飞秒激光角膜屈光手术前后高阶像差特征性变化的临床研究

发布时间：2018-02-25 23:33

  本文关键词： 近视 角膜 高阶像差 飞秒激光 准分子激光原位角膜磨镶术 准分子激光角膜前弹力层下磨镶术 微小切口 透镜取出术　出处：《天津医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的:对比分析飞秒激光 LASIK(Femtosecond laser in situ keratomileusis,FS-LASIK)手术、准分子激光角膜前弹力层下磨镶(Sub-Bowman's Keratomileusis,SBK)手术术后中长期(术后1-6个月)全眼高阶像差的特征性变化及FS-LASIK手术中不同手术参数和术中并发症对术后高阶像差的影响及相关因素的分析;探讨全飞秒激光角膜屈光手术—飞秒激光角膜微小切口基质透镜取出术(Small incision lenticule extraction,SMILE)和飞秒激光角膜基质透镜取出术(Femtosecond laser lenticule extraction,FLEx)手术后(1-3 个月)全眼高阶像差的变化特点,及与飞秒激光LASIK手术的比较分析。方法:1、对近视及近视散光患者101例201只眼行前瞻性研究,其中FS-LASIK手术患者60例119只眼,SBK手术患者41例82只眼,FS-LASIK组中薄瓣组24例47只眼及术中发生OBL的患者15例25只眼;2、另对近视及近视散光患者112例191只眼行前瞻性研究,其中SMILE手术患者34例61只眼,FLEx手术患者32例39只眼及对照组FS-LASIK手术患者46例91只眼。3、采用WaveScan 波前像差仪(WaveScan,VISX,Santa Clara,CA,USA)测量患者的波前像差,Pentacam眼前节分析系统(Oculus GmbH,Wetzlar,Germany)行角膜地形图测量。FS-LASIK与SBK手术术后1个月、3个月、6个月,SMILE与FLEx手术术后1个月,3个月进行随访测量。应用单因素方差分析、独立样本t检验及配对t检验、重复测量及Pearson线性相关等进行对比分析。结果:1.飞秒激光LASIK(FS-LASIK)手术后各个时期全眼总高阶(Sh)、彗差(C31)、球差(C40)及第三、四阶(S3、S4)均较术前增加,尤以总高阶(Sh)、球差(C40)及第四阶(S4)变化最明显(P0.05);术后3个月时,第三阶(S3)较术后1个月时增加,术后6个月时,彗差(C31)、球差(C40)及第四阶(S4)较术后3个月时增加(P0.05)。2.通过与对照组SBK组的比较,术后1个月时,垂直彗差(C3-1)及第三阶(S3)在FS-LASIK组较SBK组低(P0.05);术后3个月及6个月时,第三阶(S3)在FS-LASIK组较SBK组低(P0.05),其余项未见明显变化(P0.05)。3.FS-LASIK手术术后诱导的高阶像差与术中制作的角膜瓣厚度成负相关。薄瓣组(85/90/95μm)与正常组(105μm)术后总高阶(Sh)、球差(C40)及第三、四阶(S3、S4)均较术前增加,特别是总高阶(Sh)、球差(C40)及第四阶(S4)在术后各个时期薄瓣组均高于正常组(P0.05)。4.OBL的发生与中央角膜厚度CCT、角膜平均曲率和制作的角膜瓣厚度有关(P0.05),术前角膜越薄、角膜平均曲率越高、制作的角膜瓣越薄,越容易出现OBL。5.将OBL组和正常(无OBL)组比较发现,总高阶Sh、彗差(C31)、球差及第四阶(S4)在术后1个月时OBL组较正常组增加(P均0.05);彗差(C31)在术后3个月和6个月时在OBL组较正常组增加(P均0.05);而第三阶(S3)在术后3个月时OBL组明显高于正常组(P均0.05),6个月时两组比较接近。6.SMILE组和FLEx组术后1个月和3个月高阶像差均较术前增加,尤其是总高阶(Sh)、彗差(C3-1 C31)、球差(C40)、第三、四阶(S3、S4)(P均0.05);SMILE手术术后3个月总高阶(Sh)、球差(C40)及第四阶(S4)与术后1个月相比较有所下降(P均0.05);FLEx手术术后1个月与3个月之间差异无统计学意义(P均0.05)。7.术后1个月、3个月时总高阶(Sh)、三叶草(C33)及第六阶(S6)在SMILE组均低于FLEx组,且两组间差异有统计学意义(P均0.05);而彗差(C31)在FLEx组低于SMILE组,且两组间差异有统计学意义(P0.05)。8.术后1个月时,FLEx组中总高阶(Sh)、球差(C40)较FS-LASIK组低,且两组之间的差异具有统计学意义(P均0.05),而彗差(C31)和四叶草(C44)较FS-LASIK组高(P=0.018,0033);而3个月时,FLEx组中的总高阶(Sh)、彗差(C31)、球差(C40)、四叶草(C44)及第四阶(S4)均较FS-LASIK组低(P均0.05)。结论:1.FS-LASIK手术在矫正低阶像差的同时,诱导术源性高阶像差的产生,且具有恢复快,患者术后早期即拥有较稳定的视觉质量的优势;与SBK手术相比较,FS-LASIK手术术后患者可获得较好的视觉质量。2.在FS-LASIK手术中,制作超薄的角膜瓣,相较于正常厚度的角膜瓣而言,易诱导更多的高阶像差(以球差为主),影响患者术后视觉质量。3.OBL的发生与术前中央角膜厚度CCT、平均角膜曲率和术中制作的角膜瓣厚度有关。且OBL能诱导术后高阶像差的增加,随着角膜伤口的愈合,表现为角膜前表面不规则引起角膜彗差的增加为主。4."全飞秒激光"手术在矫正低阶像差的同时,诱导高阶像差的增加。随着角膜伤口的愈合,术后高阶像差有相对稳定并逐渐降低的趋势。5.SMILE手术中的"微小切口 "能有效降低角膜屈光手术术后的高阶像差,使患者术后获得较好的视觉质量。6.飞秒激光对角膜基质的切割移除作用能有效降低角膜屈光手术后的高阶像差,对患者术后早期高阶像差影响较准分子激光的切削消融作用较小,但需要增加样本量及延长随访时间进一步观察。
[Abstract]:Objective: comparative analysis of femtosecond laser LASIK (Femtosecond laser in situ keratomileusis, FS-LASIK) excimer laser surgery, Bowman keratomileusis (Sub-Bowman's Keratomileusis, SBK) after surgery in the long term (1-6 months postoperative) analysis of the effects of higher-order aberrations after surgery and the factors related to ocular higher-order aberrations characteristics the change of FS-LASIK in different operation parameters and operation and intraoperative complications; to investigate the femtosecond laser corneal refractive surgery, femtosecond laser corneal small incision lenticule extraction (Small incision lenticule extraction, SMILE) and the removal of femtosecond laser corneal lens (Femtosecond laser lenticule extraction, FLEx) after surgery (1-3 months) changes total higher-order aberrations, analysis and comparing with the LASIK femtosecond laser surgery. Methods: 1 of 101 patients with myopia and myopic astigmatism 201 eyes underwent prospective research The FS-LASIK surgery in 60 eyes of 119 patients, patients with SBK surgery in 41 cases 82 eyes, OBL FS-LASIK group in thin flap group 47 eyes and 24 cases in 15 patients with 25 eyes; 2, the other for myopia and myopic astigmatism in 112 patients 191 eyes underwent prospective study among SMILE patients with 34 eyes of 61 patients, patients with FLEx surgery in 32 eyes of 39 cases and control group of patients with FS-LASIK surgery in 46 eyes of 91 patients with.3, using the WaveScan wavefront analyzer (WaveScan, VISX, Santa, Clara, CA, USA) wavefront aberration measurement of patients, Pentacam system (Oculus GmbH, Wetzlar, Germany) for 1 months for cornea topographic map measurement of.FS-LASIK and SBK operation, 3 months, 6 months, 1 months after the operation of SMILE and FLEx, were measured for 3 months. By one-way analysis of variance, independent samples t test and paired t test, repeated measurement and Pearson linear correlation were analyzed. Results: 1. fly 绉掓縺鍏塋ASIK(FS-LASIK)鎵嬫湳鍚庡悇涓�鏃舵湡鍏ㄧ溂妫�

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