波前像差引导联合虹膜识别的准分子激光手术治疗中低度近视散光的疗效观察
发布时间：2018-11-02 10:26
【摘要】： 目的：本研究应用波前像差引导联合虹膜识别(个体化)的LASEK和LASIK矫正中低度近视散光,同期与普通LASIK进行比较,观察个体化准分子激光手术对于矫正散光,减少术后高阶像差的优势,以及个体化表层切削(LASEK)与基质层切削(LASIK)方式对术后高阶像差的影响,为手术方式的选择和个体化切削提供依据。 方法：对自愿接受波前像差引导联合虹膜识别的LASEK治疗的15例(29眼)患者作为治疗组A,自愿接受波前像差引导联合虹膜识别的LASIK治疗的16例(32眼)患者作为治疗组B,同期接受普通LASIK治疗的16例(30眼)患者作为对照组C,术中观察治疗组A、治疗组B的眼球旋转及瞳孔中心偏移情况,术后对比观察三组的治疗效果。 1.治疗组A、治疗组B术中发现所有眼别均发生了眼球旋转,检测出眼球旋转平均偏移角度为(3.85±2.02)。,瞳孔中心总体偏移量为X轴方向(0.23±0.18)mm,Y轴方向(0.18±0.13)m。 2.术后1个月,三组裸眼视力均达到或超过0.8。术后6个月治疗组A有62%的眼别超过术前最佳矫正视力,治疗组B有60%超过术前最佳矫正视力,对照组C有33%超过术前最佳矫正视力。术后6个月三组的平均球镜度数分别为(+0.08±0.25)D、(+0.13±0.26)D和(+0.12±0.28)D,三组比较差异无统计学意义(F=0.253,P0.05)。术后6个月三组的平均柱镜度数分别为(-0.20±0.11)D、(-0.22±0.12)D和(-0.47±0.17)D,治疗组A和治疗组B之间差异无统计学意义(P0.05),而对照组C与其它两治疗组间差异有统计学意义(P0.05)。 3.术后三组各阶段总高阶像差均方根值(RMS)均有所增加,但增加的程度有所不同。术后1个月时,治疗组B的角膜总高阶像差RMS平均增幅为78%,低于治疗组A的90%和对照组C的120%,差异有统计学意义(F=25.18,P0.05)。而到术后6个月时,治疗组A的角膜总高阶像差RMS平均增幅为71%,低于治疗组B的85%和对照组C的115%,差异有统计学意义(F=29.96,P0.05)。 4.术后三组各阶段球差和彗差值也处于增长水平。术后6个月时治疗组A、治疗组B和对照组C的球差RMS平均增幅分别为130%,146%,180%,三者比较差异有统计学意义(F=5.16,P0.05)。术后6个月时对照组C的彗差RMS平均增幅为159%,明显高于治疗组A的77%和治疗组B的80%,三者比较差异有统计学意义(F=13.68,P0.05)。 结论：波前像差引导联合虹膜识别的个体化切削治疗中低度近视散光效果良好,矫正的精确性优于普通切削对照组。对于中低度近视散光的矫正,个体化引导的LASEK术式较LASIK术式更加安全可靠。
[Abstract]:Objective: to study the correction of moderate and low myopia astigmatism with LASEK and LASIK using wavefront aberration guidance combined with iris recognition (individualized), and to observe the effect of individualized excimer laser surgery on correction of astigmatism. The advantages of reducing the high order aberration after operation, and the effect of individualized surface cutting (LASEK) and matrix layer cutting (LASIK) on the high order aberration after operation can provide the basis for the choice of operation mode and individualized cutting. Methods: fifteen patients (29 eyes) who received LASEK therapy with wavefront aberration guidance combined with iris recognition were treated as treatment group A and 16 patients (32 eyes) who voluntarily received LASIK therapy with wavefront aberration guidance and iris recognition as treatment group B, respectively. Sixteen patients (30 eyes) who were treated with common LASIK were used as control group C in the same period. The eyeball rotation and pupil center deviation of treatment group B were observed during the operation. The results of the three groups were compared after operation. 1. In treatment group A and group B, eye rotation was found in all eyes during operation. The average deviation angle of eye rotation was (3.85 卤2.02).,) and the total deviation of pupil center was (0.23 卤0.18) mm,. The direction of Y axis is (0.18 卤0.13) m. 2. 1 month after operation, the naked visual acuity of all three groups reached or exceeded 0.8. 6 months after operation, 62% of the eyes in treatment group A exceeded the preoperative best corrected visual acuity, 60% of treatment group B exceeded the preoperative best corrected visual acuity, and 33% of control group C exceeded the preoperative best corrected visual acuity. Six months after operation, the mean spherical degrees of the three groups were (0.08 卤0.25) D, (0.13 卤0.26) D and (0.12 卤0.28) D, respectively. There was no significant difference among the three groups (P 0.05). Six months after operation, the mean degree of columnoscopy in the three groups was (-0.20 卤0.11) D, (-0.22 卤0.12) D and (-0.47 卤0.17) D, respectively. There was no significant difference between the treatment group A and the treatment group B (P0.05). The control group C and the other two treatment groups between the difference was statistically significant (P0.05). 3. The root mean square (RMS) of total high order aberration increased in all three groups after operation, but the degree of increase was different. At one month after operation, the average increase of total high order aberration (RMS) in group B was 78, which was lower than that in treatment group A (90%) and control group (120 parts) (P < 0.05). At 6 months after operation, the average increase of total high order aberration (RMS) in group A was 71, which was lower than that in group B (85%) and control group (115%) (P 0.05). 4. The spherical aberration and coma difference of the three groups were also at the level of growth. At 6 months after operation, the average increase of spherical aberration (RMS) of treatment group A, treatment group B and control group C was 1 300 and 180, respectively. The difference among the three groups was statistically significant (P 0.05). At 6 months after operation, the average increase of RMS of C in the control group was 159, which was significantly higher than that in the treatment group A (77%) and the treatment group B (80%). The difference among the three groups was statistically significant (P 0.05). Conclusion: the effect of individualized ablation combined with wavefront aberration guidance and iris recognition in the treatment of low myopia astigmatism is good and the accuracy of correction is better than that of normal cutting control group. For the correction of astigmatism in medium and low myopia, the individualized LASEK procedure is more safe and reliable than that of LASIK.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.63
本文编号：2305754
[Abstract]:Objective: to study the correction of moderate and low myopia astigmatism with LASEK and LASIK using wavefront aberration guidance combined with iris recognition (individualized), and to observe the effect of individualized excimer laser surgery on correction of astigmatism. The advantages of reducing the high order aberration after operation, and the effect of individualized surface cutting (LASEK) and matrix layer cutting (LASIK) on the high order aberration after operation can provide the basis for the choice of operation mode and individualized cutting. Methods: fifteen patients (29 eyes) who received LASEK therapy with wavefront aberration guidance combined with iris recognition were treated as treatment group A and 16 patients (32 eyes) who voluntarily received LASIK therapy with wavefront aberration guidance and iris recognition as treatment group B, respectively. Sixteen patients (30 eyes) who were treated with common LASIK were used as control group C in the same period. The eyeball rotation and pupil center deviation of treatment group B were observed during the operation. The results of the three groups were compared after operation. 1. In treatment group A and group B, eye rotation was found in all eyes during operation. The average deviation angle of eye rotation was (3.85 卤2.02).,) and the total deviation of pupil center was (0.23 卤0.18) mm,. The direction of Y axis is (0.18 卤0.13) m. 2. 1 month after operation, the naked visual acuity of all three groups reached or exceeded 0.8. 6 months after operation, 62% of the eyes in treatment group A exceeded the preoperative best corrected visual acuity, 60% of treatment group B exceeded the preoperative best corrected visual acuity, and 33% of control group C exceeded the preoperative best corrected visual acuity. Six months after operation, the mean spherical degrees of the three groups were (0.08 卤0.25) D, (0.13 卤0.26) D and (0.12 卤0.28) D, respectively. There was no significant difference among the three groups (P 0.05). Six months after operation, the mean degree of columnoscopy in the three groups was (-0.20 卤0.11) D, (-0.22 卤0.12) D and (-0.47 卤0.17) D, respectively. There was no significant difference between the treatment group A and the treatment group B (P0.05). The control group C and the other two treatment groups between the difference was statistically significant (P0.05). 3. The root mean square (RMS) of total high order aberration increased in all three groups after operation, but the degree of increase was different. At one month after operation, the average increase of total high order aberration (RMS) in group B was 78, which was lower than that in treatment group A (90%) and control group (120 parts) (P < 0.05). At 6 months after operation, the average increase of total high order aberration (RMS) in group A was 71, which was lower than that in group B (85%) and control group (115%) (P 0.05). 4. The spherical aberration and coma difference of the three groups were also at the level of growth. At 6 months after operation, the average increase of spherical aberration (RMS) of treatment group A, treatment group B and control group C was 1 300 and 180, respectively. The difference among the three groups was statistically significant (P 0.05). At 6 months after operation, the average increase of RMS of C in the control group was 159, which was significantly higher than that in the treatment group A (77%) and the treatment group B (80%). The difference among the three groups was statistically significant (P 0.05). Conclusion: the effect of individualized ablation combined with wavefront aberration guidance and iris recognition in the treatment of low myopia astigmatism is good and the accuracy of correction is better than that of normal cutting control group. For the correction of astigmatism in medium and low myopia, the individualized LASEK procedure is more safe and reliable than that of LASIK.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.63
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