided smart pulse technology-transepithelial photorefractive keratectomy with different ablation zone diameter

目的观察并探讨在角膜地形图引导的结合智能脉冲技术的经上皮准分子激光屈光性角膜切削术中,选取不同的激光切削光学区对高阶像差的影响效果。方法共127例(共203眼)接受个性化经上皮准分子激光屈光性角膜切削术,根据等效球镜度数,低度近视为A组,设定手术中有效切削光学区6.3 mm为A6.3组、6.7 mm为A6.7组、7.0 mm为A7.0组。中度近视B组,根据光学区分为B6.3组、B6.7组、B7.0组。高度近视C组,根据光学区分为C6.3组、C6.5组、C6.8组。比较各组术前及术后6个月时的裸眼视力、角膜前表面的高阶像差。结果(1)所有患者术后6个月的裸眼视力均达到或者超过术前最佳矫正视力,高阶像差均较术前有明显升高,差异有统计学意义(P<0.05);(2)低度近视组和中度近视组中总高阶像差增加值相互比较,6.3组分别与6.7组和7.0组比较差异有统计学意义(P<0.05);6.7组与7.0组之间比较差异无统计学意义(P>0.05)。(3)高度近视组中高阶像差增加值相互比较,6.3组分别与6.5组和6.8组比较差异有统计学意义(P<0.05);6.5组与6.8组之间比较差异无统计学意义(P>0.05)。结论结合智能脉冲技术的经上皮准分子激光屈光性角膜切削术,避免选择过小或者过大的有效切削光区,既节省角膜组织,又可以显著改善术后高阶像差。

Objective To observe and investigate the effects of different laser cutting optical regions on high order aberrations in the personalized surgery of corneal topography guided Smart pulse Technology-Transepithelial photorefractive keratectomy.Method A total of 127 cases(203 eyes),treated by Corneal Topography Guided Smart pulse Technology-Transepithelial photorefractive keratectomy,According to the myopia degree,the low nearsightedness was regarded as group A,and the effective cutting optical zone of 6.3 mm was set as group A6.3,6.7 mm as group A6.7,and 7.0 mm as group A7.0.Group B of moderate myopia was divided into group B6.3,group B6.7 and group B7.0,and high myopia C group was optically divided into C6.3 group,C6.5 group and C6.8 group.The naked visual acuity and high order aberrations of the anterior surface of the cornea were compared before and after 6 months operation.Results(1)The naked eye visual acuity of all patients six months after surgery reached or exceeded the preoperative best corrected visual acuity,and the high order aberrations were significantly higher than those before surgery(P<0.05).(2)The comparison of the increased value of total high-order aberration in the moderate-low myopia group showed that the difference between 6.3 group and 6.7 group as well as 7.0 group was statistically significant(P<0.05).There was no significant difference between 6.7 group and 7.0 group(P>0.05).(3)In the high myopia group,the increased value of the higher order aberration was compared with that of the 6.5 group and the 6.8 group,and the difference was statistically significant(P<0.05).There was no significant difference between 6.5 group and 6.8 group(P>0.05).Conclusion Corneal Topography Guided Smart pulse Technology-Transepithelial photorefractive keratectomy can improve postoperative high order aberrations by selecting as large an effective cutting area as possible.