飞秒激光制瓣LASIK及TransPRK手术治疗近视对角膜像差的影响

目的 观察飞秒激光制瓣LASIK手术及TransPRK手术治疗低中度近视患者对角膜像差的影响。设计 前瞻性病例对照研究。研究对象 等效球镜度-1.00 ~ -6.75 D的近视患者73例131眼。方法 37例68眼行飞秒激光制瓣LASIK手术，36例63眼行TransPRK手术。均使用阿玛仕准分子激光消像差切削模式。术前及术后1、3、6个月进行视力、屈光度、波前像差仪检查。主要指标 视力、残余屈光度、彗差、球差、总高阶像差。结果 术后1个月，飞秒激光制瓣LASIK组裸眼视力达到或超过术前最佳矫正视力者为75%，TransPRK组为47.62%（P=0.001）。术后3个月及6个月，飞秒激光制瓣LASIK组裸眼视力达到或超过术前最佳矫正视力者分别为86.76%、91.18%，TransPRK组分别为79.37%、90.48% （P=0.26，0.89）。术后残余屈光度，在术后3个月TransPRK组（0.13±0.35 D）较飞秒激光制瓣LASIK组（-0.02±0.41 D）略高，术后1个月及6个月均无显著差别。两组术后高阶像差均较术前提高（P<0.001）。术后1个月角膜彗差在TransPRK组为（0.25±0.10 μm），较飞秒激光制瓣LASIK组（0.30±0.17 μm）小（P=0.04）；术后3、6个月角膜彗差在TransPRK组分别为（0.28±0.10 μm）、（0.30±0.12 μm），与飞秒激光制瓣LASIK组（0.31±0.16 μm）、（0.35±0.11 μm）相似（P=0.12，0.13）。术后各时间点两组的球差、总高阶像差差异均无统计学意义。结论 飞秒激光制瓣LASIK手术及TransPRK手术治疗低中度近视患者术后角膜像差均有所提高，术后1个月TransPRK角膜彗差较飞秒激光制瓣LASIK小，术后3个月及6个月两种手术方式对角膜像差的影响相似。（眼科，2015，24：225-229）

The effect of femtosecond laser-assisted LASIK and transepithelial photorefractive keratectomy on corneal higher order aberrations in myopia

Objective To evaluate the effects of corneal higher-order aberrations of FEMTO LASIK and TransPRK for myopia patients. Design Prospective case control study. Participants One hundred thirty-one eyes of 73 Chinese patients with myopia and astigmatism whose spherical equivalent refraction ranged from -1.00 D to -6.75 D. Methods There were 68 eyes of 37 patients undergoing FEMTO LASIK and 63 eyes of 36 patients undergoing TransPRK using aberration free ablation with SCHWIND AMARIS excimer laser. Visual acuity, residual spherical equivalent, wavefront aberration were examined preoperatively, 1, 3 and 6 months postoperatively. Main Outcome Measures Visual acuity, manifest refraction, corneal higher-order aberrations including coma, spherical aberration and higher order aberration. Results On 1 month after surgery, the percent of postoperative UCVA better than or equal to preoperative BSCVA in FEMTO LASIK group was 75%, which was higher than in TransPRK group (47.62%) (P=0.001). On postoperative 3 and 6 months, the percent of postoperative UCVA better than or equal to preoperative BSCVA in FEMTO LASIK group was 86.76% and 91.18%, which were similar to that of TransPRK group (79.37% and 90.48% ) (P=0.26, 0.89). The residual spherical equivalent refraction in TransPRK group (0.13±0.35 D) was a little bit higher than that of FEMTO LASIK group (-0.02±0.41D). The coma of corneal in TransPRK group (0.25±0.10?m) was lower than that of FEMTO LASIK (0.30±0.17 ?m) on 1 month postoperatively (P=0.04). The coma in TransPRK group (0.28±0.10 ?m, 0.30±0.12 ?m) were similar in FEMTO LASIK (0.31±0.16 ?m, 0.35±0.11 ?m) on postoperative 3 and 6 months respectively (P=0.12 , 0.13). There were no significant differences between spherical and total higher-order aberrations on postoperative 1, 3 and 6 months. Conclusions Both FEMTO LASIK and TransPRK increase corneal higher-order aberrations. Coma was higher in FEMTO LASIK than in TransPRK group on postoperative 1 month. Corneal higher-order aberrations are comparable between two different surgeries on 3 and 6 months postoperatively. (Ophthalmol CHN, 2015, 24: 225-229)