作者:范存晖,杨茜,陈杰 作者单位:102401) 中国北京市,北京良乡医院眼科;(154002)中国黑龙江省佳木斯市,中国人民解放军第224医院眼科;(100004)中国北京市,北京好好眼科;(100073)中国北京市,北京阜仁眼科医院
【摘要】 目的:探讨波阵面像差引导的准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)和准分子激光角膜上皮瓣下磨镶术(laser epithelial keratomileusis,LASEK)对近视眼高阶像差的影响,并作对比分析。
【关键词】 准分子激光原位角膜磨镶术;准分子激光角膜上皮瓣下磨镶术;波阵面像差
Effect of LASIK or LASEK on the higher order of wavefront aberration in patients with myopia WenFang Zhang, ShengLi Chen, HaiYan Yang, Yong LiuDepartment of Ophthalmology, Beijing Liangxiang Hospital, Beijing 102401, China; Department of Ophthalmology, the 224th Hospital of Chinese PLA, Jiamusi 154002, Heilongjiang Province, China; Beijing Best Vision, Beijing 100004, China; Beijing Furen Ophthalmologic Hospital, Beijing 100073, China Abstract AIM: To explore the effects of wavefrontguided laser in situ keratomileusis (WGLASIK) and wavefrontguided laser epithelial keratomilersis (WGLASEK) on the higher order aberrations (HOAs) in patients with myopia. METHODS: Twentyeight patients (56 eyes) underwent WGLASIK or WGLASEK surgery for myopia, including 18 patients (36 eyes) for WGLASIK (IK group) and 10 patients (20 eyes) for WGLASEK (EK group). An examination on HOAs was performed on each eye preoperatively and 10 days, 1 month and 3 months postoperatively. The data of different operation methods and the HOAs before and after operation was analyzed with Students ttest between the two groups. RESULTS: Total HOA root mean square (RMS) showed an increase in both groups compared with that of preoperation, and the 3rd and 4th order aberration were dominant among theses. While, the 5th, 6th and horizontal coma (C8) were similar with that of preoperation. Spherical aberration (C12) increased at any time postoperatively in both of the groups ompared with that of preoperation. There was no significant difference between the two groups. Postoperatively, it was lower in EK group than in IK group in total, 3rd, 4th order aberration and vertical coma (C7). CONCLUSION: Both procedures could increase the HOAs, but the HOAs improvement after WGLASEK was lower than that after WGLASIK.
KEYWORDS: laser in situ keratomileusis; laser epithelial keratomileusis; wavefront aberration
方法:波阵面像差引导的LASIK手术(IK组)共18例36眼和波阵面像差引导的LASEK手术(EK组)共10例20眼,分别于术前和术后10d;1,3mo测量高阶像差,用t检验分析手术前后高阶像差的变化和不同手术方式对高阶像差影响。
结果:两组术后总高阶像差RMS值均较术前增加,以三、四阶像差增加为主,五、六阶像差和水平彗差无明显变化;两组的球差均较术前增加,两组间无差异;术后EK组的总高阶像差、三阶、四阶像差和垂直彗差均小于IK组。
结论:波阵面像差引导的LASIK 和LASEK都会使眼高阶像差不同程度的增加,LASEK的增加幅度小于LASIK。
0引言 准分子激光原位角膜磨镶术(laser in situ keratomileusis, LASIK)目前仍是角膜屈光性手术的主流方式,但表面切削的方式正在逐年增加,准分子激光角膜上皮瓣下磨镶术(laser epithelial keratomileusis,LASEK)的出现为医生和患者提供了更多的选择。有研究[13]显示:与LASIK相比,LASEK术后角膜地形图更平整、对比敏感度更高,也更有利于进行波阵面像差引导的个体化切削。我们用波阵面像差引导的LASIK和LASEK手术矫治近视,并观察了不同手术方式对近视患者高阶像差的影响,报告如下。
表1两组术前基本资料(略)
aP<0.05 vs IK组 表2手术前后各高阶像差的变化(略)
表3手术前后球差、彗差的变化(略)
1对象和方法
1.1对象 200807/11在北京阜仁眼科医院准分子激光中心接受波阵面像差引导LASIK手术(IK组)的近视患者18例36眼,波阵面像差引导LASEK手术(EK组)的近视患者10例20眼。术前两组患者的年龄、矫正视力、等效球镜的差异均无显著性意义,中央角膜厚度的差异有显著性意义(P<0.05),EK组的中央角膜厚度偏薄(表1)。
1.2方法 术前检查包括裸眼视力、裂隙灯检查、非接触式眼压、主觉验光、睫状肌麻痹验光、超声角膜测厚、三面镜眼底检查、泪膜功能检测。角膜地形图联合波阵面像差检查采用日本NIDEK公司的OPDScan ARK10000,将所得数据传输到NAVEX FinalFit 个体化切削软件,生成激光切削数据。手术均由第一作者完成。使用NIDEK EC5000CXⅡ准分子激光仪,以FinalFit 个体化切削软件生成的数据文件引导激光切削。LASIK 使用Moria M2 130 角膜刀制作角膜瓣,蒂部位于上方,激光切削区直径6.0~6.5mm,过渡区7.5~8.0mm,激光切削完毕后BSS液冲洗,角膜瓣复位。术后予1g/L氟米龙眼液点眼,第1wk 4次/d,每周递减1次,共用药4wk。人工泪液4次/d,术后2wk内同时予氧氟沙星眼液3次/d。LASEK 用200mL/L乙醇浸润角膜15~20s,上皮分离器制作上皮瓣,蒂部位于上方,激光切削区直径6.0~6.5mm,过渡区7.5~8.0mm,激光切削完毕后,用一浸润0.2g/L丝裂霉素C的海绵片放置在角膜床面20~40s,BSS液冲洗,水复位上皮瓣。予配戴绷带式角膜接触镜5d。术后予1g/L氟米龙眼液点眼,第1wk 6次/d,酌情每2wk递减1次,共用药12~14wk,人工泪液4次/d,术后2wk内同时予氧氟沙星眼液3次/d。术后1,3,10d;1,3mo复诊,检查项目包括视力、眼压、裂隙灯、验光等,并于术后10d;1,3mo进行角膜地形图联合波阵面像差检查(仪器同术前)。 统计学分析:采用SPSS 11.5 for Windows 统计软件进行数据分析。同一组中不同时间点的均数比较采用配对t检验,同一时间点两组间的均数比较采用独立样本t检验。以P<0.05为差异有显著性意义。
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