LASIK与SBK治疗中度近视患者的临床对比研究

发布时间：2019-04-16 18:52

【摘要】：目的通过研究中度近视患者传统准分子激光角膜磨镶术（LASIK）和前弹力层下角膜磨镶术（SBK）手术前后视力、屈光度、对比敏感度（CS）和高阶像差，讨论传统LASIK与SBK的安全性、有效性、可预测性和视觉质量，，评价两种手术方式的临床疗效。方法选择中度近视患者59例114眼，根据自愿原则按手术方式不同分为LASIK组与SBK组，两组各57眼，LASIK组与SBK组等效球镜（SE）分别为-4.45±0.70D、-4.63±0.72D，分别记录两组患者术前、术后1周、1个月、3个月和6个月的视力、SE、RSE、CS、高阶像差，并进行统计学分析。结果术前LASIK组与SBK组各项基本资料组间比较，差异均无统计学意义（P0.05）。术后6个月，LASIK组与SBK组术后裸眼视力≥5.0分别占82.46%、87.72%，≥4.9分别占89.47%、92.98%，剩余等效球镜（RSE）在±0.5D之间分别占80.70%、85.96%，±1.00D之间分别占87.72%、91.23%，差异均无统计学意义（P0.05）。术前，LASIK组与SBK组间各空间频率下CS比较，差异无统计学意义；术后1个月，SBK组1.5、3c/d空间频率下CS上升幅度显著高于LASIK组，余术后各时间点后各空间频率下CS差值无统计学意义。手术前后各时间点两组18c/d空间频率下CS均无明显改变；LASIK组1.5、3、6、12c/d空间频率下CS于术后1个月降至最低，1.5、3、6c/d空间频率下CS于术后3个月恢复至术前水平，12c/d空间频率下CS于术后6个月恢复至术前水平；SBK组1.5、3、6c/d空间频率下CS术后1周降至最低，12c/d空间频率下CS术后1个月降至最低，术后3个月，1.5、3、6、12c/d空间频率下CS均恢复至术前水平。术前，LASIK组与SBK组垂直慧差（C7）、水平慧差(C8)、球差(C12)和总高阶像差均方根（Rmsh）组间比较，差异均无统计学意义（P0.05）。除术后1个月SBK组C7升高幅度明显低于LASIK组外，余各时间点高阶像差差值组间比较，差异无统计学意义（P0.05）。两组患者C7、C8、C12和Rmsh均于术后1周开始显著增高（P0.05）；SBK组术后1个月C7和Rmsh较术后1周显著下降， LASIK组术后3个月C7、C12和Rmsh较术后1周显著下降，至术后6个月，两组的C7、C8、C12和Rmsh均未恢复至术前水平。结论SBK的安全性、有效性、可预测性等同于LASIK组。LASIK和SBK对视觉质量均有显著性影响，术后早期，SBK组较LASIK组视觉质量好，随着时间的推移，LASIK组与SBK组视觉质量无明显差异。
[Abstract]:Objective to study the visual acuity, diopter, contrast sensitivity (CS) and high order aberrations before and after conventional excimer laser keratomileusis (LASIK) and anterior subelastic keratomileusis (SBK) in patients with moderate myopia. To discuss the safety, effectiveness, predictability and visual quality of traditional LASIK and SBK, and to evaluate the clinical efficacy of the two surgical methods. Methods 59 patients (114 eyes) with moderate myopia were divided into LASIK group (57 eyes) and SBK group (57 eyes) according to the principle of voluntary operation. The equivalent spherical (SE) of LASIK group and SBK group were-4.45 卤0.70D and 4.63 卤0.72D, respectively, and those of LASIK group and SBK group were-4.45 卤0.70D and 4.63 卤0.72D, respectively. The visual acuity, SE,RSE,CS, high-order aberrations were recorded before operation, 1 week, 1 month, 3 months and 6 months after operation in the two groups, and statistical analysis was performed. Results there was no significant difference between LASIK group and SBK group before operation (P0.05). At 6 months after operation, the uncorrected visual acuity of LASIK group and SBK group were 82.46%, 87.72%, 89.47%, 92.98%, respectively, and the remaining equivalent spherical (RSE) was 80.70% between 卤0.5D. 85.96% and 卤1.00D accounted for 87.72% and 91.23% respectively. There was no significant difference between them (P0.05). Before operation, there was no significant difference in CS between LASIK group and SBK group under different spatial frequencies. One month after operation, the increase of CS in SBK group was significantly higher than that in LASIK group at 1.5 and 3c d spatial frequency, but there was no significant difference in CS at each spatial frequency after the rest of the operation. There was no significant change in CS at each time point before and after operation in both groups under 18c/d spatial frequency. In LASIK group, CS decreased to the lowest at 1 month, 1.5, 3, 6, 6 and 12 c / d, respectively. CS returned to pre-operation level at 3 months after operation and CS returned to pre-operation level at 6 months after operation under the spatial frequency of 1.5, 3, 6, 6, 6, 6, 6, and 6 days after the operation, and the level of CS returned to the pre-operation level at 3 months after operation. In SBK group, the spatial frequency of CS was the lowest at 1 week after operation, and the lowest at 1 month after operation for CS at the spatial frequency of 12c/d, and the level of CS returned to the level of pre-operation at the spatial frequency of 1.5, 3,3,6 and 12 c after operation for 3 months, 1.5, 3,6,6 and 12 days after operation, respectively, and that at the spatial frequency of 1. 5, 3, 6 and 12 days after operation. Before operation, there was no significant difference in vertical difference (C7), horizontal difference (C8), spherical aberration (C12) and total high order aberration between LASIK group and SBK group (P 0.05). Except one month after operation, the increase of C7 in SBK group was significantly lower than that in LASIK group, and there was no significant difference in the high-order aberrations between the two groups at each time point (P0.05). The levels of C7, C8, C12 and Rmsh in the two groups increased significantly 1 week after operation (P0.05). The levels of C7, Rmsh, C7, C12 and Rmsh in SBK group were significantly lower than those in LASIK group at 1 week after operation. At 6 months after operation, C7, C8, C12 and Rmsh in both groups did not return to the pre-operative level, and the levels of C7, C12 and Rmsh in LASIK group at 3 months after operation were significantly lower than those at 1 week after operation. Conclusion the safety, efficacy and predictability of SBK are the same as those of LASIK group. LASIK and SBK have significant effects on visual quality. Early postoperative visual quality in SBK group is better than that in LASIK group. There is no significant difference in visual quality between LASIK group and SBK group with the passage of time.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.63

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