【摘要】 目的：观察在Q值调整非球面切削与标准切削LASIK治疗近视术后角膜形态、角膜像差以及全眼的高阶像差的改变情况有无区别，从而评价两种切削方式的疗效。方法：根据等效球镜度将156例（295眼），将其分为低度组47例（89眼)，中度组71例（135眼)，高度组38例（71眼)。每组中再随机分为Q值调整非球面切削亚组(F亚组)和标准切削亚组(C亚组)：低度组中F亚组和C亚组分别有24例（45眼），23例（44眼）；中度组中分别有35例（66眼），36例（69眼）；高度组中分别有19例（36眼），19例（35眼）。总的F组共有78例（147眼），C组共有78例（148眼）。对每组中两亚组术后的视力、Q值、角膜及全眼像差进行比较。结果：随访3mo， 所有手术眼视力矫正均达到满意效果，F亚组与C亚组间屈光度差异无统计学意义；术后所有患者Q值均向正值方向发展，角膜球差（Z40）、彗差（Z31），全眼的球差（C12）、彗差（C7）、高级像差均方根值(root mean square high order,RMSh)均较术前增高（P<0.05）；低、中度近视组中，Q值、角膜球差（Z40）、全眼的球差（C12）、高级像差均方根值（RMSh）,在F亚组与C亚组间比较差异有显著性（P<0.05）；而高度近视组中这些指标在两亚组间差异无统计学意义；角膜彗差（Z31）、全眼的彗差（C7）在不同程度近视组中的两亚组间比较均无统计学意义。结论：Q值调整非球面切削与标准切削LASIK治疗近视都是安全、有效的。但前者能更好的维持低、中度近视患者术后角膜前表面形态，角膜及全眼的高阶像差的改变相对小，尤其是球差，从而改善术后患者视觉质量。
【关键词】 非球面；角膜磨镶术；激光原位；近视；角膜
Observation of LASIK with Qguided aspheric and standard ablation for difflevel myopia groups
LingFei Hu, LiMing Tao, Qing Zhang
Department of Ophthalmology, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
AbstractAIM: To analyze corneal profile , corneal aberration and entire optical system wavefront aberration in patients treated with Qguided aspheric profile ablation compared with patients having standard ablation in LASIK to correct myopia, and to evaluate the clinical effects of postoperative treatment.METHODS: According to spherical equivalent (SE), 156 patients were divided into low myopic group (89 eyes of 47 patients), moderate myopic group (135 eyes of 71 patients) and high myopic group (71 eyes of 38 patients). Each group were divided into aspheric profile subgroup (F) and standard subgroup (C). Low myopic group (F:45 eyes of 24 patients, C: 44 eyes of 23 patients.); Moderate myopic group (F:66 eyes of 35 patients; C:69 eyes of 36 patients). High myopic group (F:36 eyes of 19 patients, 35 eyes of 19 patients. A total of 147 eyes of 78 patients in F subgroup and 148 eyes of 78 patients in C subgroup.The postoperative visual acuity, Qvalue,corneal and optical eye aberration of all eyes were compared in F subgroup and C subgroup. RESULTS: The postoperative uncorrected visual acuity (UCVA) of all eyes were satisfying after 3 months' followup. There was no significant difference in term of postoperative refractions between the two subgroups. The corneal profile transformed oblate corneal asphericities after surgery. All patients' corneal aberration and optical highorder aberration increased postoperatively. In F subgroup of low and moderate myopic groups, the increased extent of Qvalue, Z04, C12 and RMSh (root mean square high) were significantly less than that of C subgroup (P<0.05), however, there was no statistical difference between these two subgroups in high myopic group.There were no significant difference between these two subgroups in all groups.CONCLUSION: Qguided aspheric profile and conventional LASIK were safe and efficient for the correction of myopia. Moreover, Qguided aspheric profile LASIK induced a smaller increment of corneal and the entire optical system of the eye highorder wavefront aberration, especially of spherical aberration in low and moderate myopic groups, and better maintained the physiology of the corneal surface than conventional treatment.
KEYWORDS: aspheric; keratomileusis; laser in situ; myopia; cornea
0引言
准分子激光原位角膜磨镶术( laser in situ keratomileusis, LASIK) 是目前临床上广泛开展的近视矫正手术，但LASIK术后患者获得良好的裸眼视力的同时，有10%～15%[1]出现视觉质量降低。个体化切削方式应运而生，Q值调整非球面切削手术是从临床实践中提炼出来的一种个体化切削方式，本文将Q值调整非球面切削与标准切削LASIK的术后疗效进行比较分析。
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