老视球差补偿性激光切削临床研究
发布时间：2018-08-21 11:41
【摘要】：目的探讨老视球差补偿性激光切削的有效性、安全性、预测性和稳定性。 方法2005-2008年在复旦大学附属眼耳鼻喉科医院行准分子激光切削的24名老视患者纳入研究(近视患者21名,远视患者3名；准分子激光原位角膜磨镶术(laser in situ keratomileusis, LASIK)术13人23眼,准分子激光上皮瓣下角膜磨镶术(laser subepithelial keratomileusis, LASEK)术11人19眼),视远矫正近视力≤J5。实验组12名均为女性,平均47.09岁,平均等效球镜值(spherical equivalent, SE)为-2.98DS。对照组12名(男5名、女7名,平均48.33岁,术前平均SE为-5.20DS)与实验组术前年龄、SE、ADD值、手术时间配对。实验组患者主导眼行准分子激光矫正的目标屈光度为-0.25DS,非主导眼的目标屈光度为-0.50DS。对照组患者主导眼目标屈光度为-0.25DS,非主导眼目标屈光度为-1.OODS。实验组非主导眼行shotfile软件补充切削。观察术后患者的屈光度、矫正远视力(corrected distant visual acuity, CDVA)裸眼远视力(uncorrected distant visual acuity, UDVA)、裸眼近视力(uncorrected near visual acuity, UNVA)、视远矫正近视力、双眼同时视远近视力、对比敏感度(contrast sensitivity, CS)。WFA-1000像差测量仪测量全眼像差,观察球差(spherical aberration, SA)(Z (4,0))术后早期及远期变化。Pentacam测角膜前表面曲率,计算2mm及4mm半径处K值均值(K2mm、K4m),观察术后ΔK(K值变化量)的连续改变即ΔK2(角膜顶点K-K2mm)、ΔK4(K2mm-K4m)的变化。末次随访时间为术后平均4.5年。SPSS13.0统计软件对数据进行统计分析,P0.05为差异有统计学意义。 结果实验组非主导眼术后3月UNVA为0.20,术后4.5年为0.40,较术后3月下降2行(p=0.019)。术后4.5年非主导眼UNVA优于主导眼1行(p=0.041)双眼视远矫正近视力无差异(p=0.365)。实验组非主导眼术后3月、4.5年UDVA差异无统计学意义(p=0.298)；术后4.5年UDVA较术前平均提高6.5行(p=0.007),较主导眼术后4.5年UDVA无差异(p=O.166)。术后4.5年,实验组双眼同时视UDVA LogMAR均值为-0.03,对照组为0.01,实验组双眼同时视UNVA LogMAR均值为0.38,实验组为0.30；实验组与对照组UDVA、UNVA均无差异(p=0.096,p=0.054)。实验组术后4.5年非主导眼UDVA较术前CDVA平均下降0.6行(p=0.009),无一人下降超过2行,术后CDVA较术前CDVA无差异(p=1.000)。实验组非主导眼术后6月与术前各个空间频率CS差异无统计学意义(n=9)；术后4.5年较术前在空间频率为1.6及0.7视角无眩光CS轻度提高(p=0.025,p=0.046；n=12),空间频率为1.0°视角的眩光CS值有轻度提高(p=0.042,n=11)。实验组非主导眼预期SE平均为-0.50DS,术后4.5年SE值为-0.53DS,与预期SE无差异(p=0.268)。实验组ADD值术前术后无差异,对照组ADD值术后较术前增大(p=0.012),术后实验组ADD较对照组小(p=0.041)。实验组非主导眼术后6月SA均值为-0.045μm,术前SA为-0.190μm,差异有统计学意义(p=0.022,n=8)；实验组非主导眼术后4.5年SA均值为-0.143μm,较术前无差异(p=0.359,n=11),较主导眼球差偏正(p=0.002,n=11)；非主导眼术后早期较术前球差偏正,后逐渐正值减少,负值增加。实验组非主导眼术前ΔK2均值为-0.022D,术后4.5年为0.303D,差异有统计学意义(p=0.005,n=9),术前Δk4均值为0.066D,术后4.5年为0.362D,差异有统计学意义(p=0.010,n=9)。术后早期ΔK较术前增大明显,远期ΔK减小回退,ΔK4变化较大。 结论老视球差补偿性激光切削短期有效、安全且预测性好,其远期有效性及稳定性有待扩大样本进一步探讨。
[Abstract]:Objective to explore the effectiveness, safety, predictability and stability of compensated laser cutting with presbyopic spherical aberration.
Methods From 2005 to 2008, 24 presbyopic patients (21 myopic patients, 3 hyperopic patients, 13 laser in situ keratomileusis (LASIK) and 23 laser subepithelial keratomileusis (LASIK) were included in the study. In the experimental group, 12 patients were all female, mean 47.09 years old, mean spherical equivalent (SE) was - 2.98DS. In the control group, 12 patients (5 males, 7 females, mean 48.33 years old, mean preoperative SE was - 5.20DS) were matched with preoperative age, SE, ADD value and operation time. The refractive index of the dominant eye was -0.25DS and the refractive index of the non-dominant eye was - 0.50DS. The refractive index of the dominant eye was - 0.25DS and the refractive index of the non-dominant eye was - 1.OODS in the control group. Corrected distant visual acuity (CDVA), uncorrected distant visual acuity (UDVA), uncorrected near visual acuity (UNVA), hyperopia corrected near visual acuity, binocular simultaneous visual acuity, contrast sensitivity (CS). WFA-1000 aberration meter measured the whole eye aberration and observed the spherical aberration. (spherical aberration, SA) (Z (4,0)) early and long-term changes after surgery. Pentacam measured corneal anterior surface curvature, calculated the mean of K value at radius 2 mm and 4 mm (K2mm, K4m), observed the continuous changes of K2 (corneal vertex K-K2mm), and K 4 (K2mm-K4m). The mean follow-up time was 4.5 years. SPSS13.0 statistical software. Statistical analysis of data showed that P0.05 was statistically significant.
Results UNVA was 0.20 at 3 months and 0.40 at 4.5 years after surgery, which was 2 rows lower than that at 3 months (p = 0.019). There was no significant difference in near vision (p = 0.365) between non-dominant eyes and dominant eyes (p = 0.041) after 4.5 years (p = 0.298). 4.5 years after operation, the mean value of UDVA LogMAR in both eyes of the experimental group was - 0.03 and that of the control group was 0.01. The mean value of UNVA LogMAR in both eyes of the experimental group was 0.38 and 0.30 respectively. There was no difference between the experimental group and the control group in UDVA and UNVA (p = 0.096, P = 0.054). There was no significant difference in postoperative CDVA between the experimental group and the control group (p = 1.000). There was no significant difference in spatial frequency CS between the experimental group and the control group (n = 9) at 6 months after surgery and at 4.5 years after surgery, compared with the preoperative spatial frequency of 1.6 and 0.7 visual angles. The CS value of glare was slightly increased (p = 0.025, P = 0.046; n = 12), and the CS value of glare was slightly increased (p = 0.042, n = 11) at the spatial frequency of 1.0 degrees. The average expected SE value of non-dominant eyes in the experimental group was - 0.50DS, 4.5 years after operation was - 0.53DS, which was not different from the expected SE value (p = 0.268). The ADD value of the experimental group was not different before and after operation, but that of the control group was higher than that before operation (p = 0.012). ADD in the experimental group was smaller than that in the control group (p = 0.041). The mean SA in the non-dominant eye was - 0.045 micron at 6 months after operation and - 0.190 micron before operation, and the difference was statistically significant (p = 0.022, n = 8); the mean SA in the non-dominant eye was - 0.143 micron at 4.5 years after operation, which was not significantly different from that before operation (p = 0.359, n = 11), and was positively different from that of the dominant eye (p = 0.002, n = 11). The mean value of preoperative K2 was - 0.022D in the experimental group and 0.303D in the postoperative 4.5 years. The difference was statistically significant (p = 0.005, n = 9). The mean value of preoperative K4 was 0.066D, and 0.362D in the postoperative 4.5 years. The difference was statistically significant (p = 0.010, n = 9). The delta K decreases and the K4 changes greatly.
Conclusion Old parallax compensated laser ablation is effective, safe and predictive in the short term. Its long-term effectiveness and stability need to be further explored by enlarging the sample.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.63
本文编号：2195601
[Abstract]:Objective to explore the effectiveness, safety, predictability and stability of compensated laser cutting with presbyopic spherical aberration.
Methods From 2005 to 2008, 24 presbyopic patients (21 myopic patients, 3 hyperopic patients, 13 laser in situ keratomileusis (LASIK) and 23 laser subepithelial keratomileusis (LASIK) were included in the study. In the experimental group, 12 patients were all female, mean 47.09 years old, mean spherical equivalent (SE) was - 2.98DS. In the control group, 12 patients (5 males, 7 females, mean 48.33 years old, mean preoperative SE was - 5.20DS) were matched with preoperative age, SE, ADD value and operation time. The refractive index of the dominant eye was -0.25DS and the refractive index of the non-dominant eye was - 0.50DS. The refractive index of the dominant eye was - 0.25DS and the refractive index of the non-dominant eye was - 1.OODS in the control group. Corrected distant visual acuity (CDVA), uncorrected distant visual acuity (UDVA), uncorrected near visual acuity (UNVA), hyperopia corrected near visual acuity, binocular simultaneous visual acuity, contrast sensitivity (CS). WFA-1000 aberration meter measured the whole eye aberration and observed the spherical aberration. (spherical aberration, SA) (Z (4,0)) early and long-term changes after surgery. Pentacam measured corneal anterior surface curvature, calculated the mean of K value at radius 2 mm and 4 mm (K2mm, K4m), observed the continuous changes of K2 (corneal vertex K-K2mm), and K 4 (K2mm-K4m). The mean follow-up time was 4.5 years. SPSS13.0 statistical software. Statistical analysis of data showed that P0.05 was statistically significant.
Results UNVA was 0.20 at 3 months and 0.40 at 4.5 years after surgery, which was 2 rows lower than that at 3 months (p = 0.019). There was no significant difference in near vision (p = 0.365) between non-dominant eyes and dominant eyes (p = 0.041) after 4.5 years (p = 0.298). 4.5 years after operation, the mean value of UDVA LogMAR in both eyes of the experimental group was - 0.03 and that of the control group was 0.01. The mean value of UNVA LogMAR in both eyes of the experimental group was 0.38 and 0.30 respectively. There was no difference between the experimental group and the control group in UDVA and UNVA (p = 0.096, P = 0.054). There was no significant difference in postoperative CDVA between the experimental group and the control group (p = 1.000). There was no significant difference in spatial frequency CS between the experimental group and the control group (n = 9) at 6 months after surgery and at 4.5 years after surgery, compared with the preoperative spatial frequency of 1.6 and 0.7 visual angles. The CS value of glare was slightly increased (p = 0.025, P = 0.046; n = 12), and the CS value of glare was slightly increased (p = 0.042, n = 11) at the spatial frequency of 1.0 degrees. The average expected SE value of non-dominant eyes in the experimental group was - 0.50DS, 4.5 years after operation was - 0.53DS, which was not different from the expected SE value (p = 0.268). The ADD value of the experimental group was not different before and after operation, but that of the control group was higher than that before operation (p = 0.012). ADD in the experimental group was smaller than that in the control group (p = 0.041). The mean SA in the non-dominant eye was - 0.045 micron at 6 months after operation and - 0.190 micron before operation, and the difference was statistically significant (p = 0.022, n = 8); the mean SA in the non-dominant eye was - 0.143 micron at 4.5 years after operation, which was not significantly different from that before operation (p = 0.359, n = 11), and was positively different from that of the dominant eye (p = 0.002, n = 11). The mean value of preoperative K2 was - 0.022D in the experimental group and 0.303D in the postoperative 4.5 years. The difference was statistically significant (p = 0.005, n = 9). The mean value of preoperative K4 was 0.066D, and 0.362D in the postoperative 4.5 years. The difference was statistically significant (p = 0.010, n = 9). The delta K decreases and the K4 changes greatly.
Conclusion Old parallax compensated laser ablation is effective, safe and predictive in the short term. Its long-term effectiveness and stability need to be further explored by enlarging the sample.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.63
【参考文献】
相关期刊论文 前1条
1 鲁静;周跃华;郑燕;;近视眼波前像差对对比敏感度的影响[J];眼科新进展;2007年09期
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