AIM: To compare and calculate the 3-year refractive results, higher-order aberrations (HOAs), contrast sensitivity (CS) and dry eye parameters after small incision lenticule extraction (SMILE) and wavefront-gui...AIM: To compare and calculate the 3-year refractive results, higher-order aberrations (HOAs), contrast sensitivity (CS) and dry eye parameters after small incision lenticule extraction (SMILE) and wavefront-guided femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for correction of high myopia and myopic astigmatism. METHODS: In this prospective, non-randomized comparative study, 78 eyes with spherical equivalent (SE) of -8.11±1.09 diopters (D) received a SMILE surgery, and 65 eyes with SE of -8.05±1.12 D received a wavefront-guided FS-LASIK surgery with the VisuMax femtosecond laser (Carl Zeiss Meditec, Jena, Germany) for flap cutting. Visual acuity, manifest refraction, CS, HOAs, ocular surface disease index (OSDI) and tear break-up time (TBUT) were evaluated during a 3-year follow-up. RESULTS: The difference of uncorrected distance visual acuity (UDVA) postoperatively was achieved at lmo and at 3mo, whereas the difference of the mean UDVA between two groups at 3y were not statistically significant (t=-1.59, P=-0.13). The postoperative change of SE was 0.89 D in the FS-LASIK group (t=5.76, P=0.00), and 0.14 D in the SMILE group (t=-0.54, P=0.59) from lmo to 3y after surgery. At 3-year postoperatively, both HOAs and spherical aberrations in the SMILE group were obviously less than those in the FS-LASIK group (P=0.00), but the coma root mean square (RMS) was higher in the SMILE group (0.59±0.26) than in the FS-LASIK group (0.29±0.14, P=0.00). The mesopic CS values between two groups were not statistically significant at 3y postoperatively. Compared with the FS-LASIK group, lower OSDI scores and longer TBUT values were found in the SMILE group at Imo and 3mo postoperatively. With regard to safety, no eye lost any line of CDVA in both groups at 3y after surgery. CONCLUSION: Both SMILE and wavefront-guided FS- LASIK procedures provide good visual outcomes. Both procedures are effective and safe, but SMILE surgery achieve more stable long-term refractive outcome and better control of early postoperative dry eye as compared to FS-LASIK.展开更多
AIM: To compare the optical quality after implantation of implantable collamer lens(ICL) and wavefront-guided laser in situ keratomileusis(WG-LASIK).METHODS: The study included 40 eyes of 22 patients with myopia...AIM: To compare the optical quality after implantation of implantable collamer lens(ICL) and wavefront-guided laser in situ keratomileusis(WG-LASIK).METHODS: The study included 40 eyes of 22 patients with myopia who accepted ICL implantation and 40 eyes of 20 patients with myopia who received WG-LASIK. Before surgery and three months after surgery, the objective scattering index(OSI), the values of modulation transfer function(MTF) cutoff frequency, Strehl ratio, and the Optical Quality Analysis System(OQAS) values(OVs) were accessed. The higher order aberrations(HOAs) data including coma, trefoil, spherical, 2^(nd) astigmatism and tetrafoil were also obtained. For patients with pupil size 〈6 mm, HOAs data were analyzed for 4 mm-pupil diameter. For patients with pupil size ≥6 mm, HOAs data were calculated for 6 mm-pupil diameter. Visual acuity, refraction, pupil size and intraocular pressures were also recorded.RESULTS: In both ICL and WG-LASIK group, significant improvements in visual acuities were found postoperatively, with a significant reduction in spherical equivalent(P〈 0.001). After the ICL implantation, the OSI decreasedslightly from 2.34±1.92 to 2.24±1.18 with no statistical significance(P=0.62). While in WG-LASIK group, the OSI significantly increased from 0.68±0.43 preoperatively to 0.91±0.53 postoperatively(Wilcoxon signed ranks test, P=0.000). None of the mean MTF cutoff frequency, Strehl ratio, OVs showed statistically significant changes in both ICL and WG-LASIK groups. In the ICL group, there were no statistical differences in the total HOAs for either 4 mmpupil or 6 mm-pupil. In the WG-LASIK group, the HOA parameters increased significantly at 4 mm-pupil. The total ocular HOAs, coma, spherical and 2^(nd) astigmatism were 0.12±0.06, 0.06±0.03, 0.00±0.03, 0.02±0.01, respectively. After the operation, these values were increased into 0.16±0.07, 0.08±0.05,-0.04±0.04, 0.03±0.01 respectively(Wilcoxon signed ranks test, all P〈0.05). At 6 mm-pupil, the induction of total HOAs was not statistically significant in the WG-LASIK group. CONCLUSION: ICL implantation has a less disturbance to optical quality than WG-LASIK. The OQAS is a valuable complementary measurement to the wavefront aberrometers in evaluating the optical quality.展开更多
Objective To evaluate the effects of preoperative soft contact lens (SCL) wear on higher-order aberrations(HOAs)correction after wavefront-guided and conventional laser in situ keratomileusis (LASIK). Methods A prospe...Objective To evaluate the effects of preoperative soft contact lens (SCL) wear on higher-order aberrations(HOAs)correction after wavefront-guided and conventional laser in situ keratomileusis (LASIK). Methods A prospective randomized double-masked comparative study was conducted in 180 eyes of 90 patients scheduled for LASIK, including 92 eyes of 46 patients with previous SCL wear. The patients were divided into four groups: no SCL-conventional group, SCL-conventional group, no SCL-wavefront group and SCL-wavefront group. Preoperative and postoperative examinations included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), contrast sensitivity and HOAs. Results The UCVA and BSCVA were 20/20 in all patients at 6 months postoperatively. And 36.3%, 22.7%, 18.1% and 35.4% gained one line or more of BSCVA in no SCL-wavefront group, SCL-wavefront group, no SCL-conventional group and SCL-conventional group, respectively. Both the safety index and efficacy index surpassed one in 4 groups and were highest in no SCL-wavefront group. The increase in root-mean-square (RMS) values of HOAs was significantly lower in no SCL-wavefront group and higher in SCL-wavefront group. At 6 months postoperatively, the increase in RMS of HOAs (RMSh) were 0.67, 1.58, 1.17 and 1.28 in no SCL-wavefront group, SCL-wavefront group, no SCL-conventional group and SCL-conventional group, respectively. Conclusion Preoperative contact lens wear has significant influence on the efficacy of HOAs correction in wavefront-guided LASIK. Patients with contact lens wear preoperatively should be cautious when scheduled for wavefront-guided LASIK.展开更多
· AIM: To compare refractive results, higher-order aberrations(HOAs), contrast sensitivity and dry eye after laser in situ keratomileusis(LASIK) performed with a femtosecond laser versus a mechanical microkeratom...· AIM: To compare refractive results, higher-order aberrations(HOAs), contrast sensitivity and dry eye after laser in situ keratomileusis(LASIK) performed with a femtosecond laser versus a mechanical microkeratome for myopia and astigmatism.·METHODS: In this prospective, non-randomized study,120 eyes with myopia received a LASIK surgery with the Visu Max femtosecond laser for flap cutting, and 120 eyes received a conventional LASIK surgery with a mechanical microkeratome. Flap thickness, visual acuity, manifest refraction, contrast sensitivity function(CSF) curves,HOAs and dry-eye were measured at 1wk; 1, 3, 6mo after surgery.·RESULTS: At 6mo postoperatively, the mean central flap thickness in femtosecond laser procedure was113.05 ±5.89 μm(attempted thickness 110 μm), and148.36 ±21.24 μm(attempted thickness 140 μm) in mechanical microkeratome procedure. An uncorrected distance visual acuity(UDVA) of 4.9 or better was obtained in more than 98% of eyes treated by both methods, a gain in log MAR lines of corrected distance visual acuity(CDVA) occurred in more than 70% of eyes treated by both methods, and no eye lost ≥1 lines of CDVA in both groups. The difference of the mean UDVA and CDVA between two groups at any time post-surgery were not statistically significant(P 】0.05). The postoperative changes of spherical equivalent occurred markedly during the first month in both groups. The total root mean square values of HOAs and spherical aberrations in the femtosecond treated eyes were markedly less than those in the microkeratome treated eyes during 6mo visit after surgery(P 【0.01). The CSF values of the femtosecond treated eyes were also higherthan those of the microkeratome treated eyes at all space frequency(P 【0.01). The mean ocular surface disease index scores in both groups were increased at 1wk, and recovered to preoperative level at 1mo after surgery. The mean tear breakup time(TBUT) of the femtosecond treated eyes were markedly longer than those of the microkeratome treated eyes at postoperative 1, 3mo(P 【0.01).·CONCLUSION: Both the femtosecond laser and the mechanical microkeratome for LASIK flap cutting are safe and effective to correct myopia, with no statistically significant difference in the UDVA, CDVA during 6mo follow-up. Refractive results remained stable after 1mo post-operation for both groups. The femtosecond laser may have advantages over the microkeratome in the flap thickness predictability, fewer induced HOAs, better CSF,and longer TBUT.展开更多
Purpose: To verify whether there exists any difference in higher order aberrations after undergoing myopic LASIK (laser in situ keratomileusis) with conventional ablation and customized ablation in different eyes of t...Purpose: To verify whether there exists any difference in higher order aberrations after undergoing myopic LASIK (laser in situ keratomileusis) with conventional ablation and customized ablation in different eyes of the same patient. Methods: This was a prospective randomized study of 54 myopic eyes (27 patients) that underwent LASIK using the Nidek EC-5000 ex-cimer laser system (Nidek, Gamagori, Japan). Topography-guided customized aspheric treatment zone (CATz) was used in the first eye of the patient (study group) and the other eye of the same patient was operated on with conventional ablation (control group). Higher order aberrations [root-mean-square (RMS) in the 5-mm zone] of both groups were observed with the Nidek OPD-Scan aberrometer before and 3 months after LASIK. Preoperative mean refractive error was similar between two eyes of the same patient (t=?0.577, P>0.05). Results: Preoperatively, higher order aberrations (RMS in the 5-mm zone) in the CATz ablation and conventional groups were (0.3600±0.0341) μm and (0.2680±0.1421) μm, respectively. This difference was not statistically significant (t=1.292, P>0.05). Three months after LASIK, higher order aberrations (RMS in 5-mm zone) in the CATz ablation and conventional groups were (0.3627±0.1510) μm and (0.3991±0.1582) μm, respectively. No statistically significant difference was noted between pre- and postoperative higher order aberrations in the CATz group (t=?0.047, P>0.05). However, a statistically significant increase in higher order aberrations was observed after conventional ablation (t=?5.261, P<0.05). A statistically sig-nificant difference was noted in the increase of higher order aberrations after LASIK between groups (t=?2.050, P=0.045). Con-clusion: LASIK with conventional ablation and topography-guided CATz ablation resulted in the same BSCVA (best specta-cle-corrected visual acuity) 3 month after LASIK. Higher order aberrations were increased, but the increase of higher order ab-errations after customized ablation treatment was less than that after conventional ablation.展开更多
AIM:To compare the effect of myopia and astigmatism correction and postoperative change in higher-order aberration as results of receiving small-incision lenticule extraction(SMILE)and femtosecond laser-assisted in si...AIM:To compare the effect of myopia and astigmatism correction and postoperative change in higher-order aberration as results of receiving small-incision lenticule extraction(SMILE)and femtosecond laser-assisted in situ keratomileusis(FS-LASIK).METHODS:A prospective and non-randomized controlled study was conducted.The subjects are divided into two groups according to different operations received:229 eyes of 116 patients in the SMILE group and 168 eyes of 86 patients in the FS-LASIK group.All subjects were followed up for 3 mo by monitoring their uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA),spherical equivalent,higher-order aberrations,and the preoperative and postoperative complications.RESULTS:At 1 wk,1,and 3 mo post-surgery,224 eyes(97.8%),227 eyes(99.1%)and 229 eyes(100%)had UCVA≥20/20 in the SMILE group,while 165 eyes(98.2%),167 eyes(99.4%)and 167 eyes(99.4%)had UCVA≥20/20 in the FS-LASIK group,respectively(χ^(2)=0.146,2.135,and 1.124;all P>0.05).BCVA reduction was not observed in both groups at 1 and 3 mo of post-surgery(χ^(2)=0.734 and 1.898,P>0.05).There was no statistically significant difference in the spherical equivalent between the two groups at 1 and 3 mo post-surgery,though the percentage of the spherical equivalent within±0.50 D at 3 mo postsurgery was 98%in the SMILE group,which was higherthan that of the FS-LASIK group(92%,χ^(2)=1.872,P>0.05).The root mean square(RMS)values of total high-order aberration,coma,and spherical aberration of the two groups increased significantly in the early postoperative period and decreased after 3 mo,but the values were still higher than the preoperative levels(P<0.05);there was no significant difference between the two groups in the RMS values of total higher-order aberrations and specific higherorder aberrations(P>0.05).The incidence of complications in the SMILE group was lower than that in the FS-LASIK group(χ^(2)=14.52,P<0.05).CONCLUSION:SMILE and FS-LASIK can effectively treat myopia,significantly improve visual acuity,and increase the total high-order aberration,spherical aberration,and coma.The incidence of complications after SMILE is relatively low.展开更多
AIM:To study the effects of different flap sizes on visual acuity,refractive outcomes,and aberrations after femtosecond laser for laser in situ keratomileusis(LASIK).METHODS:In each of the forty patients enrolled,1 ey...AIM:To study the effects of different flap sizes on visual acuity,refractive outcomes,and aberrations after femtosecond laser for laser in situ keratomileusis(LASIK).METHODS:In each of the forty patients enrolled,1 eye was randomly assigned to receive treatment with a 8.1mm diameter corneal flap,defined as the small flap,while the other eye was treated with a 8.6mm diameter corneal flap,defined as the big flap.Refractive errors,visual acuity,and higher-order aberrations were compared between the two groups at week 1,month 1 and 3 postoperatively. RESULTS:The postoperative refractive errors and visual acuity all conformed to the intended goal.Postoperative higher-order aberrations were increased,especially in spherical aberration(Z12) and vertical coma(Z7).There were no statistically significant differences between the two groups in terms of postoperative refractive errors,visual acuity,root mean square of total HOAs(HO-RMS),trefoil 30°(Z6),vertical coma(Z7),horizontal coma(Z8),trefoil 0°(Z9),and spherical aberration(Z12) at any point during the postoperative follow-up.CONCLUSION:Both the small and big flaps are safe and effective procedures to correct myopia,provided the exposure stroma meets the excimer laser ablations.The personalized size corneal flap is feasible,as we can design the size of corneal flap based on the principle that the corneal flap diameter should be equal to or greater than the sum of the maximum ablation diameter and apparatus error.展开更多
AIM: To investigate the potential differences between topography-guided(TG) and wavefront-optimized(WFO) laser in situ keratomileusis(LASIK) for the treatment of myopia.METHODS: A systematic literature search was perf...AIM: To investigate the potential differences between topography-guided(TG) and wavefront-optimized(WFO) laser in situ keratomileusis(LASIK) for the treatment of myopia.METHODS: A systematic literature search was performed to determine relevant trials comparing LASIK with TG and WFO from the time of library construction to August 2020, and The PubMed, Cochrane, Web of Science, EMBASE and Chinese databases(i.e. CNKI, CBM, WAN FANG and VIP) were accessed. The data on visual acuity, refractive status and wavefront aberration were retrieved and evaluated from three to six months after surgery. STATA(version 14.0) software was used for statistical analysis. A cumulative Meta-analysis was simultaneously performed.RESULTS: Eleven studies with a total of 1425 eyes were incorporated. No statistically significant differences were evident between TG and WFO ablation in the proportion of eyes achieving an uncorrected distance visual acuity(UCVA) of 20/20 or better(P=0.377), gaining one line or more(P=0.05), postoperative cylinder(P=0.40), vertical coma(P=0.593) and horizontal coma(P=0.957). After TG ablation, the proportion of the patients’ eyes of which postoperative refraction is within ±0.5 diopter of the target refraction was significantly higher than that undergoes WFO(P=0.003). As opposed to the WFO group, manifest refraction spherical equivalent(MRSE;P=0.000) was lower, and UCVA(P=0.005) was better in the TG group. The higher-order aberrations(HOAs;P=0.000), spherical aberration(P=0.000) and coma(P=0.000) were significantly lower in TG group. The cumulative Meta-analysis illustrated that the proportion of eyes achieving UCVA of 20/20 or better, postoperative refraction within ±0.5 diopter, and MRSE has steady between the two groups.CONCLUSION: Both TG-LASIK and WFO-LASIK are safe, effective, and predictable for correcting myopia. TG-LASIK may produce fewer aberration and is more precise than WFO-LASIK.展开更多
AIM:To compare visual performance of wavefrontguided laser in situ keratomileusis(LASIK) with iris-registration(Wg-LASIK group) and conventional LASIK(LASIK group) one year after surgery and analyze the correlation be...AIM:To compare visual performance of wavefrontguided laser in situ keratomileusis(LASIK) with iris-registration(Wg-LASIK group) and conventional LASIK(LASIK group) one year after surgery and analyze the correlation between wavefront aberrations and visual performance.·METHODS:Eight hundred and fifty-two myopic eyes of 430 patients were enrolled in this prospective study and divided into two groups:Wg-LASIK group(436eyes) and LASIK group(416 eyes).A Wavescan Wavefront aberrometer was used to analyze Zernike coefficients and the root-mean-square(RMS) of higher order aberrations,and Optec 6500 visual function instrument was used to measure contrast sensitivity(CS)before and 3,6,12 months after surgery.·RESULTS:The mean spherical equivalent(SE) in WgLASIK group was significantly better than those in LASIK group one year after surgery(P =0.024).Wg-LASIK eyes showed better CS values than LASIK eyes at all spatial frequencies with and without glare after surgery(P all【0.01).Moreover,the increase of higher RMS(RMSh),coma,RMS3,RMS4,RMS5 in Wg-LASIK group were significantly lower than those in LASIK group 1 year after surgery(P all 【0.05).The increase of coma,spherical aberration(SA),RMS3 and RMS4 in Wg-LASIK and coma and RMS3 in LASIK group were negatively correlated with reduction of contrast sensitivity 1 year after surgery.·CONCLUSION:A significant better visual performance is got in Wg-LASIK group compared with LASIK group 1year after surgery,and the Wg-LASIK is particularly suitable for eyes with high-magnitude RMSh.展开更多
文摘AIM: To compare and calculate the 3-year refractive results, higher-order aberrations (HOAs), contrast sensitivity (CS) and dry eye parameters after small incision lenticule extraction (SMILE) and wavefront-guided femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for correction of high myopia and myopic astigmatism. METHODS: In this prospective, non-randomized comparative study, 78 eyes with spherical equivalent (SE) of -8.11±1.09 diopters (D) received a SMILE surgery, and 65 eyes with SE of -8.05±1.12 D received a wavefront-guided FS-LASIK surgery with the VisuMax femtosecond laser (Carl Zeiss Meditec, Jena, Germany) for flap cutting. Visual acuity, manifest refraction, CS, HOAs, ocular surface disease index (OSDI) and tear break-up time (TBUT) were evaluated during a 3-year follow-up. RESULTS: The difference of uncorrected distance visual acuity (UDVA) postoperatively was achieved at lmo and at 3mo, whereas the difference of the mean UDVA between two groups at 3y were not statistically significant (t=-1.59, P=-0.13). The postoperative change of SE was 0.89 D in the FS-LASIK group (t=5.76, P=0.00), and 0.14 D in the SMILE group (t=-0.54, P=0.59) from lmo to 3y after surgery. At 3-year postoperatively, both HOAs and spherical aberrations in the SMILE group were obviously less than those in the FS-LASIK group (P=0.00), but the coma root mean square (RMS) was higher in the SMILE group (0.59±0.26) than in the FS-LASIK group (0.29±0.14, P=0.00). The mesopic CS values between two groups were not statistically significant at 3y postoperatively. Compared with the FS-LASIK group, lower OSDI scores and longer TBUT values were found in the SMILE group at Imo and 3mo postoperatively. With regard to safety, no eye lost any line of CDVA in both groups at 3y after surgery. CONCLUSION: Both SMILE and wavefront-guided FS- LASIK procedures provide good visual outcomes. Both procedures are effective and safe, but SMILE surgery achieve more stable long-term refractive outcome and better control of early postoperative dry eye as compared to FS-LASIK.
基金Supported by the Research Grant of Guangxi Natural Science Foundation(No.2015GXNSFCB139012No.2017GXNSFBA198320)the Research Grant of Guangxi Technology and Science Agency(No.Z2015316)
文摘AIM: To compare the optical quality after implantation of implantable collamer lens(ICL) and wavefront-guided laser in situ keratomileusis(WG-LASIK).METHODS: The study included 40 eyes of 22 patients with myopia who accepted ICL implantation and 40 eyes of 20 patients with myopia who received WG-LASIK. Before surgery and three months after surgery, the objective scattering index(OSI), the values of modulation transfer function(MTF) cutoff frequency, Strehl ratio, and the Optical Quality Analysis System(OQAS) values(OVs) were accessed. The higher order aberrations(HOAs) data including coma, trefoil, spherical, 2^(nd) astigmatism and tetrafoil were also obtained. For patients with pupil size 〈6 mm, HOAs data were analyzed for 4 mm-pupil diameter. For patients with pupil size ≥6 mm, HOAs data were calculated for 6 mm-pupil diameter. Visual acuity, refraction, pupil size and intraocular pressures were also recorded.RESULTS: In both ICL and WG-LASIK group, significant improvements in visual acuities were found postoperatively, with a significant reduction in spherical equivalent(P〈 0.001). After the ICL implantation, the OSI decreasedslightly from 2.34±1.92 to 2.24±1.18 with no statistical significance(P=0.62). While in WG-LASIK group, the OSI significantly increased from 0.68±0.43 preoperatively to 0.91±0.53 postoperatively(Wilcoxon signed ranks test, P=0.000). None of the mean MTF cutoff frequency, Strehl ratio, OVs showed statistically significant changes in both ICL and WG-LASIK groups. In the ICL group, there were no statistical differences in the total HOAs for either 4 mmpupil or 6 mm-pupil. In the WG-LASIK group, the HOA parameters increased significantly at 4 mm-pupil. The total ocular HOAs, coma, spherical and 2^(nd) astigmatism were 0.12±0.06, 0.06±0.03, 0.00±0.03, 0.02±0.01, respectively. After the operation, these values were increased into 0.16±0.07, 0.08±0.05,-0.04±0.04, 0.03±0.01 respectively(Wilcoxon signed ranks test, all P〈0.05). At 6 mm-pupil, the induction of total HOAs was not statistically significant in the WG-LASIK group. CONCLUSION: ICL implantation has a less disturbance to optical quality than WG-LASIK. The OQAS is a valuable complementary measurement to the wavefront aberrometers in evaluating the optical quality.
文摘Objective To evaluate the effects of preoperative soft contact lens (SCL) wear on higher-order aberrations(HOAs)correction after wavefront-guided and conventional laser in situ keratomileusis (LASIK). Methods A prospective randomized double-masked comparative study was conducted in 180 eyes of 90 patients scheduled for LASIK, including 92 eyes of 46 patients with previous SCL wear. The patients were divided into four groups: no SCL-conventional group, SCL-conventional group, no SCL-wavefront group and SCL-wavefront group. Preoperative and postoperative examinations included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), contrast sensitivity and HOAs. Results The UCVA and BSCVA were 20/20 in all patients at 6 months postoperatively. And 36.3%, 22.7%, 18.1% and 35.4% gained one line or more of BSCVA in no SCL-wavefront group, SCL-wavefront group, no SCL-conventional group and SCL-conventional group, respectively. Both the safety index and efficacy index surpassed one in 4 groups and were highest in no SCL-wavefront group. The increase in root-mean-square (RMS) values of HOAs was significantly lower in no SCL-wavefront group and higher in SCL-wavefront group. At 6 months postoperatively, the increase in RMS of HOAs (RMSh) were 0.67, 1.58, 1.17 and 1.28 in no SCL-wavefront group, SCL-wavefront group, no SCL-conventional group and SCL-conventional group, respectively. Conclusion Preoperative contact lens wear has significant influence on the efficacy of HOAs correction in wavefront-guided LASIK. Patients with contact lens wear preoperatively should be cautious when scheduled for wavefront-guided LASIK.
文摘· AIM: To compare refractive results, higher-order aberrations(HOAs), contrast sensitivity and dry eye after laser in situ keratomileusis(LASIK) performed with a femtosecond laser versus a mechanical microkeratome for myopia and astigmatism.·METHODS: In this prospective, non-randomized study,120 eyes with myopia received a LASIK surgery with the Visu Max femtosecond laser for flap cutting, and 120 eyes received a conventional LASIK surgery with a mechanical microkeratome. Flap thickness, visual acuity, manifest refraction, contrast sensitivity function(CSF) curves,HOAs and dry-eye were measured at 1wk; 1, 3, 6mo after surgery.·RESULTS: At 6mo postoperatively, the mean central flap thickness in femtosecond laser procedure was113.05 ±5.89 μm(attempted thickness 110 μm), and148.36 ±21.24 μm(attempted thickness 140 μm) in mechanical microkeratome procedure. An uncorrected distance visual acuity(UDVA) of 4.9 or better was obtained in more than 98% of eyes treated by both methods, a gain in log MAR lines of corrected distance visual acuity(CDVA) occurred in more than 70% of eyes treated by both methods, and no eye lost ≥1 lines of CDVA in both groups. The difference of the mean UDVA and CDVA between two groups at any time post-surgery were not statistically significant(P 】0.05). The postoperative changes of spherical equivalent occurred markedly during the first month in both groups. The total root mean square values of HOAs and spherical aberrations in the femtosecond treated eyes were markedly less than those in the microkeratome treated eyes during 6mo visit after surgery(P 【0.01). The CSF values of the femtosecond treated eyes were also higherthan those of the microkeratome treated eyes at all space frequency(P 【0.01). The mean ocular surface disease index scores in both groups were increased at 1wk, and recovered to preoperative level at 1mo after surgery. The mean tear breakup time(TBUT) of the femtosecond treated eyes were markedly longer than those of the microkeratome treated eyes at postoperative 1, 3mo(P 【0.01).·CONCLUSION: Both the femtosecond laser and the mechanical microkeratome for LASIK flap cutting are safe and effective to correct myopia, with no statistically significant difference in the UDVA, CDVA during 6mo follow-up. Refractive results remained stable after 1mo post-operation for both groups. The femtosecond laser may have advantages over the microkeratome in the flap thickness predictability, fewer induced HOAs, better CSF,and longer TBUT.
文摘Purpose: To verify whether there exists any difference in higher order aberrations after undergoing myopic LASIK (laser in situ keratomileusis) with conventional ablation and customized ablation in different eyes of the same patient. Methods: This was a prospective randomized study of 54 myopic eyes (27 patients) that underwent LASIK using the Nidek EC-5000 ex-cimer laser system (Nidek, Gamagori, Japan). Topography-guided customized aspheric treatment zone (CATz) was used in the first eye of the patient (study group) and the other eye of the same patient was operated on with conventional ablation (control group). Higher order aberrations [root-mean-square (RMS) in the 5-mm zone] of both groups were observed with the Nidek OPD-Scan aberrometer before and 3 months after LASIK. Preoperative mean refractive error was similar between two eyes of the same patient (t=?0.577, P>0.05). Results: Preoperatively, higher order aberrations (RMS in the 5-mm zone) in the CATz ablation and conventional groups were (0.3600±0.0341) μm and (0.2680±0.1421) μm, respectively. This difference was not statistically significant (t=1.292, P>0.05). Three months after LASIK, higher order aberrations (RMS in 5-mm zone) in the CATz ablation and conventional groups were (0.3627±0.1510) μm and (0.3991±0.1582) μm, respectively. No statistically significant difference was noted between pre- and postoperative higher order aberrations in the CATz group (t=?0.047, P>0.05). However, a statistically significant increase in higher order aberrations was observed after conventional ablation (t=?5.261, P<0.05). A statistically sig-nificant difference was noted in the increase of higher order aberrations after LASIK between groups (t=?2.050, P=0.045). Con-clusion: LASIK with conventional ablation and topography-guided CATz ablation resulted in the same BSCVA (best specta-cle-corrected visual acuity) 3 month after LASIK. Higher order aberrations were increased, but the increase of higher order ab-errations after customized ablation treatment was less than that after conventional ablation.
文摘AIM:To compare the effect of myopia and astigmatism correction and postoperative change in higher-order aberration as results of receiving small-incision lenticule extraction(SMILE)and femtosecond laser-assisted in situ keratomileusis(FS-LASIK).METHODS:A prospective and non-randomized controlled study was conducted.The subjects are divided into two groups according to different operations received:229 eyes of 116 patients in the SMILE group and 168 eyes of 86 patients in the FS-LASIK group.All subjects were followed up for 3 mo by monitoring their uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA),spherical equivalent,higher-order aberrations,and the preoperative and postoperative complications.RESULTS:At 1 wk,1,and 3 mo post-surgery,224 eyes(97.8%),227 eyes(99.1%)and 229 eyes(100%)had UCVA≥20/20 in the SMILE group,while 165 eyes(98.2%),167 eyes(99.4%)and 167 eyes(99.4%)had UCVA≥20/20 in the FS-LASIK group,respectively(χ^(2)=0.146,2.135,and 1.124;all P>0.05).BCVA reduction was not observed in both groups at 1 and 3 mo of post-surgery(χ^(2)=0.734 and 1.898,P>0.05).There was no statistically significant difference in the spherical equivalent between the two groups at 1 and 3 mo post-surgery,though the percentage of the spherical equivalent within±0.50 D at 3 mo postsurgery was 98%in the SMILE group,which was higherthan that of the FS-LASIK group(92%,χ^(2)=1.872,P>0.05).The root mean square(RMS)values of total high-order aberration,coma,and spherical aberration of the two groups increased significantly in the early postoperative period and decreased after 3 mo,but the values were still higher than the preoperative levels(P<0.05);there was no significant difference between the two groups in the RMS values of total higher-order aberrations and specific higherorder aberrations(P>0.05).The incidence of complications in the SMILE group was lower than that in the FS-LASIK group(χ^(2)=14.52,P<0.05).CONCLUSION:SMILE and FS-LASIK can effectively treat myopia,significantly improve visual acuity,and increase the total high-order aberration,spherical aberration,and coma.The incidence of complications after SMILE is relatively low.
文摘AIM:To study the effects of different flap sizes on visual acuity,refractive outcomes,and aberrations after femtosecond laser for laser in situ keratomileusis(LASIK).METHODS:In each of the forty patients enrolled,1 eye was randomly assigned to receive treatment with a 8.1mm diameter corneal flap,defined as the small flap,while the other eye was treated with a 8.6mm diameter corneal flap,defined as the big flap.Refractive errors,visual acuity,and higher-order aberrations were compared between the two groups at week 1,month 1 and 3 postoperatively. RESULTS:The postoperative refractive errors and visual acuity all conformed to the intended goal.Postoperative higher-order aberrations were increased,especially in spherical aberration(Z12) and vertical coma(Z7).There were no statistically significant differences between the two groups in terms of postoperative refractive errors,visual acuity,root mean square of total HOAs(HO-RMS),trefoil 30°(Z6),vertical coma(Z7),horizontal coma(Z8),trefoil 0°(Z9),and spherical aberration(Z12) at any point during the postoperative follow-up.CONCLUSION:Both the small and big flaps are safe and effective procedures to correct myopia,provided the exposure stroma meets the excimer laser ablations.The personalized size corneal flap is feasible,as we can design the size of corneal flap based on the principle that the corneal flap diameter should be equal to or greater than the sum of the maximum ablation diameter and apparatus error.
文摘AIM: To investigate the potential differences between topography-guided(TG) and wavefront-optimized(WFO) laser in situ keratomileusis(LASIK) for the treatment of myopia.METHODS: A systematic literature search was performed to determine relevant trials comparing LASIK with TG and WFO from the time of library construction to August 2020, and The PubMed, Cochrane, Web of Science, EMBASE and Chinese databases(i.e. CNKI, CBM, WAN FANG and VIP) were accessed. The data on visual acuity, refractive status and wavefront aberration were retrieved and evaluated from three to six months after surgery. STATA(version 14.0) software was used for statistical analysis. A cumulative Meta-analysis was simultaneously performed.RESULTS: Eleven studies with a total of 1425 eyes were incorporated. No statistically significant differences were evident between TG and WFO ablation in the proportion of eyes achieving an uncorrected distance visual acuity(UCVA) of 20/20 or better(P=0.377), gaining one line or more(P=0.05), postoperative cylinder(P=0.40), vertical coma(P=0.593) and horizontal coma(P=0.957). After TG ablation, the proportion of the patients’ eyes of which postoperative refraction is within ±0.5 diopter of the target refraction was significantly higher than that undergoes WFO(P=0.003). As opposed to the WFO group, manifest refraction spherical equivalent(MRSE;P=0.000) was lower, and UCVA(P=0.005) was better in the TG group. The higher-order aberrations(HOAs;P=0.000), spherical aberration(P=0.000) and coma(P=0.000) were significantly lower in TG group. The cumulative Meta-analysis illustrated that the proportion of eyes achieving UCVA of 20/20 or better, postoperative refraction within ±0.5 diopter, and MRSE has steady between the two groups.CONCLUSION: Both TG-LASIK and WFO-LASIK are safe, effective, and predictable for correcting myopia. TG-LASIK may produce fewer aberration and is more precise than WFO-LASIK.
文摘AIM:To compare visual performance of wavefrontguided laser in situ keratomileusis(LASIK) with iris-registration(Wg-LASIK group) and conventional LASIK(LASIK group) one year after surgery and analyze the correlation between wavefront aberrations and visual performance.·METHODS:Eight hundred and fifty-two myopic eyes of 430 patients were enrolled in this prospective study and divided into two groups:Wg-LASIK group(436eyes) and LASIK group(416 eyes).A Wavescan Wavefront aberrometer was used to analyze Zernike coefficients and the root-mean-square(RMS) of higher order aberrations,and Optec 6500 visual function instrument was used to measure contrast sensitivity(CS)before and 3,6,12 months after surgery.·RESULTS:The mean spherical equivalent(SE) in WgLASIK group was significantly better than those in LASIK group one year after surgery(P =0.024).Wg-LASIK eyes showed better CS values than LASIK eyes at all spatial frequencies with and without glare after surgery(P all【0.01).Moreover,the increase of higher RMS(RMSh),coma,RMS3,RMS4,RMS5 in Wg-LASIK group were significantly lower than those in LASIK group 1 year after surgery(P all 【0.05).The increase of coma,spherical aberration(SA),RMS3 and RMS4 in Wg-LASIK and coma and RMS3 in LASIK group were negatively correlated with reduction of contrast sensitivity 1 year after surgery.·CONCLUSION:A significant better visual performance is got in Wg-LASIK group compared with LASIK group 1year after surgery,and the Wg-LASIK is particularly suitable for eyes with high-magnitude RMSh.