波前像差引导的非球面个体化LASIK治疗屈光不正的视觉质量评价
发布时间：2018-08-30 16:00
【摘要】：目的 准分子激光原位角膜磨镶术(laser in situ keratomileusis, LAS IK)已经成为目前角膜屈光手术的主流方式,其以良好的稳定性、安全性、有效性和可预测性而被广泛运用,而部分患者仍抱怨术后出现眩光、光晕等光学并发症,这是因为传统的屈光手术只能矫正人眼的低阶像差,而对人眼的高阶像差却无法矫正为了能有效改善患者的这些不适症状,LASIK手术出现了个体化的切削模式,即波前像差引导的切削模式(PT)和Q值引导的非球面切削模式(AS)两种。前者可以有效消除或减少术前业已存在的高阶像差,却不能避免术中引入的球差；后者可以减少手术过程中引入的球差,保持术后角膜的非球面性,却不能矫正患者术前业已存在的高阶像差,这两种个体化的切削模式患者术后的视觉改善虽均比传统的LASIK有了很大提高,但在消除角膜屈光手术高阶像差方面都有其自身的局限性。波前像差引导的非球面个体化LASIK手术(Personalized Advanced Treatment, PTA),以波前为基础,目的在于在消除或减少术前高阶像差的同时治疗过程中不引入新的球差,减少患者术后的总高阶像差,理论上可以提高患者的视觉质量。本研究通过对近视散光患者行PTA手术术前及术后的视力、屈光度、Q值、波前像差、对比敏感度(contrast sensitivity,CS)及眩光敏感度的观察对其视觉质量进行评估。 方法 选取2010年8月～2010年12月在我院拟接受LASIK手术治疗近视及近视散光且随访时间满6个月的患者共计120例(240眼),男63例(126眼),女57例(114眼)。按随机化原则进行前瞻性研究,分为三个组：波前像差引导的非球面个体化切削组(PTA组)；波前像差引导的个体化切削组(PT组)；Q值引导的非球面个体化切削组(AS组)。三组患者术中均采用FEMTO LDV飞秒激光辅助制作角膜瓣,Technolas217z100型准分子激光机进行准分子激光切削,于术后1天、1周、1月、3月、6月复查裸眼视力(UCVA)、最佳矫正视力(BSCVA)、显然验光、波前像差、Q值、对比敏感度及眩光敏感度测试。 采用SPSS17.0统计学软件进行t检验、方差分析等统计学分析,检验水准为P0.05。 结果 1所有手术均顺利完成,未出现一例严重影响术后视觉质量的并发症发生 2视力和屈光度：(1)安全性：三组患者术后均未影响视力恢复的并发症发生,均无BSCVA的丢失；(2)有效性：三组患者术后UCVA均达到或超过术前BSCVA;(3)稳定性：三组患者术后等效球镜(MRSE)值理想,在+/-0.50D内者均占80%以上；(4)预测性：三组患者术后残留屈光度变化趋势平稳,均在+/-0.50D内。 3Q值：PTA组术后Q值均由负值变为正值,且与术前相比差异有统计学意义(Pall0.05)。三组患者术后Q值均由负值向正值改变,PTA组和PT组术后各期比较均有统计学差异(Pall0.05),和AS组比较术后早期(1周、1月)差异有统计学意义(Pall0.05),术后晚期(3月、6月)差异无统计学意义(Pall0.05)。 4高阶像差：PTA组术后总高阶像差和彗差与术前比较差异无统计学意义,球差在术后1月、3月、6月时与术前比较差异有统计学意义。术后6个月时,PTA组和PT组总高阶像差和球差比较差异有统计学意义(Pall0.05),和AS组比较差异无统计学意义(Pall0.05)。 5对比敏感度和眩光敏感度：PTA组在明视/暗视状态下术后各期各空间频率均未低于术前,在明视/暗视状态下,手术后各期对比敏感度值均未受到眩光刺激的影响。在明视状态下,术后1周时,1.5cpd和3.0cpd空间频率下,PTA组和PT组比较差异有统计学意义(Pall0.05),和AS组比较差异均无统计学意义(Pall0.05),术后6个月时,三组之间在各个空间频率下差异均无统计学意义(Pall0.05)；在暗视状态下,术后1周时,PTA组和PT组比较在1.5cpd、3.0cpd、6.0cpd空间频率下差异有统计学意义(Pall0.05),在高频组(12.0cpd、18.Ocpd)比较差异无统计学意义(Pall0.05)；在术后6个月时,PTA组在1.5cpd、3.0cpd、12cpd和18.0cpd空间频率下和PT组比较差异有统计学意义(Pall0.05),在18.0cpd空间频率下和AS组比较差异有统计学意义(P0.05)。 结论 1.波前像差引导的非球面个体化LASIK具有良好的安全性、有效性、预测性、稳定性。 2.波前像差引导的非球面个体化LASIK治疗屈光不正可以有效减少高阶像差和球差的增加,保持角膜的非球面形态,与其他两组相比,获得良好的术后视觉质量。
[Abstract]:objective
Laser in situ keratomileusis (LAS-IK) has become the mainstream method of corneal refractive surgery. It is widely used because of its good stability, safety, effectiveness and predictability. Some patients still complain of postoperative optical complications, such as glare and halo, because of traditional refraction. Surgery can only correct low-order aberrations of the human eye, but can not correct high-order aberrations of the human eye. In order to effectively improve these symptoms of patients, LASIK surgery has emerged individualized cutting mode, namely wavefront aberration-guided cutting mode (PT) and Q-guided non-spherical cutting mode (AS). The preoperative high-order aberration can not avoid the intraoperative spherical aberration; the latter can reduce the spherical aberration introduced during the operation and maintain the non-spherical cornea, but can not correct the preoperative high-order aberration of the patient, although the two individualized cutting patterns of patients with postoperative visual improvement than the traditional LASIK have Wavefront aberration-guided non-spherical personalized LASIK (PTA), based on wavefront, aims at eliminating or reducing preoperative high-order aberrations without introducing new spherical aberrations and reducing them. In this study, the visual quality of myopic astigmatism was evaluated by observing visual acuity, refraction, Q value, wavefront aberration, contrast sensitivity (CS) and glare sensitivity before and after PTA.
Method
From August 2010 to December 2010, 120 patients (240 eyes), 63 males (126 eyes) and 57 females (114 eyes) who were scheduled to undergo LASIK surgery for myopia and myopic astigmatism and had been followed up for more than 6 months were selected. Pre-aberration-guided individualized ablation group (PT group) and Q-guided non-spherical individualized ablation group (AS group). All three groups were treated with FEMTO LDV femtosecond laser-assisted corneal flap preparation. Technolas 217z100 excimer laser machine was used for excimer laser ablation. The best correction was performed on postoperative day, week, January, March and June. Visual acuity (BSCVA), apparent refraction, wavefront aberration, Q, contrast sensitivity and glare sensitivity test.
SPSS17.0 statistical software was used for t test, ANOVA and other statistical analysis. The test level was P0.05..
Result
1 all operations were successfully completed without a serious complication affecting postoperative visual quality.
2 Visual acuity and diopter: (1) Safety: No complications affecting visual acuity were found in all three groups, and no loss of BSCVA was found; (2) Effectiveness: UCVA in all three groups reached or exceeded BSCVA before surgery; (3) Stability: Equivalent spherical mirror (MRSE) was ideal in all three groups, accounting for more than 80% in +/-0.50D; (4) Predictive: The residual diopter of the three groups remained stable after +/-0.50D.
3Q value: Q value of PTA group changed from negative value to positive value, and there was significant difference compared with preoperative (Pall 0.05). Q value of three groups changed from negative value to positive value after operation. There was significant difference between PTA group and PT group in each period after operation (Pall 0.05). Compared with AS group, there was significant difference in early postoperative (1 week, 1 month), late postoperative (Pall 0.05). The difference was not statistically significant (March, June) (Pall0.05).
High-order aberration: There was no significant difference in total high-order aberration and coma between PTA group and preoperative group. There was significant difference in spherical aberration between PTA group and preoperative group at 1 month, 3 months and 6 months after operation. At 6 months after operation, there was significant difference in total high-order aberration and spherical aberration between PTA group and PT group (Pall 0.05), and there was no significant difference between AS group (P 0.05). Pall0.05).
5 Contrast sensitivity and glare sensitivity: The spatial frequency of each stage after operation in the PTA group was not lower than that before operation under the condition of bright/dark vision, and the postoperative contrast sensitivity was not affected by glare stimulation in the condition of bright/dark vision. There was statistical significance (Pall 0.05), and there was no significant difference between the three groups (Pall 0.05) and AS group (Pall 0.05). At 6 months after surgery, there was no significant difference among the three groups in all spatial frequencies (Pall 0.05). In dark vision, PTA group and PT group at 1 week after surgery were significantly different at 1.5 cpd, 3.0 cpd, 6.0 cpd spatial frequencies (Pall 0.05). There was no significant difference between the high frequency group (12.0 cpd, 18.Ocpd) (Pall 0.05); at 6 months after operation, there was significant difference between PTA group and PT group at 1.5 cpd, 3.0 cpd, 12 cpd and 18.0 cpd spatial frequencies (Pall 0.05), and there was significant difference between the 18.0 cpd spatial frequencies and AS group (P 0.05).
conclusion
1. The wavefront aberration guided non-spherical individualized LASIK has good security, effectiveness, predictability and stability.
2. Wavefront aberration-guided non-spherical individualized LASIK can effectively reduce the increase of higher-order aberration and spherical aberration, and maintain the non-spherical shape of cornea. Compared with other two groups, it can obtain good postoperative visual quality.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.63
本文编号：2213569
[Abstract]:objective
Laser in situ keratomileusis (LAS-IK) has become the mainstream method of corneal refractive surgery. It is widely used because of its good stability, safety, effectiveness and predictability. Some patients still complain of postoperative optical complications, such as glare and halo, because of traditional refraction. Surgery can only correct low-order aberrations of the human eye, but can not correct high-order aberrations of the human eye. In order to effectively improve these symptoms of patients, LASIK surgery has emerged individualized cutting mode, namely wavefront aberration-guided cutting mode (PT) and Q-guided non-spherical cutting mode (AS). The preoperative high-order aberration can not avoid the intraoperative spherical aberration; the latter can reduce the spherical aberration introduced during the operation and maintain the non-spherical cornea, but can not correct the preoperative high-order aberration of the patient, although the two individualized cutting patterns of patients with postoperative visual improvement than the traditional LASIK have Wavefront aberration-guided non-spherical personalized LASIK (PTA), based on wavefront, aims at eliminating or reducing preoperative high-order aberrations without introducing new spherical aberrations and reducing them. In this study, the visual quality of myopic astigmatism was evaluated by observing visual acuity, refraction, Q value, wavefront aberration, contrast sensitivity (CS) and glare sensitivity before and after PTA.
Method
From August 2010 to December 2010, 120 patients (240 eyes), 63 males (126 eyes) and 57 females (114 eyes) who were scheduled to undergo LASIK surgery for myopia and myopic astigmatism and had been followed up for more than 6 months were selected. Pre-aberration-guided individualized ablation group (PT group) and Q-guided non-spherical individualized ablation group (AS group). All three groups were treated with FEMTO LDV femtosecond laser-assisted corneal flap preparation. Technolas 217z100 excimer laser machine was used for excimer laser ablation. The best correction was performed on postoperative day, week, January, March and June. Visual acuity (BSCVA), apparent refraction, wavefront aberration, Q, contrast sensitivity and glare sensitivity test.
SPSS17.0 statistical software was used for t test, ANOVA and other statistical analysis. The test level was P0.05..
Result
1 all operations were successfully completed without a serious complication affecting postoperative visual quality.
2 Visual acuity and diopter: (1) Safety: No complications affecting visual acuity were found in all three groups, and no loss of BSCVA was found; (2) Effectiveness: UCVA in all three groups reached or exceeded BSCVA before surgery; (3) Stability: Equivalent spherical mirror (MRSE) was ideal in all three groups, accounting for more than 80% in +/-0.50D; (4) Predictive: The residual diopter of the three groups remained stable after +/-0.50D.
3Q value: Q value of PTA group changed from negative value to positive value, and there was significant difference compared with preoperative (Pall 0.05). Q value of three groups changed from negative value to positive value after operation. There was significant difference between PTA group and PT group in each period after operation (Pall 0.05). Compared with AS group, there was significant difference in early postoperative (1 week, 1 month), late postoperative (Pall 0.05). The difference was not statistically significant (March, June) (Pall0.05).
High-order aberration: There was no significant difference in total high-order aberration and coma between PTA group and preoperative group. There was significant difference in spherical aberration between PTA group and preoperative group at 1 month, 3 months and 6 months after operation. At 6 months after operation, there was significant difference in total high-order aberration and spherical aberration between PTA group and PT group (Pall 0.05), and there was no significant difference between AS group (P 0.05). Pall0.05).
5 Contrast sensitivity and glare sensitivity: The spatial frequency of each stage after operation in the PTA group was not lower than that before operation under the condition of bright/dark vision, and the postoperative contrast sensitivity was not affected by glare stimulation in the condition of bright/dark vision. There was statistical significance (Pall 0.05), and there was no significant difference between the three groups (Pall 0.05) and AS group (Pall 0.05). At 6 months after surgery, there was no significant difference among the three groups in all spatial frequencies (Pall 0.05). In dark vision, PTA group and PT group at 1 week after surgery were significantly different at 1.5 cpd, 3.0 cpd, 6.0 cpd spatial frequencies (Pall 0.05). There was no significant difference between the high frequency group (12.0 cpd, 18.Ocpd) (Pall 0.05); at 6 months after operation, there was significant difference between PTA group and PT group at 1.5 cpd, 3.0 cpd, 12 cpd and 18.0 cpd spatial frequencies (Pall 0.05), and there was significant difference between the 18.0 cpd spatial frequencies and AS group (P 0.05).
conclusion
1. The wavefront aberration guided non-spherical individualized LASIK has good security, effectiveness, predictability and stability.
2. Wavefront aberration-guided non-spherical individualized LASIK can effectively reduce the increase of higher-order aberration and spherical aberration, and maintain the non-spherical shape of cornea. Compared with other two groups, it can obtain good postoperative visual quality.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.63
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