0.05 D验光引导下FS-LASIK近视矫正术后临床效果观察

Clinical efficacy after FS-LASIK myopia correction guided by 0.05 D optometry

目的 探讨0.05 D验光引导下飞秒激光辅助准分子激光原位角膜磨镶术(FS-LASIK)近视矫正术后的临床效果。设计回顾性病例系列。研究对象2021年7月-2022年3月解放军联勤保障部队第九八八医院FS-LASIK手术矫正的近视患者178例(355眼)。方法回顾患者病历资料。根据患者意愿,按术前验光方法分为0.05 D组(89例177眼)和0.25 D组(89例178眼)。两组分别使用0.05 D验光方法和0.25 D验光方法进行术前屈光度测定。所有患者使用Zeimer LDV-Z2联合Zeiss Mel-80行FS-LASIK手术。记录两组实际角膜切削深度和0.05 D组采用0.25D验光模拟的角膜切削深度。术后随访6个月。在术后6个月进行视觉质量问卷调查。主要指标视力(LogMAR)、屈光度、角膜切削深度、中央角膜厚度,视觉质量问卷调查分数。结果0.05 D组患者实际角膜切削深度(84.98±15.60)μm,稍高于本组采用0.25 D验光模拟的角膜切削深度(78.14±17.68)μm及0.25D组患者实际角膜切削深度(75.42±17.14)μm(P均<0.001),而0.05 D组患者采用0.25 D验光模拟的角膜切削深度与0.25 D组患者实际角膜切削深度差异无统计学意义(P=0.129)。两组术后中央角膜厚度均较术前明显降低(t=72.459,P<0.001;t=58.693,P<0.001),但两组之间差异无统计学意义(t=-1.890,P=0.060)。术后3个月及6个月,0.05 D组裸眼视力为-0.056±0.498、-0.061±0.479,均好于0.25 D组的0.003±0.566、-0.002±0.530(P均<0.001)。术后6个月,0.05 D组裸眼视力优于术前最佳矫正视力者占67.80%,高于0.25 D组的17.42%(P<0.001)。两组患者术后不良视觉症状中均是眩光发生率最高,视物变形发生率最低。0.05 D组视疲劳发生率为1.7%,少于0.25 D组的6.7%(P=0.018),其余不良视觉症状发生比例差异无统计学意义。0.05D组视疲劳及总计评分均较0.25 D组低(U=-2.032,P=0.042;U=-2.247,P=0.025),其余症状调查问卷评分比较差异均无统计学意义。结论与0.25 D验光比较,0.05 D验光引导下FS-LASIK可以显著提升患者术后视力及主观视觉质量,且具有相同的手术安全性。

Objective To evaluate clinical efficacy after femtosecond laser-assisted in situ keratomileusis(FS-LASIK)myopia correction guided by 0.05 D optometry.Design Retrospective case series.Participants From July 2021 to March 2022,a total of 355 eyes of 178 myopic patients who underwent FS-LASIK surgery were collected in No.988 Hospital of Joint Logistic Support Force of PLA.Methods The medical records of patients were reviewed.The optometry test modality was determined by patients,and all patients were divided into the 0.05 D group(89 cases 177 eyes)and the 0.25 D group(89 cases 178 eyes)according to the method of optometry.The 0.05 D group used 0.05 D optometry method to measure preoperative diopter;meanwhile,the 0.25 D group used 0.25 D optometry method to measure preoperative diopter.All patients underwent FS-LASIK with Zeimer LDV-Z2 and Zeiss Mel-80.The actual corneal ablation depth of the both groups and the corneal ablation depth simulated by 0.25 D optometry of the 0.05 D group were recorded.The patients were followed up for 6 months.And the visual quality questionnaire was conducted at 6 months postoperatively.Main Outcome Measures Visual acuity(LogMAR),diopter,corneal ablation depth,central corneal thickness(CCT),and visual quality questionnaire score.Results The actual corneal ablation depth of the 0.05 D group was(84.98±15.60)μm,which was slightly higher than(78.14±17.68)μm simulated by 0.25 D optometry of the 0.05 D group and(75.42±17.14)μm of the 0.25 D group(all P<0.001).There was no significant difference in the corneal ablation depth between simulated by 0.25 D optometry of the 0.05 D group and the 0.25 D group(P=0.129).The CCT of the both groups after surgery was significantly lower than that preoperative(t=72.459,P<0.001,t=58.693,P<0.001),and there was no significant difference in the CCT between the both groups after surgery(t=-1.890,P=0.060).At 3 months and 6 months after surgery,the uncorrected visual acuity(UCVA)of the 0.05 D group were-0.056±0.498,-0.061±0.479,which were better than 0.003±0.566,-0.002±0.530 of the 0.25 D group(all P<0.001).At 6 months after surgery,the percentage of UCVA better than preoperative best corrected visual acuity(BCVA)of the 0.05 D group was 67.80%,which was higher than 17.42%of the 0.25 D group(P<0.001).Among the adverse visual symptoms,the incidence of glare was the highest and the incidence of distortion was the lowest in the both groups.The incidence of asthenopia of the 0.05 D group was 1.7%,which was less than 6.7%of the 0.25 D group(P=0.018).There was no significant difference in the incidence of other symptoms.The asthenopia and total score of the 0.05 D group were significantly lower than those of the 0.25 D group(U=-2.032,P=0.042,U=-2.247,P=0.025).There was no significant difference in the scores of the questionnaire of other symptoms.Conclusion Compared with 0.25 D optometry,0.05 D optometry can significantly improve visual acuity and subjective visual quality after FS-LASIK,and has the same surgical safety.