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- 角膜表层手术与基质层手术后视觉质量比较及波前像差相关性分析
- 作者:李莹|发布时间:2011-04-04|浏览量:388次
角膜表层手术与基质层手术后视觉质量比较及波前像差相关性分析
李莹 李俏 龙琴 罗岩 艾凤荣
基金项目:国家自然科学基金(30600692)
作者单位:100730 北京,中国医学科学院 北京协和医院眼科
通讯作者:龙琴,email:longqinbj@hotmail.com北京协和医院眼科李莹
【摘要】 目的 比较角膜表层与基质层屈光手术后高阶像差等客观指标以及主观视觉主诉,并分析术后主观视觉感受与视觉质量检查的相关性。 方法 选择61例行准分子激光治疗的患者共116只眼进行分析,接受LASIK手术45例84眼,接受新型表层手术16例32眼, LASIK手术组术前SE范围为-1.25~-8.75 D,平均SE为(-5.85±1.77)D,ASA手术组术前SE范围为-2~-9.25 D,平均SE为(-5.38±1.83)D。术前及术后第1、第3、第6个月检查裸眼视力(英文全称,UCVA)、最佳矫正视力(英文全称,BSCVA)、球镜及柱镜度数、等效球镜度(英文全称,SE)以及波前像差等。术后第1、第3、第6个月由同一名医师询问患者术后总体评价、术后与术前最佳矫正视力时的视觉质量及视觉症状。 结果 术后第1个月时ASA组C7绝对值(0.17 vs. 0.32,P<0.05)、RMSh(0.39 vs. 0.50,P<0.05)、RMS3(0.29 vs. 0.38,P<0.05)、RMS6(0.07 vs. 0.09,P<0.05)均显著小于LASIK组;术后第3个月、第6个月时差异项减少。术后早期ASA组白天开车(2.92vs. 3.44,P<0.01)及夜间开车容易程度(2.92vs. 3.19,P<0.05)、白天远视力(3.40vs. 4.05,P<0.01)、夜间视力(3.11 vs. 3.60,P<0.01)、夜间眩光(2.70vs. 2.87,P<0.01)、总体视力(3.40vs. 3.95,P<0.01)的评分显著低于LASIK组,两组其他症状评分差异无统计学意义;术后6个月两组评分差异无统计学意义。同术前戴镜相比,白天远视力是患者认为优于术前的最显著项目,眩光和夜视质量下降是患者手术后早期的主要主诉。术后早期SE和球镜度变化值越大,夜间开车容易程度、夜间眩光、夜间视力评分越差。夜视症状随时间延长明显好转。术后早期总高阶像差、彗差和球差增大程度较大者夜间眩光越显著。 结论 术后早期ASA组患者视觉质量评分稍差于LASIK组,但第6个月时差异不显著。术后早期SE、球镜度、高阶像差的变化值越大,夜间视觉质量越差,夜间眩光越显著。
Comparison of visual quality between surface ablation and stromal ablation surgeries and analysis of relationship between visual quality and wavefront aberrations
Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
1. 【Abstract】 Objective To compare higher order aberrations and visual qulity after surface and stromal ablation surgeries; to evaluate relationship between subjective visual perception and objective results of visual quality related examinations. Methods This prospective study included 116 eyes of 61 patients who seek for refractive surgery; 84 eyes of 45 patients received laser in situ keratomileusis (LASIK) and 32 eyes of 16 patients received advanced surface ablation (ASA). Spherical equivalent (SE) of LASIK group ranged from -1.25 to -8.75 D, average was (-5.85±1.77) D, SE of ASA group -2~-9.25 D, average was (-5.38±1.83) D. Record uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), spherical and cylindrical diopter, SE, and wavefront aberrations of patients before and 1, 3, 6 months after ablation. Obtain general evaluation, comparisons of pre- and post-operation visual quality and symptoms by the same clinician 1, 3, 6 months after ablative surgery. Results C7(0.17 vs. 0.32,P<0.05), RMS3(0.29 vs. 0.38,P<0.05), RMS6(0.07 vs. 0.09,P<0.05), and RMSh (0.39 vs. 0.50,P<0.05)of ASA group was significantly smaller than that of LASIK group 1 month after surgery; differences between groups were smaller 3 and 6 month after surgery. Early postoperative scales of driving(diurnal, 2.92vs. 3.44,P<0.01; nocturnal, 2.92vs. 3.19,P<0.05), diurnal distant sight vision(3.40vs. 4.05,P<0.01), nocturnal vision(3.11 vs. 3.60,P<0.01), glare (2.70vs. 2.87,P<0.01)and general vision (3.40vs. 3.95,P<0.01)were lower in ASA group than in LASIK, while symptoms of two groups had no significant difference. Scales between groups 6 month after surgery had no significant difference. Compared with best spectacle corrected vision preoperatively, diurnal sight vision improved in most patients, while glare and worse nocturnal was complained by most patients. Early postoperative changes of SE and spherical diopter negatively correlated with nocturnal driving, glare, nocturnal vision scales. Nocturnal symptoms improved with follow-up. Symptoms of glare positively correlated with postoperative coma, spherical aberration, and HOA. Conclusions HOA of ASA group were smaller than that of LASIK. Early postoperative visual quality scales of ASA were lower than that of LASIK, which disappeared 6 months post-surgery. Larger early postoperative changes of SE, spherical diopter, and HOA correlated with worse nocturnal visual quality and glare.
【Key words】 Myopia; laser in situ keratomileusis; laser subepithelial keratomileusis; epipolis laser in situ keratomileusis; wavefront aberration; quality of vision
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