OQAS对不同制瓣方式的个性化LASIK手术术后视觉质量的评估
发布时间：2018-12-13 22:32
【摘要】：目的:使用OQAS分别对飞秒激光和角膜板层刀制瓣的个性化准分子激光原位角膜磨镶术术后患者的视觉质量进行定性及定量的分析,完善个性化手术术后视觉质量的评定方法,进一步探讨飞秒激光辅助的优势及原因。 方法:选取2009年3月～2010年9月间于我院准分子激光治疗中心拟行个性化LASIK手术,符合手术标准,年龄18岁至40岁之间的患者106例(212只眼)进行回顾分析,术前均由同一指定眼科医师对患者进行系统眼部检查并对检查结果进行综合评定入组,两组术前性别、年龄、瞳孔直径、裸眼视力及等效球镜均经过X2或配对T检验,差异无统计学意义(P0.05)。分别使用Moria-M2角膜板层刀(106只眼)及Intralase-FS60飞秒激光(106只眼)对两组患者设计制作相同厚度110μm的角膜瓣,然后使用VISX S4准分子激光治疗仪对两组患者进行相同直径6.5mm的个性化切削,术后常规用药,嘱患者分别于术后第1d、1mo、3mo复查,进行视力、眼压、电脑验光、裂隙灯、角膜地形图、WASCA波前像差仪、OQAS视觉质量分析检查,并对各指标在不同时期的变化进行统计学分析整理。 结果: 1㖞两组术中及术后均未见明显并发症。 2㖞视力与屈光状态:术后1mo及3mo两组患者UCVA均有显著提高,组间比较Intralase-FS60组优于Moria-M2组(P㩳0.05);术后3mo组间BSCVA无明显统计学差异(P=0.171㧐0.05);两组的有效性指数及安全性指数无明显统计学差异;1d~3mo间等效球镜(D)度数变化分别为Moria-M2组0.73D,Intralase-FS60组0.50D,说明两组患者术后3个月间屈光状态均较稳定。 3㖞波前像差:①从增加倍数上看,术后3mo Moria-M2组的HOA ROM变化不大,基本恢复至术前(1.06倍),而Intralase-FS60组则明显优于术前(0.79倍);②波前像差两组均以Z7、Z8和Z12增加为主,其中Moria-M2组各值均高于术前和Intralase-FS60组(P=0.019、0.012、0.016㩳0.05),具有统计学差异。 4 ) OQAS参数变化:①出射瞳孔为4mm下的视网膜二维成像状态,Intralase-FS60组术后第1d成像效果明显差于Moria-M2组,散射明显,到3mo时Moria-M2组已基本同于术前水平,而Intralase-FS60组的成像状况则优于术前,与波前结果一致;②术后第1d Intralase-FS60组50%MTF频率和熄灭频率均低于Moria-M2组(P=0.034、0.024㩳0.05),而术后3mo Moria-M2组50%MTF频率低于术前,熄灭频率基本同术前水平,Intralase-FS60组50%MTF频率接近术前,熄灭频率则优于术前,组间比较Intralase-FS60组两者均高于Moria-M2组(P㩳0.05);③术后第1d Intralase-FS60组各OVs均低于Moria-M2组,第3mo时Intralase-FS60组的OV9%高于Moria-M2组(P=0.015㩳0.05)。 结论: 1.飞秒激光辅助个性化LASIK手术术后晚期效果确切,相对于机械角膜板层刀具有诸多优点,患者术后可以获得更好的生活视觉质量。 2. OQAS可以获得更多的视网膜成像信息,直观准确描述球内散射情况,且稳定性好,干扰少,是一种客观的测量视觉质量的方法,与波前像差互相补充,可对视觉质量进行综合分析。
[Abstract]:Objective: to qualitatively and quantitatively analyze the visual quality of patients with femtosecond laser and lamellar keratoplasty flap after laser in situ keratomileusis (LASIK) with OQAS, and to improve the evaluation method of visual quality after individualized surgery. The advantages and reasons of femtosecond laser assistance are discussed. Methods: from March 2009 to September 2010, 106 patients (212 eyes) aged between 18 and 40 years were selected to perform individualized LASIK operation in our hospital's excimer laser treatment center. The patients were systematically examined by the same ophthalmologist before operation and the results were evaluated comprehensively. The sex, age, pupil diameter, naked vision and equivalent spherical lens were all examined by X2 or paired T test in the two groups before operation. The difference was not statistically significant (P0.05). The corneal flaps with the same thickness of 110 渭 m were designed and fabricated with Moria-M2 lamellar knife (106eyes) and Intralase-FS60 femtosecond laser (106eyes). Then VISX S4 excimer laser therapy instrument was used to carry out individualized ablation of 6.5mm of the same diameter in the two groups. The patients were given routine medication after operation. The patients were asked to recheck their eyesight, intraocular pressure, computer optometry and slit lamp at 1 month and 3 mo after operation, respectively. Corneal topography, WASCA wavefront aberration, OQAS visual quality analysis, and statistical analysis of the changes of each index in different periods. Result: 1? There were no obvious complications during and after operation in both groups. 2? Visual acuity and refractive state: the UCVA of 1mo and 3mo groups were significantly improved after operation, the Intralase-FS60 group was better than the Moria-M2 group (P0. 05), there was no significant difference in BSCVA between the postoperative 3mo group (P0. 171), and there was no significant difference between the two groups (P0. 171- 0. 05). There was no significant difference in efficacy index and safety index between the two groups, and the change of (D) degree of equivalent spherical mirror between 1d~3mo group and Moria-M2 group was 0.73 DX Intralase-FS60 group 0.50D, which indicated that the refractive state of the two groups was stable within 3 months after operation. 3? Wavefront aberration: 1 from the point of increasing multiple, the HOA ROM of 3mo Moria-M2 group changed little, basically recovered to preoperative (1.06 times), but Intralase-FS60 group was obviously superior to pre-operation group (0.79 times); 2 the wavefront aberrations were mainly increased in Z7 + Z8 and Z12 groups, and the values of Moria-M2 group were higher than those of preoperative and Intralase-FS60 groups (P0. 019 ~ 0. 012 0. 016 卤0. 05), and there was statistical difference between the two groups (P < 0. 019, P < 0. 05). 4) the change of OQAS parameters: 1the ejection pupil was the state of 2-D retinal imaging under 4mm, the imaging effect of Intralase-FS60 group on the first day after operation was obviously worse than that of Moria-M2 group, and the scattering was obvious. By 3mo, the Moria-M2 group was basically the same as the preoperative level. The imaging status of Intralase-FS60 group was better than that of pre-operation, which was consistent with the results of wavefront. 2on the first day after operation, the frequency of 50%MTF and extinguishment in Intralase-FS60 group was lower than that in Moria-M2 group (P0.034 0. 024 0. 05), but the frequency of 50%MTF in postoperative 3mo Moria-M2 group was lower than that before operation, and the extinguishing frequency was basically the same as that before operation. The frequency of 50%MTF in Intralase-FS60 group was close to that before operation, and the extinguishing frequency was higher than that before operation. The frequency of 50%MTF in Intralase-FS60 group was higher than that in Moria-M2 group (P0. 05). 3 on the first day after operation, the OVs of Intralase-FS60 group was lower than that of Moria-M2 group, and the OV9% of Intralase-FS60 group was higher than that of Moria-M2 group at the first day of 3mo (P0. 015 卤0. 05). Conclusion: 1. The effect of femtosecond laser assisted individualized LASIK surgery is accurate and has many advantages over mechanical lamellar keratectomy. Patients can obtain better quality of life after operation. 2. OQAS can obtain more information of retinal imaging, describe the scattering in sphere directly and accurately, and has good stability and less interference. It is an objective method to measure visual quality and complement the wavefront aberration. Visual quality can be comprehensively analyzed.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.63
本文编号：2377368
[Abstract]:Objective: to qualitatively and quantitatively analyze the visual quality of patients with femtosecond laser and lamellar keratoplasty flap after laser in situ keratomileusis (LASIK) with OQAS, and to improve the evaluation method of visual quality after individualized surgery. The advantages and reasons of femtosecond laser assistance are discussed. Methods: from March 2009 to September 2010, 106 patients (212 eyes) aged between 18 and 40 years were selected to perform individualized LASIK operation in our hospital's excimer laser treatment center. The patients were systematically examined by the same ophthalmologist before operation and the results were evaluated comprehensively. The sex, age, pupil diameter, naked vision and equivalent spherical lens were all examined by X2 or paired T test in the two groups before operation. The difference was not statistically significant (P0.05). The corneal flaps with the same thickness of 110 渭 m were designed and fabricated with Moria-M2 lamellar knife (106eyes) and Intralase-FS60 femtosecond laser (106eyes). Then VISX S4 excimer laser therapy instrument was used to carry out individualized ablation of 6.5mm of the same diameter in the two groups. The patients were given routine medication after operation. The patients were asked to recheck their eyesight, intraocular pressure, computer optometry and slit lamp at 1 month and 3 mo after operation, respectively. Corneal topography, WASCA wavefront aberration, OQAS visual quality analysis, and statistical analysis of the changes of each index in different periods. Result: 1? There were no obvious complications during and after operation in both groups. 2? Visual acuity and refractive state: the UCVA of 1mo and 3mo groups were significantly improved after operation, the Intralase-FS60 group was better than the Moria-M2 group (P0. 05), there was no significant difference in BSCVA between the postoperative 3mo group (P0. 171), and there was no significant difference between the two groups (P0. 171- 0. 05). There was no significant difference in efficacy index and safety index between the two groups, and the change of (D) degree of equivalent spherical mirror between 1d~3mo group and Moria-M2 group was 0.73 DX Intralase-FS60 group 0.50D, which indicated that the refractive state of the two groups was stable within 3 months after operation. 3? Wavefront aberration: 1 from the point of increasing multiple, the HOA ROM of 3mo Moria-M2 group changed little, basically recovered to preoperative (1.06 times), but Intralase-FS60 group was obviously superior to pre-operation group (0.79 times); 2 the wavefront aberrations were mainly increased in Z7 + Z8 and Z12 groups, and the values of Moria-M2 group were higher than those of preoperative and Intralase-FS60 groups (P0. 019 ~ 0. 012 0. 016 卤0. 05), and there was statistical difference between the two groups (P < 0. 019, P < 0. 05). 4) the change of OQAS parameters: 1the ejection pupil was the state of 2-D retinal imaging under 4mm, the imaging effect of Intralase-FS60 group on the first day after operation was obviously worse than that of Moria-M2 group, and the scattering was obvious. By 3mo, the Moria-M2 group was basically the same as the preoperative level. The imaging status of Intralase-FS60 group was better than that of pre-operation, which was consistent with the results of wavefront. 2on the first day after operation, the frequency of 50%MTF and extinguishment in Intralase-FS60 group was lower than that in Moria-M2 group (P0.034 0. 024 0. 05), but the frequency of 50%MTF in postoperative 3mo Moria-M2 group was lower than that before operation, and the extinguishing frequency was basically the same as that before operation. The frequency of 50%MTF in Intralase-FS60 group was close to that before operation, and the extinguishing frequency was higher than that before operation. The frequency of 50%MTF in Intralase-FS60 group was higher than that in Moria-M2 group (P0. 05). 3 on the first day after operation, the OVs of Intralase-FS60 group was lower than that of Moria-M2 group, and the OV9% of Intralase-FS60 group was higher than that of Moria-M2 group at the first day of 3mo (P0. 015 卤0. 05). Conclusion: 1. The effect of femtosecond laser assisted individualized LASIK surgery is accurate and has many advantages over mechanical lamellar keratectomy. Patients can obtain better quality of life after operation. 2. OQAS can obtain more information of retinal imaging, describe the scattering in sphere directly and accurately, and has good stability and less interference. It is an objective method to measure visual quality and complement the wavefront aberration. Visual quality can be comprehensively analyzed.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.63
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