角膜波前引導的LASIK治療低中度近視角膜高階像差的臨床觀察

【摘要】  目的：比較角膜波前像差引導下的準分子激光原位角膜磨鑲術(laser in situ keratomileusi, LASIK)和常規的LASIK對低中度近視角膜高階像差的影響。方法：采用前瞻性非隨機對比研究，選取6mo內連續的低中度近視患者32例58眼實施常規LASIK(A組，其中低度近視24眼，中度近視34眼)，34例52眼實施角膜波前引導下的個性化LASIK(B組，其中低度近視23眼，中度近視29眼)。所有手術均使用德國Schwind 公司Esiris第九代準分子激光治療儀和Carriazo Pendular鐘擺式角膜板層刀，使用4.2.0版本的Optikon keratron Scout 2000角膜地形圖對兩組患者在術前和術后3mo進行6mm瞳孔直徑時角膜高階像差檢查。結果：兩組病例角膜球差和均方根均高于術前。A組低度近視術后高階像差增加量依次為均方根0.236μm、彗差0.146μm、球差0.139μm和三葉差0.054μm，中度近視高階像差增加量依次為均方根0.367μm、球差0.284μm、彗差0.177μm和三葉差0.021μm。B組低度近視高階像差增加量依次為球差0.127μm、均方根0.088μm、三葉差0.051μm、和彗差0.042μm，中度近視高階像差增加量依次為均方根0.175μm、球差0.162μm、彗差0.027μm和三葉差0.024μm;兩組病例術后3mo裸眼視力非常接近.同樣條件下低中度近視角膜波前像差引導下的個性化LASIK切削的深度較常規LASIK深。結論：角膜波前像差引導下的低中度近視LASIK較常規LASIK角膜高階像差影響少。

【關鍵詞】  角膜波前;近視;高階像差;球差;彗差;三葉差;個性化切削

　　AbstractAIM: To compare the effects of corneal wavefront aberration guided LASIK and conventional LASIK on correcting corneal higher order aberration in low to moderate myopia.METHODS: A prospective,non�瞨andomized,controlled study included 110 low to moderate myopia eyes of 66 consecutive patients within half a year: 58 eyes of 32 patients had LASIK (A group) and 52 eyes of 34 patients had corneal wavefront aberration guided LASIK(B group).All procedures were performed Esiris ninth generation of excimer laser system and carriazo pendular microkeratome made in Germany Schwind. The Optikon keratron Scout 2000(version 4.2.0) topographer device was used to examine corneal higher order aberration related to 6mm pupil diameter before and 3 months after surgery .RESULTS: Increase was found in corneal spherical aberration and root mean square(rms) after 3 months surgery in two groups.The average increase of corneal higher order aberration was 0.236 μm in rms, 0.146 μm in coma, 0.139 μm in spherical aberration and 0.054μm in trefoil in low myopia cases of A group, A group moderate myopia cases appeared 0.367μm in rms, 0.284μm in spherical aberration, 0.177μm in coma and 0.021μm in trefoil; B group low myopia cases appeared 0.127μm in spherical aberration, 0.088μm in rms, 0.051μm in trefoil and 0.042μm in coma, B group moderate myopia cases appeared 0.175μm in rms, 0.162 μm in spherical aberra�瞭ion, 0.027μm in coma and 0.024μm in trefoil. It was very close in average naked vision after 3 months surgery between two groups. Ablation depth with wavefront aberration guided LASIK was larger than that with LASIK under the same conditions on correcting low to moderate myopia.　�rCONCLUSION: Increase change of corneal higher order aberration after LASIK is larger than the change after corneal wavefront aberration guided LASIK on correcting low to moderate myopia.

　　�rKEYWORDS: corneal wavefront aberra法律論文發表 tion;myopia;higher order aberration;spherical aberration;coma;trefoil;customized ablation

　　0引言

　　準分子激光原位角膜磨鑲術(laser in situ keratomileusi, LASIK)是目前矯治近視的主流手術，在其改善裸眼視力的同時也帶來了如眩光、光暈、重影和暗視力下降等一系列術后視覺質量下降的問題，如何降低術后高階像差的增加量已成為眼科界普遍關注的熱點。我們對角膜波前像差引導下的LASIK和常規LASIK矯治低中度近視的兩組病例術后3mo角膜高階像差進行比較，現報告如下。

　　1對象和方法法律論文發表

　　1.1對象 2009��02/2009��08期間前瞻性非隨機在我院設計低、中度近視常規LASIK組(A組)和低、中度近視角膜波前像差引導下的個性化LASIK組(B組)。A組32例58眼(其中男16例，女16例，低度近視24眼，中度近視34眼),年齡18～51歲，術前裸眼視力0.01～0.3，近視度數��0.75～��6.00D,散光度數0～��2.50D。B組34例52眼(其中男16例，女18例，低度近視23眼，中度近視29眼);年齡18～45歲，術前裸眼視力0.02～0.6，近視度數��1.50～��6.00D,散光度數0～��2.00D,兩組病例矯正視力均正常。兩組病例患者年齡、病例數、術前裸眼視力、近視度數、散光度數、光學切削區直徑，術前角膜球差、角膜彗差、角膜三