非球面切削准分子激光上皮下角膜磨镶术治疗角膜相对较薄高度近视临床疗效研究

发布时间：2018-07-07 15:33

本文选题：高度近视 + 非球面切削　；参考：《广州医学院》2010年硕士论文

【摘要】：目的通过角膜波前像差引导联合Q值优化的非球面切削的准分子激光上皮下角膜磨镶术(laser subepithelial keratomileusis,LASEK)与标准的LASEK治疗角膜相对较薄(通常患者的角膜厚度"f 500μm)的高度近视患者临床疗效对比研究,及通过角膜波前像差引导联合Q值优化的非球面切削LASEK治疗角膜相对较薄(通常患者的角膜厚度"f 500μm)的高度近视患者与角膜波前像差引导联合Q值优化的非球面切削LASIK治疗角膜相对较厚(通常患者的角膜厚度"g 500μm)高度近视患者临床疗效对比研究,以探讨非球面切削LASEK治疗薄角膜高度近视临床疗效。方法非球面LASEK组:应用非球面切削LASEK对23例42眼角膜相对较薄的高度近视患者行屈光手术。标准组:应用标准LASEK对21例40眼角膜角膜相对较薄的高度近视患者行屈光手术。非球面LASIK组:应用非球面切削LASIK对19例37眼角膜相对较厚的高度近视患者行屈光手术。研究一:通过对比非球面LASEK及标准LASEK治疗角膜相对较薄的高度近视患者,术后2周、1月、3月、6月裸眼视力。术后6个月时角膜地形图、角膜波前像差、视觉对比敏感度并进行满意度调查。研究二:通过对比非球面LASEK治疗角膜相对较薄的高度近视及非球面切削LASIK治疗角膜相对较厚的的高度近视,比较两组术后2周、1月、3月、6月检查裸眼视力。术后6个月时角膜地形图、波前像差、视觉对比敏感度并进行满意度调查。结果研究一:非球面LASEK组与标准LASEK组术后2周、1月、3月、6月裸眼视力、平均模拟角膜记读数(equivalent sinulated keratometry,e-SimK)等效值、慧差、总体像差均无统计学差异,而球差、Qs、Qf、无眩光视觉对比敏感度(3cpd)、眩光下视觉对比敏感度(3cpd、12cpd、18cpd)、患者满意度均较标准组好,差异有统计学意义。研究二:非球面LASEK组与非球面切削LASIK组术后2周、1月、3月、6月裸眼视力无统计学差异,在术后6月慧差、球差、无眩光下视觉对比敏感度、患者满意度均无统计学差异。但e-SimK、总阶像差、Qs、Qf、有眩光下视觉对比敏感度(18cpd)较非球面LASIK小,差异有统计学意义。结论非球面切削LASEK、标准LASEK治疗角膜相对较薄的高度近视及非球面切削LASIK治疗角膜相对较厚的高度近视,术后均有良好的视力恢复,有较高的安全性、有效性、可预测性。但非球面切削的LASEK,术后可明显减少术后球差、Qs、Qf的增大,减少了对比敏感度异常、眩光、夜视力差的发生,较好的保持了角膜的非球面性,且非球面切削的LASEK对角膜的厚度要求较非球面切削的LASIK低,术后临床疗效相同。所以对于角膜厚度不够行非球面切削的LASIK的薄角膜的患者多了一种可选择的治疗屈光不正手术方式
[Abstract]:Objective to compare the height of (laser subepithelial keratomileusis with standard LASEK in the treatment of corneal relatively thin (usually the corneal thickness of the patient "f 500 渭 m") by using wavefront aberration guidance combined with Q value optimization excimer laser subepithelial keratomileusis (LASEK). A comparative study of the clinical efficacy of visual patients, And Aspheric ablation LASEK with corneal wavefront aberration guidance combined with Q optimization for the treatment of high myopia patients with relatively thin cornea (usually with corneal thickness "f 500 渭 m) and with corneal wavefront aberration guidance combined with Q-optimized aspheric surface A comparative study of the clinical efficacy of LASIK in the treatment of relatively thick cornea (usually the corneal thickness of the patient "g 500 渭 m) in patients with high myopia. To investigate the clinical effect of aspherical LASEK in the treatment of high myopia of thin cornea. Methods Aspheric LASEK group: 23 cases (42 eyes) of high myopia with relatively thin cornea underwent refractive surgery with aspherical LASEK. Standard group: 21 cases (40 eyes) with relatively thin cornea were treated with refractive surgery with standard LASEK. Aspheric LASIK group: 19 cases (37 eyes) with relatively thick cornea were treated with aspherical LASIK for refractive surgery. Study 1: the patients with relatively thin cornea with high myopia were treated by comparing aspherical LASEK with standard LASEK. The visual acuity was 2 weeks, 1 month, 3 months and 6 months after operation. Corneal topography, corneal wavefront aberration, visual contrast sensitivity and satisfaction were investigated 6 months after operation. The second study was to compare the treatment of relatively thin high myopia with aspheric LASEK and the treatment of relatively thick high myopia with aspherical LASIK. The naked visual acuity was examined 2 weeks, 1 month, 3 months and 6 months after operation in the two groups. Corneal topography, wavefront aberration, visual contrast sensitivity and satisfaction were investigated 6 months after operation. Results in the first study, there was no significant difference between the aspheric LASEK group and the standard LASEK group in two weeks, one month, three months and six months after the operation. The mean simulated corneal reading (equivalent sinulated keratometry-Simk was similar to that of the standard LASEK group. There was no significant difference in the mean visual acuity between the aspherical LASEK group and the standard LASEK group. The patients' satisfaction was better than that of the standard group (P < 0.05). The spherical aberration QSF, the visual contrast sensitivity without glare (3cpd) and the visual contrast sensitivity under glare (3cpdD 12cpdl 18cpd) were better than those of the standard group (P < 0.05). Study 2: there was no significant difference in uncorrected visual acuity between aspheric LASEK group and aspherical LASIK group 2 weeks, 1 month, 3 months and 6 months after operation, but there was no significant difference in visual contrast sensitivity and patient satisfaction at 6 months after operation. However, e-Simk, total order aberration Qsf. visual contrast sensitivity (18cpd) with glare was smaller than aspheric LASIK, and the difference was statistically significant. Conclusion Aspheric ablation LASEK, standard LASEK for relatively thin corneal high myopia and aspheric LASIK for relatively thick high myopia have good visual recovery, high safety, efficacy and predictability. However, LASEK can reduce the increase of spherical aberration, decrease the incidence of contrast sensitivity abnormality, glare and night visual acuity, and maintain the asphericity of cornea. The corneal thickness of aspherical LASEK is lower than that of aspherical LASIK, and the clinical effect is the same. So for patients with a thin cornea whose thickness is not enough to be aspherical, LASIK, there is an alternative way to treat ametropia.
【学位授予单位】：广州医学院
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.63

【参考文献】