LASIK术中不同制瓣方式视觉质量的临床研究

发布时间：2018-09-05 06:18

【摘要】：背景和目的准分子激光原位角膜磨镶术是目前矫正屈光不正的主流手术。它的步骤是先在角膜上用特制的微型角膜板层刀做一个带蒂的角膜瓣,掀开角膜瓣后,在暴露的角膜基质床上进行准分子激光消融,以矫正近视、远视、散光。该手术的优点是保留了角膜上皮及前弹力层的完整性,疗效显著、术后视力恢复快。该手术的缺点是首先在角膜表面制作角膜瓣,术中因使用微型角膜板层刀制作角膜瓣而导致的并发症不可忽视,严重的并发症影响术后的视觉质量,因此角膜瓣的成功关乎手术的成败。飞秒激光是一种以脉冲形式运转的激光,持续时间非常短,只有几个飞秒,是人类目前在实验室条件下所能获得的最短脉冲,目前用于角膜手术的波长为1053nm。由于它能对角膜组织进行高精确的切割,而且不影响切割区以外的组织,具有极高的安全性,因此近年来被逐渐应用到眼科领域,尤其是准分子激光手术中角膜瓣的制作已经取得了巨大的成功。研究微型角膜板层刀制瓣与飞秒激光制瓣两种不同的制瓣方式对视觉质量的影响,对临床选择制瓣方式有应用价值。本文通过研究比较飞秒激光制瓣与微型角膜板层刀制瓣两种不同制瓣方式对术后视觉质量的影响,评价飞秒激光制瓣术后的角膜瓣质量及视觉质量。方法随机选取2009年11月至2010年4月在我院眼科准分子激光中心双眼行LASIK的近视患者100例(200眼)分为两组：飞秒组、板层刀组,飞秒组使用Femto LDV飞秒激光(瑞士Ziemer公司)制作角膜瓣,板层刀组使用Hansatome板层刀(美国博士伦公司)制作角膜瓣,两组除制作角膜瓣方式不同外,均采用同一台准分子激光机Technolas 217Z100(美国博士伦公司)进行波前像差引导的准分子激光切削。于术后1月使用傅立叶域光学相干断层扫描前节角膜模块测量两组实际角膜瓣厚度、均匀程度,于术后1周、1月、3月复查视力、波前像差、对比敏感度。采用SPSS16.0统计分析软件对实验数据进行合理的统计和分析。以α=0.05作为检验标准。结果 1角膜瓣测量：飞秒激光组预计110μm角膜瓣实际平均厚度为103.54±5.60(88-131)μm,实际厚度与预计厚度之间比较差异无统计学意义(P0.05)；其中先做眼(右眼)平均角膜瓣厚度102.17±4.80μm,后做眼(左眼)平均角膜瓣厚度104.42±4.97μm,左右眼之间比较差异无统计学意义(P0.05)。板层刀组预计110μm角膜瓣实际平均厚度130.30±14.03(90-158)μm,实际厚度与预计厚度之间比较差异有统计学意义(P0.05)；其中先做眼(右眼)平均角膜瓣厚度127.17±16.60μm,后做眼(左眼)平均角膜瓣厚度109.42±16.8μμm,左右眼之间比较差异有统计学意义(P0.05)。 2像差改变：飞秒激光组手术前后总高阶像差、3阶垂直彗差无变化,与术前比较差异无统计学意义(P0.05)；术后不同时间段,板层刀组总高阶像差、3阶垂直彗差增加大于飞秒组,差异有统计学意义(P0.05)；两组术后球差、3阶水平彗差均较术前增加,板层刀组增加大于飞秒组,差异有统计学意义(P0.05)。 3对比敏感度改变：明视状态下,术后相同时间段两组各空间频率比较差异无统计学意义(P0.05)；暗视状态下,飞秒组术后1周,在12.0c/pd、18.0 c/pd优于板层刀组,差异有统计学意义(P0.05),术后1月、术后3月两组间各空间频率比较差异无统计学意义(P0.05)；明视眩光状态下,相同时间段两组各空间频率比较差异无统计学意义(P0.05)；暗视眩光状态下,飞秒组术后1周,各空间频率优于板层刀组,差异有统计学意义(P0.05),术后1月、术后3月两组间各空间频率比较差异无统计学意义(P0.05)。结论 1飞秒激光制瓣预测性、重复性均好,制作出的角膜瓣均匀一致； 2飞秒激光制瓣,术中引入的高阶像差小； 3飞秒激光制瓣,术后对比敏感度优于板层刀组,术后视觉质量好。
[Abstract]:Background and purpose
Laser in situ keratomileusis (LASIK) is currently the mainstream surgery for refractive errors. The procedure involves making a pedicled corneal flap on the cornea with a specially designed mini-corneal lamellar knife. After removing the flap, excimer laser ablation is performed on the exposed corneal stroma bed to correct myopia, hyperopia and astigmatism. Keeping the integrity of corneal epithelium and anterior elastic layer, the curative effect is remarkable and the visual acuity recovers quickly after operation. The disadvantage of this operation is that the corneal flap is made on the corneal surface first. The complications caused by the corneal flap made with mini-corneal lamellar knife can not be ignored during the operation. The serious complications affect the visual quality after operation, so the success of the corneal flap. Femtosecond laser is a kind of laser which operates in pulse form and lasts only a few femtoseconds. Femtosecond laser is the shortest pulse that can be obtained under laboratory conditions. At present, the wavelength used in corneal surgery is 1053 nm. In recent years, it has been gradually applied to ophthalmic field, especially in excimer laser surgery, because of its high safety. To study the effect of two different methods of making corneal flap, micro lamellar knife flap and femtosecond laser flap, on visual quality, and to choose the method of making corneal flap clinically The formula has applied value.
To evaluate the visual quality and quality of corneal flap after femtosecond laser flap-making, the effects of two different methods of flap-making were compared.
Method
One hundred patients (200 eyes) with myopia undergoing LASIK were randomly divided into two groups: femtosecond group, lamellar knife group, femtosecond group, corneal flap made by Femto LDV femtosecond laser (Ziemer, Switzerland) and Hansatome lamellar knife group. In addition to the different ways of making corneal flap, the same excimer laser, Technolas 217Z100, was used for wavefront aberration-guided excimer laser ablation in both groups. The thickness of the actual corneal flap was measured by Fourier domain optical coherence tomography in the anterior segment of the cornea one month after the operation, and the degree of uniformity was measured 1 month after the operation. Zhou, January, March reviewed visual acuity, wavefront aberration, and contrast sensitivity.
SPSS16.0 statistical analysis software was used to analyze the experimental data reasonably.
Result
1 Corneal flap measurement: In femtosecond laser group, the actual average thickness of 110 micron corneal flap was 103.54 (-5.60) (88-131) micron, and there was no significant difference between the actual thickness and the expected thickness (P 0.05); the average corneal flap thickness was 102.17 (-4.80) micron in the right eye, 104.42 (-4.97) micron in the left eye and 104.42 (-4.97) micron in the left eye. There was no significant difference between the two groups (P 0.05). In the lamellar knife group, the actual average thickness of 110 micron corneal flap was estimated to be 130.30 + 14.03 (90-158) micron, and the difference between the actual thickness and the expected thickness was statistically significant (P 0.05); the average thickness of the right eye (right eye) was 127.17 + 16.60 micron, and the left eye (left eye) was 109.42 + 16 micron. The difference between.8 and m was statistically significant (P0.05).
2 aberration changes: the total high-order aberration before and after operation in femtosecond laser group, the third-order vertical coma did not change, and there was no significant difference compared with preoperative (P 0.05); different time after operation, the total high-order aberration in the lamellar knife group, the third-order vertical coma increased more than the femtosecond group, the difference was statistically significant (P 0.05); the postoperative spherical aberration, the third-order horizontal coma were all more significant than the femtosecond group. Before operation, the lamellar knife group increased more than the femtosecond group, and the difference was statistically significant (P0.05).
3 Contrast sensitivity changes: In open vision, there was no significant difference in spatial frequency between the two groups at the same time after surgery (P 0.05); in dark vision, femtosecond group was superior to the lamellar knife group at 12.0c/pd and 18.0c/pd one week after surgery, and the difference was statistically significant (P 0.05). Significance of learning (P 0.05); In glare state, there was no significant difference in spatial frequency between the two groups at the same time period (P 0.05); In glare state, the spatial frequency of femtosecond group was better than that of laminar knife group at 1 week after surgery, and the difference was statistically significant (P 0.05). There was no significant difference in spatial frequency between the two groups at 1 month and 3 months after surgery. Meaning (P0.05).
conclusion
1 femtosecond laser has good predictive accuracy and good repeatability.
2. The high order aberration introduced by femtosecond laser is small.
3 the femtosecond laser flap was better than the lamellar knife group in postoperative contrast sensitivity, and the visual quality was good after operation.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.63

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