【摘要】 目的:探讨角膜波面像差引导的准分子激光个体化屈光手术(optimized refractive keratectomycustomized ablation, ORK)治疗高度近视患者术后角膜表面规则性和对称性情况。方法:对50例100眼高度近视患者行角膜波面像差引导的准分子激光个体化屈光手术治疗,对同期50例100眼高度近视患者用传统LASIK治疗 ,观察两组疗效,并采用角膜地形图检查仪测量两组术后6mo的角膜地形图变化[包括角膜曲率,K1,K2,表面非对称指数( surface asymmetry index,SAI) ,表面规则指数( surface regularity index, SRI)]。结果:与术前比较, 两组术后角膜曲率、K1,K2, SAI，SRI降低(均为P<0.05)。ORK组术后6mo SAI，SRI改善优于传统组(均为P<0.05)。结论:角膜波面像差引导的准分子激光个体化屈光手术与传统LASIK比较, 角膜波面像差引导的准分子激光个体化屈光手术治疗的患者术后6mo角膜规则性和对称性优于应用传统LASIK治疗的患者。
【关键词】 角膜波面像差引导的准分子激光个体化屈光手术;准分子激光原位角膜磨镶术;表面非对称指数;表面规则指数
Changes of corneal topography after ORK compared with LASIK
LiMing Liu, ShaoFei Wang, Nuliman
Department of Ophthalmology,Peoples Hospital of Xinjiang Uygur Autonomous Region, Urumchi 830001, Xinjiang Uygur Autonomous Region,China
AbstractAIM: To investigate the corneal surface regularity and symmetry after optimized refractive keratectomycustomized ablation(ORK) surgery for treatment of high myopia.METHODS:Fifty patients 100 eyes with high myopia underwent optimized refractive keratectomycustomized ablation therapy ,and for the same period 50 patients 100 eyes with high myopia were treated with conventional LASIK, the effect of two groups was observed,and the corneal topography changes,including corneal curvature, K1, K2, surface asymmetry index (SAI), surface regularity index (SRI) of the two groups after 6 months were observed with corneal topography. RESULTS:Compared with that of preoperative, postoperative corneal curvature, K1,K2, decreased, SAI, SRI reduced (each P <0.05). The improvement of was SAI and SRI in ORK group after 6 months superior to that in the LASIK group (each P<0.05). CONCLUSION: The cornea of the patients who underwent optimized refractive keratectomycustomized ablation therapy is more of regularity and symmetry than that of conventional LASIK patients after 6 months.
KEYWORDS: optimized refractive keratectomy; laser in situ keratomileusis; surface asymmetry index; surface regularity index
0引言
角膜波面像差引导的准分子激光个体化屈光手术矫正近视是用电脑精确控制的准分子激光，根据个体角膜不规则者制定一对一个性化切削方案，根据近视度数和有无散光在瞳孔区的角膜基质层进行刻蚀，使眼角膜前表面稍稍变平，从而使外界光线能够准确地在眼底视网膜上汇聚成像，达到矫正近视的目的。常规准分子激光角膜屈光手术只能矫正较低阶像差，但不能矫正较高阶像差，术后常有光晕、眩、夜间视力下降等视觉质量下降。而个体化治疗方案很好的解决这一缺陷，个性化更注重于角膜的形态，很好地维持正常角膜形态，避免手术造成新的高阶像差的出现，减少因手术而造成的视觉质量的下降，从而使得视力恢复更快、术后视力更好、残留散光更少和角膜地形图分析更均称。
1对象和方法
1.1对象
收集我院眼科激光中心200801/200904施行ORK术患者50例100眼，男22例(汉族15例，维吾尔族7例)，女28例(汉族18例，维吾尔族10例)，LASIK术患者50例(100眼)，男24例(汉族13例，维吾尔族11例)，女26例(汉族14例，维吾尔族12例)，选择标准：(1)年龄18～30岁;(2)屈光度稳定时间>2a;(3)停戴角膜接触镜>2wk;(4)除外眼部病变、全身结缔组织病变及严重免疫性疾病。术前等效球镜度数为2.00～18.00D，角膜厚度>470μm，矫正视力>0.6者。表1 ORK组与LASIK组术前、术后角膜地形图参数比较(略)
1.2方法
1.2.1角膜地形图检查方法
用TMS23角膜地形图检查仪( Tomey公司,美国) ,每眼重复测定2次,对中心X，Y轴在±0.20mm以内, Z轴±0.40mm以内,提取图形并对中心最好、偏位最少的一幅图打印,并记录角膜曲率,K1,K2,表面规则指数(surface regularity index, SRI)、表面不对称指数(surface asymmetry index, SAI)，筛查圆锥角膜。所有患者在术前、术后6mo分别进行角膜地形图检查。
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