ORK—CAM角膜像差引导的LASIK治疗高度散光的临床评价

目的评价ORK—CAM角膜波前像差引导的个性化LASIK治疗高度散光的临床效果。方法采用随机对照研究，选择近视性散光（验光度数和轴向与角膜地形图数据大致相同）32．00D，等值球镜度≤8．00D的67例（89眼）患者采用随机表分为两组，ORK—CAM组39例（53眼）接受ORK．CAM非球面切削的LASIK治疗；LASIK组28例（36眼）接受传统LASIK治疗。两组术前球镜度数分别为（-4．23±1．31）D和（-4．42±1．58）D（P〉0．05）；柱镜度数分别为（2．50±0．52）D和-（2．49±0．47）D（P〉0．05）。平均随访6个月，手术前后观察患者视力、屈光度、高阶像差、Q值变化和对比敏感度等情况。结果ORK．CAM组和LASIK组术后球镜度数分别为（-0．14±0．76）D和（-0．12±0．82）D（P〉0．05）；柱镜数度分别为（-0．51±0．63）D和（-0．98±1．21）D（P〈0．01）。裸眼视力≥1．0者分别占81％和80％（P〉0．05）；术后慧差分别为（0．33±0．15）μm和（0．42±0．27）μm（P〈0．05）；球差分别为（0．51±0．24）μm和（0．92±0．32）μm（P〈0．01）；Q值分别为0．55±0．34和1．17±1．23（P〈0．001）；ORK—CAM组1个月时对比敏感度恢复到术前水平，而LASIK组3个月时才接近术前水平。结论ORK—CAM角膜波前像差引导的个性化LASIK治疗近视性高度散光的像差矫正优于传统LASIK。

Clinic evaluation of topography guided LASIK for high astigmatism treatment

Objective To evaluate the clinic effect of topography guided （Optimized Refractive Keratectomy- Custom Ablation Manager, ORK-CAM） laser in situ keratomileusis （LASIK） for high astigmatism treatment. Methods Sixty-seven cases （89 eyes） with high corneal astigmatism were randomly divided into ORK-CAM group （39 cases, 53 eyes） which accepted Schwind Esiris ORK-CAM topography-guided LASIK and LASIK group （28 cases, 36 eyes） which accepted standard small optical zones flying-spot ablation LASIK. The preoperative average subjective spherical refraction was （ -4.23±1.31）D,（ -4.42±1.58）D,and cylindrical refraction was （ -2.50 ±0.52）D, （ -2.49 ±0.47）D in ORK-CAM group and LASIK group respectively （P 〉 0.05）. All cases were followed up for 6 months. Results The postoperative subjective refraction was （ -0.14 ±0.76） D and （ -0.12±0.82） D （P 〉0.05）, and cylindrical refrac- tion was （ - 0.51±0.63） D and （ - 0.98±1.21 ） D （P 〈 0.01 ） in ORK-CAM group and LASIK group respectively. Eighty-one percent of the ORK-CAM group achieved 1.0 or better visual acuity while that in the comparative group was 80%. There was no significant difference of postoperative visual acuity between two groups （P 〉 0.05 ）. The coma was （0.33±0.15） μm and （0.42±0.27） μm （P〈0.05）, the spherical aberration was （0.51±0.24） μm and （0.92±0.32）μm （P 〈0.01 ）, and the Q-value was 0.55±0.34 and 1.17±1.23（P 〈0.001 ） in ORK-CAM group and LASIK group respectively. One month after operation, the contrast sensitivity of ORK-CAM group returned to their pre-operative level, and that of LASIK group returned to preoperative level at the third months after operation. Conclusions ORK- CAM topography guided LASIK for high corneal astigmatism treatment is superior to conventional LASIK.