光学切削区对准分子激光屈光术后视觉质量的影响

发布时间：2018-06-22 20:01

本文选题：光学切削区 + 暗适应瞳孔直径　；参考：《昆明医学院》2011年硕士论文

【摘要】：目的：通过对临床患者行准分子激光角膜原位磨镶术术前、术后视觉质量的数据收集、对比分析。研究角膜光学切削区直径与暗适应下瞳孔直径关系,探讨个性化LASIK手术光学切削区大小的选择,以改善患者术后的视觉质量。方法：选择2010年5月一2010年12月于我院行非球面LASIK手术并能坚持随访复查的患者242人共450眼,男122人(232眼)、女120人(220眼),年龄：18-24岁、平均年龄：(21.6±1.4),暗适应下瞳孔直径：5.0—8.0 mm,角膜曲率：40.045.0 D角膜光学区厚度：(540.67±29.56)μm等效柱镜度数区域0～-2.00D,等效球镜度数区域：-0.50～-9.00D。按屈光度分为三组：轻度近视组(-0.50～-3.00D)、中度近视组(-3.25～-6.00D)、高度近视组(-6.25～-9.00D)。三组中分别随机分配相对等量的手术患者,再将各组患者按光学切削区与暗适应下瞳孔直径大小关系分为：A组：光学切削区大于暗适应下瞳孔直径区域0.1mm—0.5mm。B组：光学切削区等于暗适应下瞳孔直径区域。C组：光学切削区小于暗适应下瞳孔直径区域O.1mm—1.0mm。D组：光学切削区小于暗适应下瞳孔直径区域1.1mm—2.0mm。E组：光学切削区小于暗适应下瞳孔直径区域2.1 mm—3.0mm。各组中分别记录下于患者术前矫正视力、裸眼视力,术后次日、术后1月、术后3月、术后6月的裸眼视力、常规LASIK术后的专科检查和术后术后1月、术后3月、术后6月视觉对比敏感度。结果：LASIK术后242人(450眼),术后次日裸眼视力68.44%的患者视力达到术前矫正视力,术后一月裸眼视力85.78%的患者达到术前矫正视力,术后三月裸眼视力90.67%的患者达到术前矫正视力,术后六月的裸眼视力91.78%达到术前矫正视力。三组屈光度术后的视觉质量：各组患者的光学切削区大于暗适应瞳孔直径0.1mm—0.5mm区域(A组)和光学切削区等于暗适应下瞳孔直径区域(B组)的术后中间视觉和眩光对比敏感度均较术前显著提高,视觉质量明显改善,有统计学显著性差异(P0.05)。各屈光度患者的光学切削区小于暗光瞳孔区域0.1mm—1.0mm(C组)和光学切削区小于暗光瞳孔区域1.1mm—2.0mm(D组)的术后中间视觉和眩光对比敏感度均较术前显著提高,视觉质量明显改善。各屈光度患者的光学切削区小于暗适应下瞳孔直径区域2.1mm—3.0mm(E组)的术后中间视觉和眩光对比敏感度及视觉质量均较术前显著提高,但对比同组屈光度光学切削区与暗适应瞳孔直径关系的C组、D组术后中间视觉和眩光对比敏感度则明显下降,有统计学显著性差异(P0.05)。各组屈光度患者术后三月的中间视觉及眩光对比度的视觉质量比术前和术后一月的明显提高,与术后六月的视觉质量基本一致,无统计学差异(P0.05)。各组患者术后次日、一月、三月、六月的裸眼视力平均达到术前矫正视力的超过90%。术后有9例患者(18眼)的中间视觉和眩光对比敏感度和术前无明显统计学差异。结论：准分子激光角膜原位磨镶术术后视觉质量、裸眼视力均有提高,且手术是安全可靠的。首次得出各屈光度组术后中间视觉及眩光对比敏感度在光学切削区暗适应瞳孔2.1-3.0mm区域时,有明显的视觉质量下降趋势。为确保满意的术后视觉质量,建议手术光学切削区暗适应瞳孔直径2mm范围为最佳手术区域。
[Abstract]:Objective: To study the relationship between the diameter of the optical cutting area of the cornea and the pupil diameter under the dark adaptation, and to discuss the selection of the size of the optical cutting area for the individual LASIK operation in order to improve the visual quality of the patients after the excimer laser in situ keratomileusis.
Methods: 450 eyes, 122 men (232 eyes), 120 women (220 eyes), age: 18-24 years old: (21.6 + 1.4), dark adapted to the lower pupil diameter: 5 - 8 mm, corneal curvature: 40.045.0 D corneal optical area thickness: (540.67): (540.67), 242 men, 122 men (232 eyes) and 120 women (220 eyes), who were able to follow up the follow-up review in our hospital in May 2010. The degree area of the equivalent cylindrical mirror was 0 ~ -2.00D, and the degree area of the equivalent sphere mirror was divided into three groups according to the diopter of -0.50 to -9.00D.: mild myopia group (-0.50 to -3.00D), moderate myopia group (-3.25 to -6.00D), and high myopia group (-6.25 to -9.00D). The three groups were randomly assigned to the operation patients with relative equal quantities, and then the patients were cut by optical cutting in each group. The relationship between the area and the dark adapted pupil diameter is divided into A group: the optical cutting area is larger than the dark adapted pupil diameter area 0.1mm 0.5mm.B group: the optical cutting area is equal to the dark adapted pupil diameter area.C group: the optical cutting area is smaller than the dark adapted pupil diameter region O.1mm 1.0mm.D group: the optical cutting area is smaller than the dark adaptation pupil. The hole diameter area 1.1mm - 2.0mm.E group: the optical cutting area is less than the dark adapted pupil diameter area 2.1 mm - 3.0mm. respectively recorded in the patients' corrected visual acuity, naked eye vision, the next day after operation, January after operation, March after operation, June postoperative naked eyesight, routine LASIK postoperative specialist examination and postoperative January, March postoperative, 6 after operation. Month vision contrast sensitivity.
Results: 242 people (450 eyes) after LASIK, the visual acuity of 68.44% of the bare eyesight of the next day after the operation, the visual acuity was achieved before the operation, and the visual acuity of 85.78% of the naked eye one month after the operation was achieved. The postoperative corrected visual acuity was achieved in 90.67% of the naked eye in March. 91.78% of the naked eyes after the operation reached the preoperative corrected visual acuity. Three groups of visual acuity were reached before the operation. Three groups of visual acuity were reached before the operation. Visual quality after refractive surgery: the optical cutting area in each group was greater than that of the dark adapted pupil diameter 0.1mm - 0.5mm region (group A) and the optical cutting area was equal to the dark adapted pupil diameter region (group B), and the contrast sensitivity of the middle vision and glare was significantly higher than that before the operation, and the visual quality was significantly improved (P 0.05). The optical cutting area of each diopter is less than the dark pupil area 0.1mm - 1.0mm (group C) and the optical cutting area is less than the dark pupil area 1.1mm 2.0mm (D group), and the contrast sensitivity of the middle vision and the glare is significantly higher than that before the operation, and the visual quality is obviously improved. The optical cutting area of each diopter is less than the dark adaptive pupil. The contrast sensitivity and visual quality of 2.1mm - 3.0mm (group E) in the hole diameter area were significantly higher than those before the operation, but compared with the group C with the relationship between the optical cutting area and the dark adapted pupil diameter in the same group, the contrast sensitivity of the middle vision and the glare after the D group was significantly decreased, and there was a statistically significant difference (P0.05).
The visual quality of the contrast of the middle vision and glare of the diopter in each group of diopter in March was significantly higher than that before and after the operation. The visual quality was basically consistent with the visual quality in June after the operation. There was no statistical difference (P0.05). The average visual acuity of the patients in each group was more than 90%. on the day after the operation, one month, March, and June.
There was no significant difference in the contrast sensitivity between the intermediate vision and glare in 9 patients (18 eyes).
Conclusion: the visual quality of the excimer laser in situ keratomileusis is improved and the operation is safe and reliable. It is the first time that the contrast sensitivity of the middle vision and glare of the refractive index group has obvious visual quality decline when the optical cutting area is dark adapted to the pupil 2.1-3.0mm area. In terms of visual quality, it is suggested that the range of 2mm of dark adaptation to pupil diameter should be the best operative area.
【学位授予单位】：昆明医学院
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.63

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