LASIK与LASEK治疗高度近视角膜形态及高阶像差的研究

发布时间：2018-01-13 16:14

本文关键词：LASIK与LASEK治疗高度近视角膜形态及高阶像差的研究　出处：《重庆医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：研究高度近视患者行准分子激光原位角膜磨镶术（laser insitu keratomileusis，LASIK）、Q值介导的个体化切削准分子激光原位角膜磨镶术（laser in situ keratomileusis with Q-value adjustedcustomized，，Q-LASIK）、准分子激光上皮下角膜磨镶术（lasersubepithelial keratomileusis，LASEK）和Q值介导的个体化切削准分子激光上皮下角膜磨镶术（laser subepithelial keratomileusiswith Q-value adjusted customized，Q-LASEK）手术前后裸眼视力、角膜前隆情况和角膜球差的变化，探讨适合高度近视患者的准分子激光切削手术方式。方法：取2012年1月至2012年7月行LASIK、Q-LASIK、LASEK、Q-LASEK手术的高度近视患者，其中常规LASIK患者11例19眼，Q-LASIK患者14例27眼，常规LASEK患者12例21眼，Q-LASEK患者8例14眼，分别在术前、术后1周、术后1月、术后3月、术后6月时检查裸眼视力（UCVA）、最佳矫正视力（BCVA）等,并运用眼前节系统检查角膜厚度、角膜后表面前隆情况及角膜球差，并对结果运用卡方检验、t检验等进行统计学分析。结果：术后四组患者的裸眼视力都较术前明显提高，大部分患者达到了术前最佳矫正视力，差异没有统计学意义（p＞0.05）。四组角膜后表面前隆情况，差异均有统计学意义（p均0.05）。其中常规LASIK和Q-LASIK与常规LASEK和Q-LASEK组在术后1周时角膜后表面前隆高度的差异，有显著的统计学意义（P 0.05），而术后1月、术后3月和术后6月时均无统计学差异（p均＞0.05））。四组术后角膜球差均较术前增大，但Q-LASIK组和Q-LASEK组球差增大幅度小于常规LASIK组和常规LASEK组，差异有统计学意义（p＜0.05）。结论：准分子激光切削手术在矫正高度近视方面均有较好的临床效果，Q值引导的个体化激光切削手术能明显的减低医源性角膜球差。高度近视患者行准分子手术后角膜后表面均有前隆，但LASEK较LASIK轻，发生医源性圆锥角膜的可能性低，高度近视行LASEK较LASIK更安全。
[Abstract]:Objective: to study the application of laser insitu keratomileusissis (LASIKI) in patients with high myopia by laser in situ keratomileusis (LASK). Q value mediated individualized excimer laser in situ keratomileusis (. Laser in situ keratomileusis with Q-value adjustedcustomized. Q-LASIKI, excimer laser subepithelial keratomileusis. LASEK) and Q value mediated individualized excimer laser keratomileusis (LASEK) and Q value mediated keratomileusis (LASEK). Laser subepithelial keratomileusiswith Q-value adjusted customized. Before and after Q-LASEK operation, the changes of naked eyesight, anterior corneal protuberance and corneal spherical aberration were studied, and the excimer laser ablation method suitable for high myopia patients was discussed. Methods: from January 2012 to July 2012, the patients with high myopia underwent LASIKOQ-LASIK Q-LASEK operation. Among them, there were 11 cases (19 eyes) with routine LASIK and 14 cases (27 eyes) with Q-LASIK, and 12 cases (21 eyes) with routine LASEK, 8 cases (14 eyes) with Q-LASEK. At preoperative, 1 week, January, March and June, the uncorrected visual acuity (UCVA) and the best corrected visual acuity (BCVA) were examined respectively, and the corneal thickness was examined by the anterior segment system. The posterior corneal surface protuberance and corneal spherical aberration were analyzed statistically by chi-square test and t test. Results: the uncorrected visual acuity of the four groups was significantly improved than that of the preoperative patients, and most of the patients achieved the best corrected visual acuity before operation. The difference was not statistically significant (P > 0.05). The difference was statistically significant (P < 0.05). The difference of anterior elevation of corneal posterior surface between routine LASIK and Q-LASIK group and routine LASEK and Q-LASEK group at 1 week after operation. There was significant statistical significance (P < 0.05), but there was no significant difference between the four groups on January, March and June. The corneal spherical aberration in the four groups was larger than that before operation. But the spherical aberration of Q-LASIK group and Q-LASEK group was smaller than that of routine LASIK group and routine LASEK group, the difference was statistically significant (p < 0.05). Conclusion: excimer laser ablation has good clinical effect in correcting high myopia. Q-guided individualized laser ablation can significantly reduce iatrogenic corneal spherical aberration. After excimer surgery, the corneal posterior surface of patients with high myopia has anterior protuberance, but LASEK is lighter than LASIK. Iatrogenic keratoconus is less likely to occur and LASEK is safer for high myopia than LASIK.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R779.6

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