波前像差引导与波前像差优化LASIK治疗近视散光疗效的对比观察

目的：观察波前像差引导LASIK与波前像差优化LASIK对全眼高阶像差在0.3μm以下近视散光眼的疗效差异。

方法：前瞻性病例系列研究。收集在我院就诊拟行LASIK手术的近视散光患者30例60眼。每位患者随机选取一眼接受波前像差引导的LASIK,对侧眼接受波前像差优化的LASIK。术后6mo观察患者的视力、屈光度、全眼高阶像差及暗光下对比敏感度。采用配对样本t检验和χ²检验进行统计学分析。

结果：术后6mo,波前像差引导组与波前像差优化组分别有93%及90%的术眼裸眼视力≥5.0,两组术后等效球镜值在±0.50D范围内的比例分别为87%及83%,差异无统计学意义(P>0.05)。两组术后均未出现最佳矫正视力丢失2行或以上的情形。两组术后总高阶像差、球差、彗差均较术前增大(P<0.01),但增幅在两组间无统计学差异(P>0.05)。两组术后6mo暗光下对比敏感度在各个空间频率均恢复至术前水平,差异无统计学意义(P>0.05)。

结论：对术前全眼高阶像差小于0.3μm的近视散光眼,波前像差引导LASIK与波前像差优化LASIK对术后视力、屈光度、全眼高阶像差及对比敏感度的影响无明显差异。     

虹膜识别联合波前像差引导的LASIK手术临床疗效

目的 观察虹膜识别联合波前像差引导的准分子激光原位角膜磨镶术(LASIK)对近视和近视性散光的治疗效果.方法 前瞻性病例对照研究.选择术前高阶像差均方根(RMS HO)≥0.30 μm的近视或近视性散光患者30例(30眼),随机分为A组和B组.A组患者接受虹膜识别联合波前像差引导的LASIK手术,B组患者接受传统的LASIK手术.术前及术后1个月、3个月分别行波前像差检查和对比敏感度测试.采用两独立样本t检验.结果 随访至术后3个月,A组和B组的logMAR视力分别为-0.12±0.06和-0.09±0.07,两组间差异无统计学意义.术后1个月,A组患者的RMS HO值明显小于B组,差异有统计学意义(t=-2.097,P＜0.05).术后3个月,A组患者在明视无眩光环境1.5 c/d空间频率和3.0 c/d空间频率及暗视无眩光环境18 c/d空间频率下的对比敏感度均较B组患者高,差异均有统计学意义(t=2.517、2.175、2.263,P＜0.05).结论 虹膜识别联合波前像差引导的LASIK手术治疗近视和近视性散光安全、有效,在减少术后高阶像差、提高视觉质量方面具有明显的优势.     

虹膜识别联合波前像差引导的LASIK手术临床疗效

目的 观察虹膜识别联合波前像差引导的准分子激光原位角膜磨镶术(LASIK)对近视和近视性散光的治疗效果.方法 前瞻性病例对照研究.选择术前高阶像差均方根(RMS HO)≥0.30 μm的近视或近视性散光患者30例(30眼),随机分为A组和B组.A组患者接受虹膜识别联合波前像差引导的LASIK手术,B组患者接受传统的LASIK手术.术前及术后1个月、3个月分别行波前像差检查和对比敏感度测试.采用两独立样本t检验.结果 随访至术后3个月,A组和B组的logMAR视力分别为-0.12±0.06和-0.09±0.07,两组间差异无统计学意义.术后1个月,A组患者的RMS HO值明显小于B组,差异有统计学意义(t=-2.097,P＜0.05).术后3个月,A组患者在明视无眩光环境1.5 c/d空间频率和3.0 c/d空间频率及暗视无眩光环境18 c/d空间频率下的对比敏感度均较B组患者高,差异均有统计学意义(t=2.517、2.175、2.263,P＜0.05).结论 虹膜识别联合波前像差引导的LASIK手术治疗近视和近视性散光安全、有效,在减少术后高阶像差、提高视觉质量方面具有明显的优势.     

虹膜定位对飞秒联合波前像差引导LASIK治疗近视散光的疗效

目的：：虹膜定位对飞秒联合波前像差引导LASIK治疗近视散光疗效变化观察。方法：取同期进行飞秒联合波前像差引导LASIK治疗且柱镜>1.0D并有1a随访记录的近视患者,飞秒激光制作角膜瓣后启动虹膜定位成功行波前像差引导 LASIK 术(试验组)67例129眼与飞秒激光制作角膜瓣后无虹膜定位行波前像差引导LASIK术(对照组)82例161眼。在同一台激光机下进行激光切削。术后1、3、6mo,1a分别对两组患者术后裸眼视力( uncorrected visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)、电脑验光、波前像差结果对比分析。结果：术后1、3 mo UCVA超过术前BCVA 1行者,两组比较差异有统计学意义(χ2=6.423, P=0.011;χ2=14.431, P<0.01);术后1d,1mo残留散光两组比较差异均有统计学意义(t=1.98,P<0.05;t=2.23,P<0.05);术后6mo,1a UCVA及术后3、6mo,1a残留散光两组比较差异无统计学意义(P>0.05)。术后1a内两组高阶像差均方根值、球差、彗差均增加,较术前比较差异有统计学意义(P<0.05)。术后1、3mo高阶像差均方根值两组比较差异均有统计学意义(P<0.05)。术后1、3、6mo,1a彗差的增加试验组较对照组明显减少,两组比较差异均有统计学意义(P<0.05)。结论：虹膜定位技术的应用在飞秒制瓣联合波前像差引导LASIK治疗近视散光中,具有术后裸眼视力恢复快,高阶像差均方根值及彗差增加较少,残留散光少的特点,具有更好更稳定的治疗效果。     

波前像差联合Q值优化的非球面切削治疗中低度近视的临床研究

目的:探讨波前像差引导联合Q值优化的非球面切削的准分子激光原位角膜磨镶术(laser in situkeratomileusis,LASIK)治疗中低度近视眼的临床疗效。方法:随机选取欲行LASIK治疗的符合条件的中低度近视患者158例进行前瞻性研究,分别对40眼使用波前像差联合非球面切削程序(A组),38眼使用Q值优化的非球面切削程序(B组),39眼使用波前像差程序(C组),41眼使用标准切削进行LASIK手术(D组),比较术前和术后1,3,6mo的波前像差值、裸眼视力、最佳矫正视力和验光值。结果:158例研究对象中所有患者手术均成功,在术后6mo随访期间无1例患者发生严重的并发症,4组间比较手术的精确性、安全性、有效性无统计学差异(P>0.05);术后6moA组总高阶像差均方根值和球差均方根值较其它3组小。结论:与标准的LASIK、单独使用波前像差或Q值优化的非球面切削技术相比波前像差引导联合Q值优化的非球面切削的LASIK手术更能有效地减少术后高阶像差的增加、改善术后视觉质量。     

高度近视Zyoptix-LASIK和Artisan有晶状体眼人工晶状体植入术对视觉质量的影响

目的探讨高度近视Zyoptix-LASIK和有晶状体眼Artisan人工晶状体（IOL）植入术后高阶像差和对比敏感度的差异。方法按照术眼中央角膜厚度是否能够满足准分子激光角膜原位磨镶术（LASIK）的条件,将术眼分为LASIK组和ArtisanIOL组。LASIK组15例30眼接受波前像差引导的个体化LASIK,平均年龄27.6岁,屈光度-7.0～-12.0D平均等效球镜（-9.16±1.15）D;ArtisanIOL组17例30眼接受虹膜固定性有晶状体眼ArtisanIOL植入术,平均年龄29.1岁,屈光度-8.0～-14.0D平均等效球镜（-11.51±1.62）D。对比2组术后视力、最佳矫正视力、瞳孔大小、屈光状态、高阶像差、明光、暗光、暗光眩光条件下的对比敏感度等指标。高阶像差值以均方根（RMS）表示,测量总高阶像差（RMSh）、3阶X轴彗差（RMS3x）、3阶Y轴彗差（RMS3y）、4阶球差（RMS4s）及4阶像差（RMS4g）。结果术前2组间年龄和高阶像差的差异均无统计学意义（P〉0.05）。术后ArtisanIOL组的高阶像差低于LASIK组,其中2组间RMSh、RMS3x和RMS4g的差异均有统计学意义（P〈0.05）。术后2组高阶像差与术前相比均增高,但ArtisanIOL组手术前后RMS3x的差异无统计学意义（P=0.793）。ArtisanIOL组在明光、暗光、暗光眩光条件下各空间频率的对比敏感度均高于LASIK组,暗光条件下3、6、12cpd空间频率间的差异有统计学意义（P〈0.05）。结论与个体化LASIK相比,高度近视有晶状体眼植入ArtisanIOL后高阶像差的增加较少,且其暗光下中高空间频率对比敏感度优于LASIK。     

Q值引导SBK与LASIK术后对比敏感度及高阶像差对照观察

目的 探讨Q值引导的前弹力层下角膜磨镶术(Sub-Bowman's Keratomileusis,SBK)与角膜原位磨镶术(Laser In Situ Keratomileusis,LASIK)矫正近视患者术后高阶像差、对比敏感度的变化.方法 采用非随机对照临床研究,将2012年1～6月在浙江丽水市中心医院眼科接受Q值引导个性化准分子激光治疗的近视散光患者分为2组.A组36例(72只眼)患者接受SBK;B组28例(56只眼)患者接受LASIK.所有患者术前及术后检测高阶像差及暗环境下无眩光干扰检测对比敏感度,并将结果进行比较.随诊复查时间为术后1、3、6、12个月.结果 术前两组各项指标比较,差异无统计学意义(均P ＞0.05).SBK组对比敏感度术后3～6个月恢复至术前水平,LASIK组术后6～12个月恢复至术前水平;术后12个月,SBK组各空间频率对比敏感度均优于LASIK组,以低、中频率段较为显著.术后12个月,SBK组平均高阶像差为(0.476±0.137)μm,LASIK组为(0.83±0.154) μm,两者差异有统计学意义(P =0.001).结论 Q值引导个性化切削下,SBK与LASIK相比可减少手术诱导的高阶像差,更快地恢复低、中、高空间频率的对比敏感度.     

前弹力层下角膜磨镶术治疗近视的视觉质量观察

目的 探讨前弹力层下角膜磨镶术(sub-Bowman's keratomileusis,SBK)治疗近视散光患者术后的高阶像差、对比敏感度.方法 采用随机对照临床研究,将自愿接受激光治疗的近视散光患者分为2组.A组71例(71眼)患者接受SBK,B组67例(67眼)患者接受常规LASIK.所有患者均取右眼进行分析,并将结果进行比较.术前及术后检测高阶像差、对比敏感度,进行视觉质量主观满意度调查问卷等.随诊时间为术后1周、1个月、3个月、6个月、12个月.结果 术前2组各项指标比较,差异无统计学意义(均为P＞0.05).术后12个月,SBK组平均高阶像差为(0.416±0.067)μm,LASIK组为(0.614±0.098)μm,2者差异有统计学意义(t=-13.922,P=0.001);SBK组对比敏感度术后3～6个月恢复至术前水平,LASIK组术后6～12个月恢复至术前水平,术后12个月,在明亮及昏暗状态下,SBK组各空间频率对比敏感度优于LASIK组,其中明亮状态下低、中空间频率差异均有统计学意义;昏暗状态下低、中、高空间频率差异均有统计学意义.SBK组的患者主观满意率为95.8%,LASIK组为89.6%.结论 与常规LASIK相比,SBK可减少手术诱导的高阶像差,更快地恢复低、中、高空间频率的对比敏感度,患者的满意度更高.     

波前像差引导的个体化切削技术在LASEK术中应用的研究

目的:探讨波前像差引导的个体化切削技术对LASEK患者术后高阶像差的影响。方法:将均方根(RMS)值>0.3的不适合做LASIK术的近视患者40例80眼随机分为2组。其中1组20例40眼行普通LASEK术,另1组20例40眼应用波前像差引导的个体化切削程序(Zyoptix)进行LASEK术;所有术眼术前及术后1,3mo行像差测量。结果:术前两组高阶像差,彗差,球差相比无统计学意义(P>0.05),在6mm的瞳孔直径下,术后1mo两组高阶像差,彗差,球差较术前增加,个体化切削组高阶像差,彗差,球差增加幅度低于常规组,有统计学意义(P<0.05),术后3mo时,总体高阶像差,彗差,球差较1mo时有所下降,个体化组增加幅度仍小于普通组。结论:Zyoptix波前引导LASEK术后高阶像差增加幅度小于普通LASEK术。     

角膜波前像差引导的个性化LASIK和常规LASIK治疗近视的临床研究

目的比较常规准分子激光原位角膜磨镶术（Laser in situ Keratomileusis，LASIK）和角膜波前像差引导的个性化准分子激光原位角膜磨镶术（corneal wavefront aberrations guidedL ASIK，CW-GLASIK）治疗近视眼术后患者视觉质量的变化，探讨角膜波前像差引导的个性化准分子激光原位角膜磨镶术对对比敏感度和眩光以及角膜波前像差的影响，评价其手术的有效性。方法选取拟做LASIK手术的近视眼患者（近视球镜≤-10．00D，散光≤-2．5D）随机分成两组，一组行常规LASIK手术，另一组行角膜波前像差引导的个性化LASIK手术，手术均采用德国Schwind公司Esiris’准分子激光治疗系统，微角膜刀采用Moria LSK-ONE气动平推刀，对比敏感度检查采用Vector Vision CSV-1000HGT，角膜波前像差分析采用德国OPTIKON 2000 Keratron Scout分析仪。手术光学区直径为（6．0-7．0）mm，波前像差分析为6mm瞳孔直径。术前、术后检查裸眼视力、屈光度、对比敏感度及角膜地形图并进行波前像差分析。结果术后两组的裸眼视力均达到术前矫正视力，无显著性差异（P〉0．05）。两组术后1m时对比敏感度及眩光和术前比较均明显下降，差异有显著性（P〈0．05），术后3m时各空间频率对比敏感度和眩光均有所恢复，但均未达到术前水平，角膜波前像差引导的个性化LASIK组在各空间频率的对比敏感度和眩光同术前比较，无显著性差异，LASIK组在各空间频率的对比敏感度和眩光和术前比较差异有显著性（P〈0．05），角膜波前像差引导的个性化LASIK组在中（6c／d）、高（12c／d、18c／d）空间频率的对比敏感度和眩光明显好于常规LASIK组，有显著性差异（p〈0．05）。两组术后1m、3m角膜彗差、球差均比术前增大，但角膜波前像差引导的个性化LASIK组较常规LASIK组增大幅度小，差异有统计学意义（P〈0．05）。结论角膜波前像差引导的LASIK手术能有效地矫正近视，改善近视眼患者术后对比敏感度，降低术后彗差和球差，手术效果稳定、安全。     

屈光手术前个体眼高阶像差与中间视觉状态下瞳孔大小

目的:研究眼高阶像差的分布(HOAs)和mesopic瞳孔的大小在个体中筛选的屈光手术。 方法:我们采用Zywave像差分析仪（博士伦）分别对患有近视、近视散光和复性近视散光患者1240例2458眼和患有远视、远视散光和复性远视散光患者110例215眼的高阶像差和瞳孔大小进行检测。所有患者屈光不正均可矫正,无屈光手术史或潜在疾病。HOAs的均方根值、总球面像差、总斜射球面像差和中间视觉状态下瞳孔的大小进行了分析,眼高阶像差测量均在瞳孔≥6.0mm,且瞳孔大小的测量均为在中间视觉状态下进行。 结果:HOAs均方根值、总球面像差和总斜射球面像差在近视眼组与远视眼组分别为0.369±0.233μm、0.133±0.112μm、0.330±0.188μm;0.418±0.214μm、0.202±0.209μm、0.343±0201μm。与近视患者相比,远视患者的总HOAs和总球面像差更大(P均＜0.01)。年龄匹配分析显示在远视眼组只有总球面像差较高（P=0.05）。近视眼组的中间视觉状态下瞳孔大小较大（P≤0.05）。 结论:实验结果表明两组的HOAs的水平有显著差异,这对于将行屈光手术的伊朗人很重要。远视眼组的总球面像差显著高于近视眼组,中间视觉状态下瞳孔大小在近视眼组较大。     

Ocular higher-order aberrations and mesopic pupil size in individuals screened for refractive surgery

AIM: To study the distribution of ocular higher-order aberrations(HOAs) and mesopic pupil size in individuals screened for refractive surgery. METHODS: Ocular HOAs and mesopic pupil size were studied in 2 458 eyes of 1 240 patients with myopia, myopic astigmatism and compound myopic astigmatism and 215 eyes of 110 patients with hyperopia, hyperopic astigmatism and compound hyperopic astigmatism using the Zywave aberrometer (Busch& Lomb). All patients had correctable refractive errors without a history of refractive surgery or underlying diseases. Root-mean-square values of HOAs, total spherical aberration, total coma and mesopic pupil size were analyzed. Ocular HOAs were measured across a ≥ 6.0 mm pupil, and pupil size measurements were performed under the mesopic condition. RESULTS: The mean values of HOAs, total spherical aberration and total coma in the myopic group were 0.369μm, ±0.233, 0.133± 0.112μm and 0.330±0.188μm, respectively. In the hyperopic group the mean values of HOAs, total spherical aberration and total coma were 0.418μm ±0.214, 0.202±0.209μm and 0.343±0.201μm, respectively. Hyperopes showed greater total HOAs (P<0.01) and total spherical aberration (P<0.01) compared to myopes. In age-matched analysis, only the amount of total spherical aberration was higher in the hyperopic group (P=0.05). Mesopic pupil size in the myopic group was larger (P≤0.05). CONCLUSION: The results suggested that significant levels of HOAs were found in both groups which are important for planning refractive surgeries on Iranians. There were significantly higher levels of total spherical aberration in hyperopes compared to myopes. Mesopic pupil size was larger in myopic group.     

Corneal wavefront-guided ablation with the Schwind ESIRIS laser for myopia

PURPOSE: To evaluate the outcome of corneal wavefront-guided LASIK for the treatment of myopia and myopic astigmatism. METHODS: This study included 56 myopic virgin eyes of 28 patients with a mean spherical equivalent refraction of -4.40 +/- 1.83 diopters (D) (range: -1.25 to -9.75 D) and astigmatism < 2.50 D. The corneal wavefront aberrations were analyzed using a corneal topography system. The preoperative corneal wavefront aberration data obtained from the above analyses combined with manifest refraction were used to generate a customized ablation profile. The safety, efficacy, and predictability of the correction, contrast sensitivity, and corneal higher order wavefront aberrations were evaluated. RESULTS: At 1-year follow-up, the mean residual spherical equivalent refractive error was -0.15 +/- 0.3 D (range: 0 to -1.25 D) and mean cylinder was -0.54 +/- 0.34 D (range: 0 to -1.50 D). Ninety-five percent of eyes were in the residual refractive error range of +/- 0.50 D and uncorrected visual acuity improved by 1.00 D or better in 94% of eyes. The safety index and efficacy index were 1.13 and 0.92, respectively. After treatment, corneal higher order wavefront aberrations with a 6-mm pupil diameter increased significantly (paired sample t test, P < .01), and contrast sensitivity with glare had small reductions at high spatial frequencies. Changes in spherical-like aberration (R = 0.708, P < .001) and higher order wavefront aberration (R = 0.449, P = .001), except for coma-like aberration (P = .238), were positively correlated with the amount of achieved correction. CONCLUSIONS: Evaluation of clinical results showed that corneal wavefront-guided LASIK for the correction of myopia and myopic astigmatism was safe and effective. There was an increase in all higher order aberrations postoperatively.     

Cyclosporine a 0.05% eye drops for the treatment of subepithelial infiltrates after epidemic keratoconjunctivitis

Background

To compare the corneal high-order aberrations (HOAs), asphericity and regularity after Q-value guided laser in situ keratomileusis (LASIK) and laser epithelial keratomileusis (LASEK) in high myopic astigmatism.

Methods

In this retrospectively comparative study, we measured the corneal HOAs, asphericity indices (Q values) and corneal regularity indices preoperatively and 36?months postoperatively in 70 eyes (35 patients) with Q-value guided surgeries. All the patients with high myopic astigmatism were divided into two groups which included 34 eyes underwent LASIK and 36 eyes underwent LASEK procedures. The main impact factors of the high-order aberrations were also analyzed.

Results

In the two groups, the efficacy index was more than 1.00 and safety index approached 1.00 at year 3 postoperatively. Statistically significant (P?<?0.05) increased in Q values and main corneal HOAs (spherical aberrations and coma) following Q-value guided LASIK and LASEK procedures. Spherical aberrations increased more in the LASEK group and there was statistically difference compared to the LASIK group (P?<?0.05). LASEK had better effects in correcting corneal astigmatism (P?<?0.05). All the corneal regularity indices after surgeries increased and there was no significant difference (P?=?0.707, P?=?0.8 and P?=?0.224, respectively) between the two groups. The main impact factors of spherical aberration included the optic zone size, changes of Q value, surgical procedure and the corrected refraction.

Conclusions

In high myopic astigmatism, Q-value guided ablation showed good safety, efficacy and predictability. Q value, regularity indices, spherical aberration and coma increased in both LASIK and LASEK procedures. Astigmatism could be corrected more effectively by LASEK but greater spherical aberration could be created. The difference might be related to the different healing mechanisms. Optic zone size and the corrected refraction might be the main influence factors on the anterior corneal high order aberrations.     

Comparison of higher-order aberrations after wavefront-guided laser in situ keratomileusis and laser-assisted subepithelial keratectomy

PURPOSE: To compare the higher-order aberrations (HOAs) in 70 eyes (38 patients) that had wavefront-guided laser in situ keratomileusis (LASIK) with those in 70 eyes (40 patients) that had wavefront-guided laser-assisted subepithelial keratectomy (LASEK) for the treatment of myopia. SETTING: Department of Ophthalmology, Yonsei University College of Medicine, Myongdong Bal-geun sesang Eye Clinic, and Seran Eye Center, Seoul, Korea. METHODS: In a prospective study, 140 consecutive eyes of 78 patients were treated with wavefront-guided LASIK or LASEK according to the patient's choice after each procedure had been thoroughly explained. The patients were followed for 6 months. Best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), manifest refraction, and wavefront aberrations were measured at baseline and 1, 3, and 6 months after surgery. RESULTS: There were no significant differences in postoperative BCVA, UCVA, and manifest refraction between groups. The mean root-mean-square wavefront error of HOAs for a scotopic pupil in the wavefront-guided LASIK group was significantly smaller than that in the wavefront-guided LASEK group at 1 month. Analyzing individual Zernike coefficients, the spherical aberration and second coma were significantly smaller in the wavefront-guided LASIK group than in the wavefront-guided LASEK group at 1 month. This difference in HOAs between groups disappeared at 3 and 6 months. CONCLUSIONS: The HOAs in the scotopic condition were not different between the wavefront-guided LASIK and LASEK groups beginning 3 months after surgery. However, the HOAs in the LASIK and LASEK groups had a different time course, especially in the case of spherical aberration. This finding suggests that postoperative changes in aberration contribute to the final outcome of wavefront-guided ablation.     

Q值引导与波前引导的LASIK治疗近视的初步研究

目的:观察Q值引导与波前引导的LASIK治疗近视的疗效。方法:接受非球面切削与波前引导的LASIK治疗26例患者(52眼),每名患者的1眼使用Q值引导的切削,另1眼使用波前引导的个性化切削进行LASIK手术,分析2组的治疗效果。结果:术后3mo,2组手术眼视力矫正均满意,其间屈光度无差别(P>0.05);Q值引导组与波前引导组比较其术后角膜更倾向于长椭球形,Q值(0.24±0.32)低于波前引导组Q值(0.53±0.41)(P<0.01),当瞳孔直径为6mm时,两组术后高阶像差RMS均有增加,Q值引导组术后球差增加的幅度小于波前引导组,而彗差增加的幅度大于波前引导组。术后眩光发生率两组无显著性差异(P>0.05)。结论:使用Q值引导与波前引导的LASIK治疗近视及近视散光均是安全有效的,但仍存在不足,需要进一步改进、优化或整合。     

三种不同手术对屈光不正患者术后视觉质量及高阶像差的比较

目的：探讨飞秒激光制瓣的准分子激光原位角膜磨镶术(FS-LASIK)、角膜地形图引导LASIK(TG-LASIK)和飞秒激光小切口角膜基质透镜取出术(SMILE)对屈光不正患者术后视觉质量及高阶像差的效果。

方法：纳入2019-12/2020-02本院屈光中心收治的296例586眼单纯近视或近视散光患者。在明确手术适应证的前提下,患者自行选择接受FS-LASIK、TG-LASIK、SMILE手术,其中FS-LASIK组95例189眼,TG-LASIK组104例205眼,SMILE组97例192眼。收集患者术前及术后6、12mo时视力、屈光度、角膜地形图、高阶像差及对比敏感度。

结果：术后6、12mo各组患者裸眼视力、最佳矫正视力及球镜度数、柱镜度数、等效球镜度数均优于术前(P<0.05),组间比较均无差异(P>0.05)。术后6、12mo TG-LASIK组角膜表面规则指数、表面非对称指数均显著低于SMILE组、FS-LASIK组(P<0.05); SMILE组、FS-LASIK组组间比较无差异(P>0.05)。术后6、12mo时FS-LASIK组总高阶像差、彗差、球差及术后6mo时三叶草像差高于TG-LASIK组、SMILE组(P<0.05); 术后6、12mo时SMILE组球差显著低于其他两组(P<0.05)。术后6、12mo时TG-LASIK组在无眩光及有眩光时12.0、18.0c/d频率下对比敏感度显著高于SMILE组、FS-LASIK组(P<0.05)。

结论：FS-LASIK、TG-LASIK、SMILE三种手术均可获得较为满意的治疗效果,但TG-LASIK术后像差增加较小,角膜形态更规则,视觉质量更高。     

有和无虹膜识别波阵面像差引导的准分子激光原位角膜磨镶术治疗近视或近视散光眼临床对比研究

目的 探讨应用虹膜识别技术进行波阵面像差引导的准分子激光原位角膜磨镶术(LASIK)治疗近视或近视散光眼术后视力结果以及像差和对比敏感度变化.方法 前瞻性系列病例研究,对158只近视或近视性散光眼(85例)分为两组,一组应用虹膜识别技术进行波阵面像差引导的LASIK治疗(虹膜识别组),另一组不应用虹膜识别技术通过角膜缘作标记点进行波阵面像差引导的LASIK治疗(无虹膜识别组).对两组术后视力、残余屈光度、高阶像差均方根值和对比敏感度进行对比分析.计量资料采用完全随机设计两样本均数比较,计数资料采用x2检验.结果 两组术后10 d、1个月和3个月之间的平均裸眼视力(t=0.039,0.058,0.898;P=0.844,0.810,0.343)、最佳矫正视力(t =0.320,0.440,1.515; P=0.572,0.507,0.218)以及残留的屈光度[等值球镜(t=0.027,0.215,0.238;P=0.869,0.643,0.626)、球镜(t=0.145,0.117,0.038;P=0.704,0.732,0.845)和柱镜(t =1.676,1.936,0.334;P=0.195,0.164,0.563)]差异均无统计学意义.术后3个月虹膜识别组的安全性指数为1.06,无虹膜识别组为1.03;虹膜识别组的有效性指数为1.01,无虹膜识别组为1.00;虹膜识别组93.83％眼和无虹膜识别组90.91％眼等值球镜在±0.50 D内(x2=0.479,P=0.489),虹膜识别组98.77％眼和无虹膜识别组97.40％眼的等值球镜在±1.00D内(Fisher精确检验,P=0.613),两组安全性、有效性和可预测性之间均无差异.无虹膜识别组术后1个月和术后3个月3阶像差的均方根值比虹膜识别组大(t =3.414,-2.870;P=0.027,0.045),表现在彗差上;两组总体高阶像差(t=0.386,1.132;P=0.719,0.321)、4阶像差(t=0.808,2.720;P=0.464,0.063)和5阶像差(t =0.148,-1.717;P=0.890,0.161)之间无差异.术后3个月两组所有频段对比敏感度已达到术前水平,虹膜识别组在暗视下3.0 c/d(t =3.209,P=0.002)和6.0 c/d(t =2.997,P=0.004)频段对比敏感度高于无虹膜识别组,眩光对比敏感度明视下在3.0c/d(t =3.423,P=0.001)和6.0c/d(t =6.986,P=0.000)频段与暗视下在1.5c/d(t =9.839,P=0.000)和3.0c/d(t =7.367,P =0.000)虹膜识别组高于无虹膜识别组,其余各频段之间无差异.结论 虽然应用虹膜识别技术与不应用虹膜识别技术进行波阵面像差引导的LASIK,术后同样能够获得较好视力;但是应用虹膜识别技术可以减少术后彗差,提高对比敏感度.     

波阵面引导与常规准分子激光原位角膜磨镶术后对比敏感度和主观感觉的比较

目的探讨波阵面引导的准分子激光原位角膜磨镶术（LASIK）和传统LASIK给患者带来的主观方面的疗效差别。方法98例患者（98只眼）随机分为两组,试验组51人（51只眼）,对照组47人（47只眼）,分别接受波阵面引导的LASIK和传统LASIK,观察手术前后试验组与对照组对比敏感度和主观评估以及像差的变化。结果术后在光晕、夜晚视力、眩光和夜驾不适较术前变化的评估上,试验组不同程度地优于对照组（P〈0．05）;术后两组对比敏感度在各频段有差别,但以暗视下中、低频段较明显;手术后像差在两组间的差异有统计学意义,其对主观评估和对比敏感度的影响集中在夜视下和暗视下低、中频段,其中离焦和球差的影响最为明显,垂直彗差对主观评估和对比敏感度的影响与离焦和球差的影响方向相反。结论在术后对比敏感度和主观评估上,波阵面引导的LASIK优于传统LASIK组,这种优势主要与前者大幅度地降低了术后离焦和球差有关,垂直彗差可部分中和它们对视觉质量的影响。