作者：蒋韵佳，李一壮，钱 涛，武志峰，孙 松 作者单位：(1.无锡市第二人民医院 眼科，江苏 无锡 214000;2.南京大学附属鼓楼医院 眼科，江苏 南京 210008)
【摘要】 目的 对比研究低中度和高度近视两组准分子激光原位角膜磨镶术(LASIK)手术前后客观视力、像差、对比敏感度、眩光敏感度的差别，以综合评价术前屈光度对LASIK术后视觉质量的影响。方法 对行LASIK术的66例(132眼)按等效屈光度(SE)分为两组：低中度近视组(68眼)，SE<-6.00 D;高度近视组(64眼)，SE≥-6.00 D。采用ARK-10000波前像差分析仪和带眩光光源的CSV-1000E眩光敏感度测量仪分别测量术前和术后1周，1、3个月的客观视力、像差、对比敏感度和眩光敏感度并进行两组间比较。结果 (1)术前术后各期最佳矫正视力低中度近视组均优于高度近视组(均P<0.01)。(2)术前与术后各期(1周，1、3个月)比较总体像差高度近视组均高于低中度近视组(P<0.01，P<0.01，P<0.05，P<0.01)，各高阶像差成分中，术前两组无明显差异(P>0.05);术后3个月内彗差、球差高度近视组高于低中度近视组(P<0.01)，而三叶草像差、四叶草像差和高阶散光两组间无明显差异(P>0.05)。(3)术前，两组在空间高频区(18.0 c·d-1)对比敏感度有差异，低中度近视组优于高度近视组(P<0.05);术后早期两组对比敏感度均下降，随时间逐渐恢复，其中高度近视组下降更明显恢复也较慢。至术后3个月两组均恢复至术前水平，高频区对比敏感度低中度近视组仍优于高度近视组(P<0.05)。(4) 术前，两组在12.0 c·d-1频率上眩光敏感度有差异，低中度近视组优于高度近视组(P<0.05)。术后早期两组眩光敏感度均下降，随时间逐渐恢复;其中高度近视组下降更明显，恢复较慢。至术后3个月两组均恢复至术前水平，两组间各频率眩光敏感度均无明显差异(P>0.05)。结论 (1)近视LASIK术后早期的视觉质量低中度近视组优于高度近视组;(2)术后视觉质量的恢复高度近视组慢于低中度近视组;(3)两组术后中晚期均拥有良好的视觉质量。
【关键词】 准分子激光原位角膜磨镶术;像差;对比敏感度;眩光敏感度
Comparison of visual function after laser in situ keratomileusis between
moderate myopia and high myopia
JIANG Yunjia1，LI Yizhuang2，QIAN Tao2，WU Zhifeng1，SUN Song1(1.Department of Ophthalomology，Wuxi No.2 People’s Hospital,Wuxi 214000，China;2.Department of
Ophthalomology，Nanjing Drum Tower Hospital，Nanjing University，Nanjing 210008，China)
Abstract：Objective To evaluate the effect of diopter correction on visual function after laser in situ keratomileusis (LASIK) by comparing moderate myopia with high myopia.Method Sixtysix patients 132 eyes were divided into 2 groups based on spherical equivalent：moderate myopia group(﹤-6.00 D,68 eyes) and high myopia group(≥-6.00 D，64 eyes).Visual activity，aberration，contrast sensitivity and glare sensitivity were measured by phoropter，ARK-10000 wavefront analyzer，and CSV-1000E with glare respectively.Results (1)Best spectaclecorrect visual acuity was better in moderate myopia group before and after LASIK(P<0.01).(2)Total aberration was higher in high myopia group before and after LASIK(P<0.01，P<0.01，P<0.05，P<0.01).No significant difference in higher order aberration was found between 2 groups before LASIK(P>0.05).After LASIK,total coma and total spherical aberration were higher in high myopia group(P<0.01)while total trefoil, total 4foil and high astigmatism didn’t show significant differences between 2 groups(P>0.05).(3)Contrast sensitivity was better in moderate myopia group at spatial frequency 18.0 c·d-1 before LASIK(P<0.05).After LASIK，contrast sensitivity in both groups decreased with high myopia group decreased to the greater extent.Within 3 months，they returned gradually to preLASIK levels;but high myopia group recovered more slowly.(4)Glare sensitivity was better in moderate myopia group at spatial frequency 12.0 c·d-1 before LASIK(P<0.05).After LASIK，glare sensitivity in both groups decreased with high myopia group decreased more.After 3 months，they both returned to preLASIK levels.And no significant difference in glare sensitivity was seen between 2 groups at any frequency(P>0.05).Conclusions (1)The disturbance of visual function after LASIK is more prevalent in patients with high myopia.(2)The visual function recovery occurs slower in patients with high myopia.(3)After a period of recovery time，visual function is found good in both groups.
Key words：laser in situ keratomileusis;aberration;contrast sensitivity;glare sensitivity
(Modern Medical Journal,2009,37:254257)
随着近视准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)的广泛开展，临床上发现存在术前屈光度高的人比屈光度低的人术后视觉主诉普遍要多的现象。本实验就是围绕这一现象，通过测量对比低中度和高度近视两组客观视力、像差、对比敏感度(contrast sensitivity,CS)和眩光敏感度(glare sensitivity，GS)，综合评价术前屈光度对LASIK术后视觉质量的影响。
1 资料与方法
1.1 研究对象
选取2006年1月至2006年4月在南京市鼓楼医院眼科进行LASIK术的66例(男39例，女27例)132眼，平均球镜度(-5.57±2.30) D，柱镜度(-0.61±0.53) D。所有病例均符合LASIK手术适应证且自愿做LASIK手术。术前最佳矫正视力均在4.9以上。
1.2 方法
按等效屈光度(spherical equivalent refraction，SE)分为两组：低中度近视组(68眼)，SE<-6.00 D;高度近视组(64眼)，SE≥-6.00 D。术前最佳矫正视力，标准主觉验光由同一医师进行，用NIDEK ARK-10000波前像差分析仪测量自然状态下眼光学系统像差，VECTOR VISION CSV-1000E(带眩光光源)测量最佳矫正视力状态下CS及测试距离2.5 m处眩光光源垂直面照度为50 lx时的GS。常规LASIK手术(NIDEK EC5000CXⅡ激光平台)由同一手术医生完成。术后1周及1、3个月进行随访，各项检查同术前。
1.3 统计学处理
应用SPSS 11.5软件包处理数据，结果以x-±s表示。术前术后各时期两组间比较用成组t检验。
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