本文關(guān)鍵詞： 近視 角膜 高階像差 飛秒激光 準(zhǔn)分子激光原位角膜磨鑲術(shù) 準(zhǔn)分子激光角膜前彈力層下磨鑲術(shù) 微小切口 透鏡取出術(shù)　出處：《天津醫(yī)科大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:對比分析飛秒激光 LASIK(Femtosecond laser in situ keratomileusis,FS-LASIK)手術(shù)、準(zhǔn)分子激光角膜前彈力層下磨鑲(Sub-Bowman's Keratomileusis,SBK)手術(shù)術(shù)后中長期(術(shù)后1-6個月)全眼高階像差的特征性變化及FS-LASIK手術(shù)中不同手術(shù)參數(shù)和術(shù)中并發(fā)癥對術(shù)后高階像差的影響及相關(guān)因素的分析;探討全飛秒激光角膜屈光手術(shù)—飛秒激光角膜微小切口基質(zhì)透鏡取出術(shù)(Small incision lenticule extraction,SMILE)和飛秒激光角膜基質(zhì)透鏡取出術(shù)(Femtosecond laser lenticule extraction,FLEx)手術(shù)后(1-3 個月)全眼高階像差的變化特點,及與飛秒激光LASIK手術(shù)的比較分析。方法:1、對近視及近視散光患者101例201只眼行前瞻性研究,其中FS-LASIK手術(shù)患者60例119只眼,SBK手術(shù)患者41例82只眼,FS-LASIK組中薄瓣組24例47只眼及術(shù)中發(fā)生OBL的患者15例25只眼;2、另對近視及近視散光患者112例191只眼行前瞻性研究,其中SMILE手術(shù)患者34例61只眼,FLEx手術(shù)患者32例39只眼及對照組FS-LASIK手術(shù)患者46例91只眼。3、采用WaveScan 波前像差儀(WaveScan,VISX,Santa Clara,CA,USA)測量患者的波前像差,Pentacam眼前節(jié)分析系統(tǒng)(Oculus GmbH,Wetzlar,Germany)行角膜地形圖測量。FS-LASIK與SBK手術(shù)術(shù)后1個月、3個月、6個月,SMILE與FLEx手術(shù)術(shù)后1個月,3個月進行隨訪測量。應(yīng)用單因素方差分析、獨立樣本t檢驗及配對t檢驗、重復(fù)測量及Pearson線性相關(guān)等進行對比分析。結(jié)果:1.飛秒激光LASIK(FS-LASIK)手術(shù)后各個時期全眼總高階(Sh)、彗差(C31)、球差(C40)及第三、四階(S3、S4)均較術(shù)前增加,尤以總高階(Sh)、球差(C40)及第四階(S4)變化最明顯(P0.05);術(shù)后3個月時,第三階(S3)較術(shù)后1個月時增加,術(shù)后6個月時,彗差(C31)、球差(C40)及第四階(S4)較術(shù)后3個月時增加(P0.05)。2.通過與對照組SBK組的比較,術(shù)后1個月時,垂直彗差(C3-1)及第三階(S3)在FS-LASIK組較SBK組低(P0.05);術(shù)后3個月及6個月時,第三階(S3)在FS-LASIK組較SBK組低(P0.05),其余項未見明顯變化(P0.05)。3.FS-LASIK手術(shù)術(shù)后誘導(dǎo)的高階像差與術(shù)中制作的角膜瓣厚度成負相關(guān)。薄瓣組(85/90/95μm)與正常組(105μm)術(shù)后總高階(Sh)、球差(C40)及第三、四階(S3、S4)均較術(shù)前增加,特別是總高階(Sh)、球差(C40)及第四階(S4)在術(shù)后各個時期薄瓣組均高于正常組(P0.05)。4.OBL的發(fā)生與中央角膜厚度CCT、角膜平均曲率和制作的角膜瓣厚度有關(guān)(P0.05),術(shù)前角膜越薄、角膜平均曲率越高、制作的角膜瓣越薄,越容易出現(xiàn)OBL。5.將OBL組和正常(無OBL)組比較發(fā)現(xiàn),總高階Sh、彗差(C31)、球差及第四階(S4)在術(shù)后1個月時OBL組較正常組增加(P均0.05);彗差(C31)在術(shù)后3個月和6個月時在OBL組較正常組增加(P均0.05);而第三階(S3)在術(shù)后3個月時OBL組明顯高于正常組(P均0.05),6個月時兩組比較接近。6.SMILE組和FLEx組術(shù)后1個月和3個月高階像差均較術(shù)前增加,尤其是總高階(Sh)、彗差(C3-1 C31)、球差(C40)、第三、四階(S3、S4)(P均0.05);SMILE手術(shù)術(shù)后3個月總高階(Sh)、球差(C40)及第四階(S4)與術(shù)后1個月相比較有所下降(P均0.05);FLEx手術(shù)術(shù)后1個月與3個月之間差異無統(tǒng)計學(xué)意義(P均0.05)。7.術(shù)后1個月、3個月時總高階(Sh)、三葉草(C33)及第六階(S6)在SMILE組均低于FLEx組,且兩組間差異有統(tǒng)計學(xué)意義(P均0.05);而彗差(C31)在FLEx組低于SMILE組,且兩組間差異有統(tǒng)計學(xué)意義(P0.05)。8.術(shù)后1個月時,FLEx組中總高階(Sh)、球差(C40)較FS-LASIK組低,且兩組之間的差異具有統(tǒng)計學(xué)意義(P均0.05),而彗差(C31)和四葉草(C44)較FS-LASIK組高(P=0.018,0033);而3個月時,FLEx組中的總高階(Sh)、彗差(C31)、球差(C40)、四葉草(C44)及第四階(S4)均較FS-LASIK組低(P均0.05)。結(jié)論:1.FS-LASIK手術(shù)在矯正低階像差的同時,誘導(dǎo)術(shù)源性高階像差的產(chǎn)生,且具有恢復(fù)快,患者術(shù)后早期即擁有較穩(wěn)定的視覺質(zhì)量的優(yōu)勢;與SBK手術(shù)相比較,FS-LASIK手術(shù)術(shù)后患者可獲得較好的視覺質(zhì)量。2.在FS-LASIK手術(shù)中,制作超薄的角膜瓣,相較于正常厚度的角膜瓣而言,易誘導(dǎo)更多的高階像差(以球差為主),影響患者術(shù)后視覺質(zhì)量。3.OBL的發(fā)生與術(shù)前中央角膜厚度CCT、平均角膜曲率和術(shù)中制作的角膜瓣厚度有關(guān)。且OBL能誘導(dǎo)術(shù)后高階像差的增加,隨著角膜傷口的愈合,表現(xiàn)為角膜前表面不規(guī)則引起角膜彗差的增加為主。4."全飛秒激光"手術(shù)在矯正低階像差的同時,誘導(dǎo)高階像差的增加。隨著角膜傷口的愈合,術(shù)后高階像差有相對穩(wěn)定并逐漸降低的趨勢。5.SMILE手術(shù)中的"微小切口 "能有效降低角膜屈光手術(shù)術(shù)后的高階像差,使患者術(shù)后獲得較好的視覺質(zhì)量。6.飛秒激光對角膜基質(zhì)的切割移除作用能有效降低角膜屈光手術(shù)后的高階像差,對患者術(shù)后早期高階像差影響較準(zhǔn)分子激光的切削消融作用較小,但需要增加樣本量及延長隨訪時間進一步觀察。
[Abstract]:Objective: comparative analysis of femtosecond laser LASIK (Femtosecond laser in situ keratomileusis, FS-LASIK) excimer laser surgery, Bowman keratomileusis (Sub-Bowman's Keratomileusis, SBK) after surgery in the long term (1-6 months postoperative) analysis of the effects of higher-order aberrations after surgery and the factors related to ocular higher-order aberrations characteristics the change of FS-LASIK in different operation parameters and operation and intraoperative complications; to investigate the femtosecond laser corneal refractive surgery, femtosecond laser corneal small incision lenticule extraction (Small incision lenticule extraction, SMILE) and the removal of femtosecond laser corneal lens (Femtosecond laser lenticule extraction, FLEx) after surgery (1-3 months) changes total higher-order aberrations, analysis and comparing with the LASIK femtosecond laser surgery. Methods: 1 of 101 patients with myopia and myopic astigmatism 201 eyes underwent prospective research The FS-LASIK surgery in 60 eyes of 119 patients, patients with SBK surgery in 41 cases 82 eyes, OBL FS-LASIK group in thin flap group 47 eyes and 24 cases in 15 patients with 25 eyes; 2, the other for myopia and myopic astigmatism in 112 patients 191 eyes underwent prospective study among SMILE patients with 34 eyes of 61 patients, patients with FLEx surgery in 32 eyes of 39 cases and control group of patients with FS-LASIK surgery in 46 eyes of 91 patients with.3, using the WaveScan wavefront analyzer (WaveScan, VISX, Santa, Clara, CA, USA) wavefront aberration measurement of patients, Pentacam system (Oculus GmbH, Wetzlar, Germany) for 1 months for cornea topographic map measurement of.FS-LASIK and SBK operation, 3 months, 6 months, 1 months after the operation of SMILE and FLEx, were measured for 3 months. By one-way analysis of variance, independent samples t test and paired t test, repeated measurement and Pearson linear correlation were analyzed. Results: 1. fly 縐掓縺鍏塋ASIK(FS-LASIK)鎵嬫湳鍚庡悇涓椂鏈熷叏鐪兼，

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