提高准分子激光屈光手术成像质量的临床研究

Clinical Study on Improving the Quality of Vision of Excimer Laser Refractive Surgery

目的为了提高准分子激光术后的成像质量,研究切实可行的临床措施。方法通过不同的验光方法、激光设备和手术方法,研究激光术后成像质量和手术疗效。结果采用激光线性小区域扫描和飞点大区域扫描,术后出现眩光的发生率分别为33.64%和15.89%,两组差别有显著意义(P<0.05)。术前采用医学验光法,LASIK组和LASEK组术后出现视疲劳的发生率均小于常规验光法组,两种方法比较差别有显著意义(P<0.05)。采用TOSCA对LASIK术后明显偏心者5例6眼进行治疗,术后患者重影和眩光主诉明显好转,裸眼视力和矫正视力均明显提高。LASIK与LASEK比较,术后对比敏感度LASEK组下降幅度小于LASIK组,术后3月LASIK组高阶像差增加明显大于LASEK组。结论术前采用医学验光,选择飞点大区域的激光扫描设备,采用TDSCA技术以及开展LASEK手术是当前提高准分子激光治疗近视手术成像质量的可行措施。

Purpose To investigate the clinical effective methods of improving the quality of vision of excimer laser refractive surgery. Methods The clinical outcome of excirner laser refractive surgery by comparing different refraction methods,different laser machines and different operative methods was studied. Results The incidence of postoperative glare in group with small optical zone linear ablation and group using flying-spot large optical zone ablation were 33.64% and 15.89% . respectively(P<0.05) .The incidence of postoperative ocular fatigue in group using medical refraction was fewer than that using ordinary refraction ( P < 0.05). Significant decentration was found in 6 eyes of 5 patients after LASIK. After topography-supported customized ablation (TOSCA) treatment, all patients had a significant reduction in the perception of ghost image and glare. Uncorrected visual acuity ( UCVA) and best spectacle-corrected visual acuity (BSCVA) were both increased significantly.Comparing the effect of LASIK with LASEK on contrast sensitivity and wavefront aberration, the decrease of contrast sensitivity in post-LASEK group was smaller than that of post-LASIK group.The increase of higher-order aberrations was significantly larger in LASIK group than that in LASEK group 3 months after surgery. Conclusion Employing medical refraction, Choosing flying-spot system ablation with large optical zone, using TOSCA for irregular comeal surface and following LASEK procedure are the useful methods for improving the quality of vision of excimer laser refractive surgery.