角膜地形图引导的LASIK与非球面LASIK治疗有散光近视眼的对比研究

发布时间：2018-07-06 19:05

本文选题：散光 + 准分子激光原位角膜磨镶术　；参考：《浙江大学》2010年硕士论文

【摘要】： [目的]比较角膜地形图引导的个性化准分子激光原位角膜磨镶术(TOSCA-LASIK)与传统非球面准分子激光原位角膜磨镶术(ASA-LASIK)治疗有散光近视眼的临床疗效。 [方法]将符合入选条件的有散光近视眼(散光-0.75D)随机分组,使用Carl Zeiss公司的MEL80准分子激光机系统,分别选择TOSCA和ASA切削模式施行LASIK手术。随访3月,观察术后裸眼视力、最佳矫正视力、主觉验光度数、高阶像差、对比敏感度及角膜地形图的变化并进行对比,同时应用Alpins法进行散光矫正分析。数据由SPSS16.0统计软件进行分析处理,P0.05时存在统计学意义。 [结果]本研究入选38例69眼,均获随访。TOSCA组20例36眼,ASA组18例33眼。TOSCA组1月和3月时裸眼视力不低于1.0者分别占86.1%和94.4%,ASA组占78.8%和82.7%。应用Alpins法进行散光矫正分析：角膜地形图水平,TOSCA组的绝对平均角度误差显著小于ASA组(p=0.014)；在验光水平和角膜地形图水平,两组的算术平均幅度误差均存在显著性差异(P=O,P=0.012),同时,在角膜地形图水平,TOSCA组的幅度误差(0.05±0.42D)较ASA组(-0.37±0.76D)更接近于0(P=0.05)；平整指数,矫正指数在TOSCA组也较ASA组大且在角膜地形图水平,TOSCA组均更接近于1.0(P0.05)；两组的球镜矫正指数在屈光水平无显著性差异,在角膜地形图水平,TOSCA组显著大于ASA组(P=0.005)。术后1月,TOSCA组的总高阶像差为0.488±0.189,ASA组为0.600±0.146,两者具有显著性差异(P=0.007)；术后3月,两组总高阶像差、总彗差、球差均无显著性差异。两组病例术后3月无眩光对比敏感度较术前降低,TOSCA组显著性差异出现在4.2 cpd(P=0.030),ASA组出现在4.2,6.6,10.6 cpd(p=0.001,p=0.002,p=0.034)；眩光对比敏感度手术前后无显著性差异；两组间各空间频率对比敏感度变化百分比无显著性差异。 [结论]角膜地形图引导的个性化准分子激光原位角膜磨镶术治疗有散光近视眼安全有效,预测性佳,与传统的非球面切削模式相比,矫正散光更完全,有更大的概率获得较好裸眼视力。
[Abstract]:[objective] to compare the clinical effect of individualized laser in situ keratomileusis (TOSCA-LASIK) and traditional aspherical laser in situ keratomileusis (ASA-LASIK) in the treatment of astigmatism myopia. [methods] the patients with astigmatism myopia (-0.75D) were randomly divided into two groups. The MEL80 excimer laser system of Carl Zeiss Company was used to perform LASIK operation in TOSCA and ASA cutting mode respectively. The uncorrected visual acuity, best corrected visual acuity, principal optometry, high order aberration, contrast sensitivity and corneal topographic map were observed and compared. Astigmatism correction was analyzed by Alpins method. There was statistical significance when the data were analyzed by SPSS 16.0 statistical software. [results] in this study, 38 cases (69 eyes) were followed up. 18 cases (33 eyes), 18 cases (33 eyes) of ASA group (20 cases) and 36 eyes (36 eyes) of TOSCA group were followed up. The uncorrected visual acuity was 86.1% in Tosa group and 78.8% and 82.7% in ASA group at 1 and 3 months, respectively. Alpins method was used to analyze astigmatism correction: the absolute mean angle error of the corneal topographic map group was significantly lower than that of the ASA group (p0. 014), and there was significant difference between the two groups in the level of optometry and the corneal topographic map (P < 0. 012), at the same time, there was a significant difference between the two groups in the arithmetic mean amplitude error (P < 0. 012). The amplitude error of TOSCA group (0.05 卤0.42D) was closer to 0 (P0. 05) than that of ASA group (-0.37 卤0.76D), the leveling index and correction index in TOSCA group were also larger than those in ASA group and close to 1.0 (P0.05) at corneal topographic level. There was no significant difference in the refractive level between the two groups, and the corneal topographic level in TOSCA group was significantly higher than that in ASA group (P0. 005). The total high order aberrations in TOSCA group were 0.488 卤0.189 and 0.600 卤0.146 respectively at one month after operation (P0. 007), but there was no significant difference in total high order aberration, total coma and spherical aberration between the two groups at 3 months after operation. There was no significant difference in contrast sensitivity between the two groups in 4.2 cpd (P0. 030) and 4. 2 卤6. 6 卤10. 6 cpd (p0. 001) and 0. 002% (p0. 034), but there was no significant difference between the two groups before and after operation. There was no significant difference in the percentage of spatial frequency contrast sensitivity between the two groups. [conclusion] the individualized laser in situ keratomileusis guided by corneal topography is safe, effective and predictable in the treatment of myopia with astigmatism. The correction of astigmatism is more complete than the traditional aspheric cutting mode. There is a greater chance of better naked vision.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.63

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