波前像差引导FS-LASIK矫正中高度近视患者术后1年眼前节变化

Anterior segment changes of patients with medium and high myopia one year after the wavefront aberration-guided femtosecond laser-assisted in situ keratomileusis

目的探讨波前像差引导FS-LASIK矫正中高度近视患者术后1年对眼前节结构的影响。方法收集2020年7月至2021年3月在徐州市第一人民医院就诊符合手术适应证且接受波前像差引导FS-LASIK患者共40例78眼的临床资料,分为中度近视组和高度近视组;分别于术前、术后1个月、术后1年行Pentacam AXL眼前节分析仪测量眼前节,包括角膜后表面Q值,全角膜像差,后表面高阶像差、球差、彗差,角膜后表面曲率、顶点高度及最薄点高度,前房深度(ACD)、前房容积(ACV)和前房角(ACA),并对比分析。结果中度近视组患眼角膜后表面曲率和角膜后表面Q值术前与术后1个月、术后1年相比差异均有统计学意义(均为P<0.05),高度近视组患眼角膜后表面最薄点高度和角膜后表面Q值术前与术后1年相比差异均有统计学意义(均为P<0.05)。中度近视组患眼角膜后表面垂直彗差术前与术后1个月、术后1年相比差异均有统计学意义(均为P<0.05),高度近视组患眼全角膜像差、角膜后表面球差和垂直彗差术前与术后1个月、术后1年相比差异均有统计学意义(均为P<0.05)。中度近视组及高度近视组患眼ACD、ACV术前与术后1个月、术后1年相比差异均有统计学意义(均为P<0.05),ACA术前术后相比差异均无统计学意义(均为P>0.05)。术后1年和术前球差变化值与术前等效球镜度(SE)相关性分析发现,高度近视组患眼球差变化值与术前SE呈中度相关(r=-0.349,P=0.025),而中度近视组患眼球差变化值与术前SE无明显相关性(r=-0.052,P=0.758)。结论波前像差引导FS-LASIK虽然对患者高阶像差有一定改善,但对角膜后表面和前房结构仍然有一定影响,主要集中在中央区,对周边影响相对较小,术后1年眼前节结构相对稳定。

Objective To investigate the effect of wavefront aberration-guided femtosecond laser-assisted in situ keratomileusis(FS-LASIK)on the anterior segment structure of patients with medium and high myopia 1 year after the operation.Methods Clinical data of 40 patients(78 eyes)who met the surgical indications and received wavefront aberration-guided FS-LASIK in Xuzhou No.1 People’s Hospital from July 2020 to March 2021 was collected.These patients were divided into the medium myopia group and the high myopia group.Pentacam AXL anterior segment analyzer was used to measure and analyze the anterior segment parameters before,1 month and 1 year after the operation,including total corneal aberration,Q value,high-order aberration,spherical aberration,coma aberration,curvature,height at the vertex and height at the thinnest point of the posterior corneal surface,anterior chamber depth(ACD),anterior chamber volume(ACV)and anterior chamber angle(ACA).Results In the medium myopia group,there were significant differences in the posterior corneal surface curvature and Q value before,1 month and 1 year after the operation(all P<0.05).In the high myopia group,there were significant differences in the height at the thinnest point and Q value of the posterior corneal surface before and 1 year after the operation(all P<0.05).In the medium myopia group,there was a significant difference in the vertical coma aberration of the posterior corneal surface before,1 month and 1 year after the operation(all P<0.05).In the high myopia group,there were significant differences in the total corneal aberration,spherical aberration and vertical coma aberration of the posterior corneal surface before,1 month and 1 year after the operation(all P<0.05).In both groups,there were significant differences in ACD and ACV before,1 month and 1 year after the operation(all P<0.05),but no significant difference in ACA before and after the operation(both P>0.05).The correlation analysis between the preoperative and 1-year postoperative difference of spherical aberration and the preoperative spherical equivalent(SE)showed that the difference of spherical aberration in the high myopia group was moderately correlated with the preoperative SE(r=-0.349,P=0.025),while the difference of spherical aberration in the medium myopia group was not significantly correlated with the preoperative SE(r=-0.052,P=0.758).Conclusion Although wavefront aberration-guided FS-LASIK can improve the high-order aberration of patients,it has a certain impact on the posterior corneal surface and anterior chamber structure,mainly concentrated in the central area,with a small impact on the periphery.The anterior segment structure tends to be stable 1 year after the operation.