前弹力层下激光角膜磨镶术与传统LASIK治疗近视的临床对比研究

发布时间：2018-04-08 11:27

本文选题：前弹力层下激光角膜磨镶术　切入点：准分子激光原位角膜磨镶术　出处：《浙江大学》2011年硕士论文

【摘要】：【目的】比较One-Use-Plus角膜机械板层刀操作的前弹力层下激光角膜磨镶术(OUP-SBK)与传统厚瓣准分子激光原位角膜磨镶术(LASIK)在矫正近视时的疗效。【方法】选择于我院接受准分子激光手术治疗的近视患者43例(84只术眼)并分为SBK组和LASIK组接受相应术式治疗,其中SBK组(48只术眼)和LASIK组(36只术眼)术前的平均等效球镜度数分别为-6.48±2.74D(-2.75～-14.00D)和-7.36±1.79D(-3.50～-10.75D),观察术后1月和3月两组的裸眼视力(UCVA)、最佳矫正视力(BSCVA)、等效球镜、高阶像差和对比敏感度(CS),比较两种手术方法的有效性、可预测性、稳定性以及术后视觉质量的变化情况。【结果】术后3月,SBK组和LASIK组的平均UCVA分别为0.98±0.19和1.01±0.20(Snellen表),其中SBK组中UCVA达1.0和大于1.0的患者分别占62.5%和14.6%,LASIK组中分别为44.4%和25.0%,相比均无显著性差异(p0.05)；SBK组和LASIK组的平均BSCVA分别为1.07±0.12和1.08±0.17(Snellen表),其中SBK组中BSCVA达1.0和大于1.0的患者分别占70.8%和29.2%,LASIK组中分别为58.4%和33.3%,相比均无显著性差异(p0.05)；SBK组等效球镜度数在±0.5D和±1.0D范围内的术眼分别占77.08%(37只眼)和87.50%(42只眼), LASIK组等效球镜度数在±0.5D和±1.0D范围内的术眼分别占75.00%(27只眼)94.44%(34只眼),两组相比均无显著性差异(p0.05)。两组术后1月到3月的等效球镜度数变化量相比无显著性差异(p0.05)。术后两组的高阶像差、彗差和球差均较术前显著增加,术后3月SBK组球差的总增量(0.28±0.15um)显著低于LASIK组(0.77±0.36um)(p=0.000),高阶像差和彗差的总增量无显著差异(p0.05)。术后SBK组在全频谱空间频率的眩光CS值均较术前显著下降(p0.05),相比之下,LASIK组仅在低空间频率上显著下降；SBK组非眩光CS值在低空间频率(1.0、1.7cpd)显著低于LASIK组(p=0.005,p=0.000),眩光CS值在中低空间频率(1.0、1.7、2.6、4.2cpd)显著低于LAISK组(p=0.014,p=0.000,p=0.003,p=0.014)。 [结论]本实验中,OUP-SBK在治疗近视上和LASIK具有相同的有效性、可预测性和稳定性,同时SBK拓宽了LASIK的治疗范围,使更多的高度近视和角膜厚度不足患者接受手术治疗；OUP-SBK手术引入的高阶像差与LASIK无异,引入的球差显著低于LASIK,提示SBK手术能够更好的维持角膜生物力学稳定性。本研究同时观察到SBK组术后中低频区眩光对比敏感度值显著低于LASIK组,提示其术后早期的夜间视觉质量可能差于LASIK。
[Abstract]:[objective] to compare the effect of One-Use-Plus mechanical lamellar laser keratomileusis (OUP-SBK) and conventional thick flap laser in situ keratomileusis (LASK) in the correction of myopia.[methods] Forty-three patients (84 eyes) with myopia received excimer laser surgery in our hospital were divided into two groups: SBK group and LASIK group.High order aberration and contrast sensitivity were compared to compare the effectiveness and predictability of the two surgical methods.There was no significant difference between the two groups in the change of equivalent spherical degree from 1 month to 3 months after operation (p 0.05).Higher order aberration, coma and spherical aberration in SBK group were significantly higher than those before operation. The total increment of spherical aberration in SBK group was significantly lower than that in LASIK group (0. 77 卤0. 36 ump 0.000) 3 months after operation. There was no significant difference in the total increment of high order aberration and coma between the two groups (p 0. 05).The frequency of middle and low spatial frequency was 1.70 ~ 2.6m 4.2cpdd, which was significantly lower than that of LAISK group (P = 0.014, P = 0.000, P 0.003, P = 0.014, P = 0.014, P = 0.014, P = 0.014).[conclusion] in this study, OUP-SBK has the same efficacy, predictability and stability as LASIK in the treatment of myopia, and SBK broadens the range of LASIK treatment.At the same time, we observed that the contrast sensitivity of glare in the middle and low frequency area in SBK group was significantly lower than that in LASIK group, suggesting that the early night visual quality of SBK group might be worse than that of LASIK group.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.63

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