高度近视准分子激光原位角膜磨镶术后对比敏感度的研究

发布时间：2018-03-25 20:04

  本文选题：角膜磨镶术　切入点：激光原位　出处：《郑州大学》2011年硕士论文

【摘要】：背景与目的 准分子激光原位角膜磨镶术治疗近视以其安全性和有效性,已成为当今角膜屈光手术的首选术式。然而角膜屈光手术矫正屈光不正的同时改变了原来角膜的正常形态,这就可能引起术后视觉质量的下降,出现对比敏感度下降、眩光、光晕以及夜视力差等症状。随着患者对术后视觉质量的不满,临床医生逐渐认识到有关对比敏感度研究的重要性与必要性,尤其是暗环境下的对比敏感度。对比敏感度是评价人眼视功能的重要指标,并且它的变化早于视野、眼底和视力的改变,能够准确、及时地反映视功能的变化,还能对手术方式和术后疗效作出准确的评价。在眼科领域,国内外虽然有对比敏感度的研究报道,但对于高度近视准分子激光原位角膜磨镶术后暗环境下对比敏感度的研究较少,并且结果不尽相同。 本研究收集术前等值球镜为(-6.00--12.75)D的近视患者66例(129眼)进行前瞻性研究,旨在探讨高度近视行准分子激光原位角膜磨镶术治疗后的临床疗效,对比敏感度度的变化及与其他参数如术前屈光度、瞳孔直径,手术切削光区直径、性别、年龄和眩光的相关性。 方法 连续收集2010年5月至2010年8月在我院准分子激光治疗中心接受准分子激光原位角膜磨镶术治疗的66例129只高度近视眼,进行前瞻性研究。所有患者均进行术前和术后1、3、6个月裸眼视力、最佳矫正视力和屈光度的检查,采用CSV-1000E型对比敏感度测试仪进行暗环境下对比敏感度的检查,观察高度近视准分子激光原位角膜磨镶术后对比敏感度的变化,并分析与其相关的术前屈光度、手术切削光区直径和眩光等因素的关系。 采用SPSS17.0统计软件进行数据统计学分析,均数用(x±s)表示,对比敏感度变化用单因素方差分析(ANOVA),眩光对对比敏感度影响用配对t检验,相关性分析用Pearson相关,P0.05作为差异有统计学意义的标准。 结果 1.术后6个月95只眼(73.60%)裸眼视力≥1.0,有效指数0.996,安全性指数1.052,122只眼(94.57%)屈光度在±1.00D之内,97只眼(75.19%)屈光度在±0.50D之内。 2.术后1个月低频段(3c/d)、中(6、12c/d)和高频段(18c/d)对比敏感度均有明显下降；术后6个月低频段对比敏感度可恢复至术前水平(二者差异无统计学意义,P0.05),但中、高频段对比敏感度尚未恢复至术前水平(差异均有统计学意义P0.05)。 3.术前屈光度与术前和术后对比敏感度均呈负相关,尤其是中、高频段对比敏感度；手术切削光区直径的大小与术后对比敏感度呈正相关,尤其是暗视情况下的低、中频段对比敏感度；有眩光时对比敏感度均较无眩光时对比敏感度低,所有空间频段差异均有统计学意义(P0.05)。 4.对比敏感度与性别、年龄和瞳孔直径均不相关。 结论 1.高度近视准分子激光原位角膜磨镶术后暗环境下对比敏感度均较术前下降；术后6个月时,低频段对比敏感度已恢复至术前水平,但中、高频段对比敏感度均未恢复至术前水平。 2.暗环境下对比敏感度与术前屈光度呈负相关、与手术切削光区直径呈正相关,有眩光时对比敏感度比无眩光时对比敏感度低。
[Abstract]:Background and purpose
Excimer laser in situ keratomileusis for its safety and effectiveness, has become the preferred technique in corneal refractive surgery and corneal refractive surgery. However, ametropia correction has changed the original corneal normal form, which may decrease the postoperative visual quality, contrast sensitivity decreased, glare, halo night vision and other symptoms. Patients with poor dissatisfaction with the visual quality after the surgery, doctors gradually realized the importance and necessity of studying on contrast sensitivity, especially the contrast sensitivity in the dark environment. The sensitivity is an important index for evaluating the human visual function, and it changes early in the field of vision, fundus and the change of visual acuity, accurately, timely reflect the changes of visual function, can make an accurate evaluation on the efficacy of surgery and after surgery. In the field of Ophthalmology at home and abroad, although the statistic Sensitivity studies have been reported. However, there are few studies on the contrast sensitivity in the dark environment after laser in situ keratomileusis for high myopia, and the results are different.
This study collected the preoperative spherical equivalent (-6.00--12.75) for 66 cases of D patients with myopia (129 eyes) were prospectively studied to explore clinical effect of high myopia excimer laser in situ keratomileusis corneal treatment, changes of contrast sensitivity degree and other parameters such as preoperative diopter, pupillary diameter. Surgical ablation diameter, gender, age and correlation of glare.
Method
From May 2010 to August 2010 to accept continuous laser in situ keratomileusis for treatment of 66 cases of 129 eyes with high myopia after excimer laser treatment center in our hospital were prospectively studied. All patients underwent preoperative and postoperative 1,3,6 months uncorrected visual acuity, best corrected visual acuity and refraction examination, used CSV-1000E contrast sensitivity tester for mesopic contrast sensitivity examination, observation of high myopia after laser in situ keratomileusis contrast sensitivity changes, and analyze the related preoperative refraction, the relationship between surgery ablation diameter and glare and other factors.
The data were analyzed by SPSS17.0 statistical software, with mean (x + s) said that the analysis of the changes of contrast sensitivity with single factor variance (ANOVA), paired t test on the effect of glare contrast sensitivity, correlation analysis using Pearson correlation, P0.05 as statistically significant.
Result
1. 6 months after surgery, 95 eyes (73.60%) uncorrected visual acuity 1, effective index 0.996, security index in 1.052122 eyes (94.57%) diopter within 1.00D, 97 eyes (75.19%) diopter within 0.50D.
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