SBK术后高阶像差和视觉质量的临床研究

发布时间：2019-06-06 01:38

【摘要】：背景前弹力层下准分子激光原位角膜磨镶术(sub-Bowman's keratomileusis, SBK)是2008年新问世的角膜屈光手术,具有术后视力恢复快、干眼发生率低、治疗范围更广等优点,但术后也出现了种种视觉质量问题,受到了屈光手术医师的重视。目的观察和分析近视眼患者SBK术后高阶像差(higher order aberration, HO A)、对比敏感度(contrast sensitivity, CS)、眩光对比敏感度(glare contrast sensitivity, GS)等参数的变化,并与准分子激光原位角膜磨镶术(laser in situ keratomileusis, LASIK)相比较,探讨SBK术后高阶像差与对比敏感度的关系,更加全面综合地评价SBK术后视觉质量,从而为准分子激光矫正近视眼获得更良好的视觉质量提供临床依据。方法采用自身前-后对照及病例-对照研究设计。选取2010年12月～2011年12月就诊于解放军91中心医院眼科中心的78名近视眼患者,其中SBK为病例观察组,LASIK为病例对照组,术前行裸眼视力(uncorrected visual acuity, UCVA)、最佳矫正视力(best corrected visual acuity, BSCVA)、电脑验光、眼压、裂隙灯、角膜地形图、眼底等常规检查。应用NIDEK OPD SCAN波前像差分析仪术前和术后1周、1月、3月、6月分别测量暗室条件下眼波前像差。应用Optec6500视功能检查仪术前和术后1周、1月、3月、6月分别测量暗环境下对比敏感度及眩光对比敏感度。手术(激光平台：NIDEK EC5000CⅩⅡ)均由同一医师完成。术后坚持复查随访。详细记录检查数据并采用SPSS13.0软件进行一般性统计描述、正态性检验、方差分析、独立样本t检验、Pearson相关分析等统计学分析和处理。结果 1.术前SBK组和LASIK组最佳矫正视力、柱镜、中央角膜厚度、角膜瓣厚度、T.Sph、T.Trefoil、Total和眼压进行比较,差异具有统计学意义(P0.05)。 2.SBK组和LASIK组不同时段裸眼视力比较,差异均无统计学意义(P0.05)。 3.SBK组和LASIK组术前两组柱镜比较,具有显著性差异(P=0.004)。 4.SBK组内Total、High、T.Coma、T.Trefoil、T.Sph、HitsAig手术前后进行比较,差异具有统计学意义(P0.05)；LASIK组内Total、T.Trefoil、T.Sph手术前后进行比较,具有显著性差异(P=0.000,P=0.000,P=0.000);组间比较：T.Sph在术前、术后1月和术后3月进行比较,差异具有统计学意义(P0.05),T.Trefoil在术前、术后3月进行比较,差异具有统计学意义(P0.05),Total在术前、术后1月和术后3月进行比较,差异具有统计学意义(P0.05)。 5.术后两组高阶像差增幅：T.Sph在术后1周、术后1月进行比较,具有显著性差异(P0.05)；Total在术后1月、术后6月进行比较,差异具有统计学意义(P0.05)。 6.SBK组1.5c/d、6.0c/d、12.0c/d空间频率下对比敏感度术前后进行比较,差异具有统计学意义(P0.05)。 7.SBK组术前,球差对12.0c/d频段的对比敏感度有影响,且呈负相关(r=-0.391)。术后1月,彗差对12.0c/d、18.0c/d频段的对比敏感度有影响,且均呈负相关(r=-0.366,r=-0.311)；球差对12.0c/d频段的对比敏感度有影响,呈负相关(r=-0.381)；而三叶草差与对比敏感度无明显相关。结论 1.SBK术后视觉质量优于LASIK. 2.SBK术后高阶像差和LASIK术后高阶像差均呈增长趋势。 3.SBK术后彗差、球差、三叶草差、总高阶像差均方根值增幅小于LASIK。 4.SBK术前,球差主要影响对比敏感度；术后一月,彗差和球差主要影响对比敏感度。
[Abstract]:background The in-situ keratomileussis (SBK) of the first-layer laser in situ keratomileussis (SBK) is a new corneal refractive surgery in 2008. It has the advantages of fast postoperative visual recovery, low incidence of dry eye and wider treatment scope. The subject is subject to the weight of the refractive surgeon. View. Objective To observe and analyze the changes of high-order aberration (HO A), contrast sensitivity (CS) and glare contrast sensitivity (GS) in patients with myopia and to be combined with laser in situ keratomileussis, LSISI. K) The relationship between the high-order aberration and contrast sensitivity after SBK operation was discussed, and the visual quality of the post-operation of SBK was evaluated in a more comprehensive and comprehensive manner. supply Bed basis. The method uses its own front-back control and A case-control study was designed. From December 2010 to December 2011,78 patients with myopia were seen from the 91 Central Hospital of the PLA, where the SBK was the case observation group, the LASIK was the case control group, and the preoperative visual acuity (UCVA) and the best corrected vision (BS) were the best corrected visual acuity (BS). CVA), computer optometry, intraocular pressure, slit lamp, corneal topography The routine examination of the fundus and the like was performed. The NIDEK OPD SCAN wavefront aberration analyzer was applied before and after the operation for 1 week, January, March and June respectively. The pre-operative and postoperative 1-week,1-,3-and 6-month post-operative contrast sensitivity of the Otec6500 visual function tester were measured in a dark environment, respectively. Contrast sensitivity of degree of glare and glare. (Laser platform: NIDEK EC5000C X II ) is completed by the same physician The follow-up was maintained after the operation. The examination data was recorded in detail and the general statistical description was performed using the SPSS13.0 software, positive and negative, analysis of variance, independent sample t-test, Pearson correlation analysis iso-series Results 1. The best corrected vision, post-lens, central corneal thickness, corneal flap thickness, T. Sph, T. Trefoil, Total and intraocular pressure were compared in the preoperative SBK group and the LASIK group. There was a statistical significance (P 0.05).2. The visual acuity of the naked eyes in the SBK group and the LASIK group was poor and the difference was poor. The comparison of the two groups before and after the operation of the SBK group and the LASIK group There was a significant difference (P = 0.004).4. The total, High, T. Coma, T. Trefoil, T. Sph, and Sweig operations in the SBK group were statistically significant (P = 0.000, P = 0.000, P = 0, P = 0.000, P = 0.000, P = 0). The difference was statistically significant (P0.05). The difference was statistically significant (P0.05), and the difference was statistically significant (P0.05). Total was before operation,1 month after operation and 3 months after operation. The difference was statistically significant (P0.05).5. The increase of higher-order aberration in the two groups after operation: T. Sph compared with one month after the operation, with significant difference (P0.05); Total was 1 month after operation, and 6 months after operation. The difference was statistically significant (P0.05).6. Contrast sensitivity at the spatial frequencies of 1.5 c/ d, 6.0 c/ d, and 12.0 c/ d in the SBK group. The difference was statistically significant (P0.05) before and after the operation. The contrast sensitivity of 12.0c/ d and 18.0 c/ d bands was negatively correlated (r =-0.366, r =-0.311) and negative correlation (r =-0.366, r =-0.311) and negative correlation (r =-0.366, r =-0.311) and negative correlation (r =-0.366, r =-0.311). =- 0.381); and the clover difference and contrast sensitivity were not Conclusion 1. The visual quality of SBK is superior to LASIK. 2. Higher-order aberrations after SBK and higher-order aberrations after LASIK showed a trend of growth. The post-operation coma, spherical aberration, clover difference and total high-order aberration of BK were smaller than that of LASIK.4. SB
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.63

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