波前像差引導(dǎo)的非球面?zhèn)�體化LASIK治療屈光不正的視覺質(zhì)量評(píng)價(jià)
發(fā)布時(shí)間：2018-08-30 16:00
【摘要】：目的 準(zhǔn)分子激光原位角膜磨鑲術(shù)(laser in situ keratomileusis, LAS IK)已經(jīng)成為目前角膜屈光手術(shù)的主流方式,其以良好的穩(wěn)定性、安全性、有效性和可預(yù)測(cè)性而被廣泛運(yùn)用,而部分患者仍抱怨術(shù)后出現(xiàn)眩光、光暈等光學(xué)并發(fā)癥,這是因?yàn)閭鹘y(tǒng)的屈光手術(shù)只能矯正人眼的低階像差,而對(duì)人眼的高階像差卻無法矯正為了能有效改善患者的這些不適癥狀,LASIK手術(shù)出現(xiàn)了個(gè)體化的切削模式,即波前像差引導(dǎo)的切削模式(PT)和Q值引導(dǎo)的非球面切削模式(AS)兩種。前者可以有效消除或減少術(shù)前業(yè)已存在的高階像差,卻不能避免術(shù)中引入的球差；后者可以減少手術(shù)過程中引入的球差,保持術(shù)后角膜的非球面性,卻不能矯正患者術(shù)前業(yè)已存在的高階像差,這兩種個(gè)體化的切削模式患者術(shù)后的視覺改善雖均比傳統(tǒng)的LASIK有了很大提高,但在消除角膜屈光手術(shù)高階像差方面都有其自身的局限性。波前像差引導(dǎo)的非球面?zhèn)�體化LASIK手術(shù)(Personalized Advanced Treatment, PTA),以波前為基礎(chǔ),目的在于在消除或減少術(shù)前高階像差的同時(shí)治療過程中不引入新的球差,減少患者術(shù)后的總高階像差,理論上可以提高患者的視覺質(zhì)量。本研究通過對(duì)近視散光患者行PTA手術(shù)術(shù)前及術(shù)后的視力、屈光度、Q值、波前像差、對(duì)比敏感度(contrast sensitivity,CS)及眩光敏感度的觀察對(duì)其視覺質(zhì)量進(jìn)行評(píng)估。 方法 選取2010年8月～2010年12月在我院擬接受LASIK手術(shù)治療近視及近視散光且隨訪時(shí)間滿6個(gè)月的患者共計(jì)120例(240眼),男63例(126眼),女57例(114眼)。按隨機(jī)化原則進(jìn)行前瞻性研究,分為三個(gè)組：波前像差引導(dǎo)的非球面?zhèn)�體化切削組(PTA組)；波前像差引導(dǎo)的個(gè)體化切削組(PT組)；Q值引導(dǎo)的非球面?zhèn)�體化切削組(AS組)。三組患者術(shù)中均采用FEMTO LDV飛秒激光輔助制作角膜瓣,Technolas217z100型準(zhǔn)分子激光機(jī)進(jìn)行準(zhǔn)分子激光切削,于術(shù)后1天、1周、1月、3月、6月復(fù)查裸眼視力(UCVA)、最佳矯正視力(BSCVA)、顯然驗(yàn)光、波前像差、Q值、對(duì)比敏感度及眩光敏感度測(cè)試。 采用SPSS17.0統(tǒng)計(jì)學(xué)軟件進(jìn)行t檢驗(yàn)、方差分析等統(tǒng)計(jì)學(xué)分析,檢驗(yàn)水準(zhǔn)為P0.05。 結(jié)果 1所有手術(shù)均順利完成,未出現(xiàn)一例嚴(yán)重影響術(shù)后視覺質(zhì)量的并發(fā)癥發(fā)生 2視力和屈光度：(1)安全性：三組患者術(shù)后均未影響視力恢復(fù)的并發(fā)癥發(fā)生,均無BSCVA的丟失；(2)有效性：三組患者術(shù)后UCVA均達(dá)到或超過術(shù)前BSCVA;(3)穩(wěn)定性：三組患者術(shù)后等效球鏡(MRSE)值理想,在+/-0.50D內(nèi)者均占80%以上；(4)預(yù)測(cè)性：三組患者術(shù)后殘留屈光度變化趨勢(shì)平穩(wěn),均在+/-0.50D內(nèi)。 3Q值：PTA組術(shù)后Q值均由負(fù)值變?yōu)檎?且與術(shù)前相比差異有統(tǒng)計(jì)學(xué)意義(Pall0.05)。三組患者術(shù)后Q值均由負(fù)值向正值改變,PTA組和PT組術(shù)后各期比較均有統(tǒng)計(jì)學(xué)差異(Pall0.05),和AS組比較術(shù)后早期(1周、1月)差異有統(tǒng)計(jì)學(xué)意義(Pall0.05),術(shù)后晚期(3月、6月)差異無統(tǒng)計(jì)學(xué)意義(Pall0.05)。 4高階像差：PTA組術(shù)后總高階像差和彗差與術(shù)前比較差異無統(tǒng)計(jì)學(xué)意義,球差在術(shù)后1月、3月、6月時(shí)與術(shù)前比較差異有統(tǒng)計(jì)學(xué)意義。術(shù)后6個(gè)月時(shí),PTA組和PT組總高階像差和球差比較差異有統(tǒng)計(jì)學(xué)意義(Pall0.05),和AS組比較差異無統(tǒng)計(jì)學(xué)意義(Pall0.05)。 5對(duì)比敏感度和眩光敏感度：PTA組在明視/暗視狀態(tài)下術(shù)后各期各空間頻率均未低于術(shù)前,在明視/暗視狀態(tài)下,手術(shù)后各期對(duì)比敏感度值均未受到眩光刺激的影響。在明視狀態(tài)下,術(shù)后1周時(shí),1.5cpd和3.0cpd空間頻率下,PTA組和PT組比較差異有統(tǒng)計(jì)學(xué)意義(Pall0.05),和AS組比較差異均無統(tǒng)計(jì)學(xué)意義(Pall0.05),術(shù)后6個(gè)月時(shí),三組之間在各個(gè)空間頻率下差異均無統(tǒng)計(jì)學(xué)意義(Pall0.05)；在暗視狀態(tài)下,術(shù)后1周時(shí),PTA組和PT組比較在1.5cpd、3.0cpd、6.0cpd空間頻率下差異有統(tǒng)計(jì)學(xué)意義(Pall0.05),在高頻組(12.0cpd、18.Ocpd)比較差異無統(tǒng)計(jì)學(xué)意義(Pall0.05)；在術(shù)后6個(gè)月時(shí),PTA組在1.5cpd、3.0cpd、12cpd和18.0cpd空間頻率下和PT組比較差異有統(tǒng)計(jì)學(xué)意義(Pall0.05),在18.0cpd空間頻率下和AS組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論 1.波前像差引導(dǎo)的非球面?zhèn)�體化LASIK具有良好的安全性、有效性、預(yù)測(cè)性、穩(wěn)定性。 2.波前像差引導(dǎo)的非球面?zhèn)�體化LASIK治療屈光不正可以有效減少高階像差和球差的增加,保持角膜的非球面形態(tài),與其他兩組相比,獲得良好的術(shù)后視覺質(zhì)量。
[Abstract]:objective
Laser in situ keratomileusis (LAS-IK) has become the mainstream method of corneal refractive surgery. It is widely used because of its good stability, safety, effectiveness and predictability. Some patients still complain of postoperative optical complications, such as glare and halo, because of traditional refraction. Surgery can only correct low-order aberrations of the human eye, but can not correct high-order aberrations of the human eye. In order to effectively improve these symptoms of patients, LASIK surgery has emerged individualized cutting mode, namely wavefront aberration-guided cutting mode (PT) and Q-guided non-spherical cutting mode (AS). The preoperative high-order aberration can not avoid the intraoperative spherical aberration; the latter can reduce the spherical aberration introduced during the operation and maintain the non-spherical cornea, but can not correct the preoperative high-order aberration of the patient, although the two individualized cutting patterns of patients with postoperative visual improvement than the traditional LASIK have Wavefront aberration-guided non-spherical personalized LASIK (PTA), based on wavefront, aims at eliminating or reducing preoperative high-order aberrations without introducing new spherical aberrations and reducing them. In this study, the visual quality of myopic astigmatism was evaluated by observing visual acuity, refraction, Q value, wavefront aberration, contrast sensitivity (CS) and glare sensitivity before and after PTA.
Method
From August 2010 to December 2010, 120 patients (240 eyes), 63 males (126 eyes) and 57 females (114 eyes) who were scheduled to undergo LASIK surgery for myopia and myopic astigmatism and had been followed up for more than 6 months were selected. Pre-aberration-guided individualized ablation group (PT group) and Q-guided non-spherical individualized ablation group (AS group). All three groups were treated with FEMTO LDV femtosecond laser-assisted corneal flap preparation. Technolas 217z100 excimer laser machine was used for excimer laser ablation. The best correction was performed on postoperative day, week, January, March and June. Visual acuity (BSCVA), apparent refraction, wavefront aberration, Q, contrast sensitivity and glare sensitivity test.
SPSS17.0 statistical software was used for t test, ANOVA and other statistical analysis. The test level was P0.05..
Result
1 all operations were successfully completed without a serious complication affecting postoperative visual quality.
2 Visual acuity and diopter: (1) Safety: No complications affecting visual acuity were found in all three groups, and no loss of BSCVA was found; (2) Effectiveness: UCVA in all three groups reached or exceeded BSCVA before surgery; (3) Stability: Equivalent spherical mirror (MRSE) was ideal in all three groups, accounting for more than 80% in +/-0.50D; (4) Predictive: The residual diopter of the three groups remained stable after +/-0.50D.
3Q value: Q value of PTA group changed from negative value to positive value, and there was significant difference compared with preoperative (Pall 0.05). Q value of three groups changed from negative value to positive value after operation. There was significant difference between PTA group and PT group in each period after operation (Pall 0.05). Compared with AS group, there was significant difference in early postoperative (1 week, 1 month), late postoperative (Pall 0.05). The difference was not statistically significant (March, June) (Pall0.05).
High-order aberration: There was no significant difference in total high-order aberration and coma between PTA group and preoperative group. There was significant difference in spherical aberration between PTA group and preoperative group at 1 month, 3 months and 6 months after operation. At 6 months after operation, there was significant difference in total high-order aberration and spherical aberration between PTA group and PT group (Pall 0.05), and there was no significant difference between AS group (P 0.05). Pall0.05).
5 Contrast sensitivity and glare sensitivity: The spatial frequency of each stage after operation in the PTA group was not lower than that before operation under the condition of bright/dark vision, and the postoperative contrast sensitivity was not affected by glare stimulation in the condition of bright/dark vision. There was statistical significance (Pall 0.05), and there was no significant difference between the three groups (Pall 0.05) and AS group (Pall 0.05). At 6 months after surgery, there was no significant difference among the three groups in all spatial frequencies (Pall 0.05). In dark vision, PTA group and PT group at 1 week after surgery were significantly different at 1.5 cpd, 3.0 cpd, 6.0 cpd spatial frequencies (Pall 0.05). There was no significant difference between the high frequency group (12.0 cpd, 18.Ocpd) (Pall 0.05); at 6 months after operation, there was significant difference between PTA group and PT group at 1.5 cpd, 3.0 cpd, 12 cpd and 18.0 cpd spatial frequencies (Pall 0.05), and there was significant difference between the 18.0 cpd spatial frequencies and AS group (P 0.05).
conclusion
1. The wavefront aberration guided non-spherical individualized LASIK has good security, effectiveness, predictability and stability.
2. Wavefront aberration-guided non-spherical individualized LASIK can effectively reduce the increase of higher-order aberration and spherical aberration, and maintain the non-spherical shape of cornea. Compared with other two groups, it can obtain good postoperative visual quality.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R779.63
本文編號(hào)：2213569
[Abstract]:objective
Laser in situ keratomileusis (LAS-IK) has become the mainstream method of corneal refractive surgery. It is widely used because of its good stability, safety, effectiveness and predictability. Some patients still complain of postoperative optical complications, such as glare and halo, because of traditional refraction. Surgery can only correct low-order aberrations of the human eye, but can not correct high-order aberrations of the human eye. In order to effectively improve these symptoms of patients, LASIK surgery has emerged individualized cutting mode, namely wavefront aberration-guided cutting mode (PT) and Q-guided non-spherical cutting mode (AS). The preoperative high-order aberration can not avoid the intraoperative spherical aberration; the latter can reduce the spherical aberration introduced during the operation and maintain the non-spherical cornea, but can not correct the preoperative high-order aberration of the patient, although the two individualized cutting patterns of patients with postoperative visual improvement than the traditional LASIK have Wavefront aberration-guided non-spherical personalized LASIK (PTA), based on wavefront, aims at eliminating or reducing preoperative high-order aberrations without introducing new spherical aberrations and reducing them. In this study, the visual quality of myopic astigmatism was evaluated by observing visual acuity, refraction, Q value, wavefront aberration, contrast sensitivity (CS) and glare sensitivity before and after PTA.
Method
From August 2010 to December 2010, 120 patients (240 eyes), 63 males (126 eyes) and 57 females (114 eyes) who were scheduled to undergo LASIK surgery for myopia and myopic astigmatism and had been followed up for more than 6 months were selected. Pre-aberration-guided individualized ablation group (PT group) and Q-guided non-spherical individualized ablation group (AS group). All three groups were treated with FEMTO LDV femtosecond laser-assisted corneal flap preparation. Technolas 217z100 excimer laser machine was used for excimer laser ablation. The best correction was performed on postoperative day, week, January, March and June. Visual acuity (BSCVA), apparent refraction, wavefront aberration, Q, contrast sensitivity and glare sensitivity test.
SPSS17.0 statistical software was used for t test, ANOVA and other statistical analysis. The test level was P0.05..
Result
1 all operations were successfully completed without a serious complication affecting postoperative visual quality.
2 Visual acuity and diopter: (1) Safety: No complications affecting visual acuity were found in all three groups, and no loss of BSCVA was found; (2) Effectiveness: UCVA in all three groups reached or exceeded BSCVA before surgery; (3) Stability: Equivalent spherical mirror (MRSE) was ideal in all three groups, accounting for more than 80% in +/-0.50D; (4) Predictive: The residual diopter of the three groups remained stable after +/-0.50D.
3Q value: Q value of PTA group changed from negative value to positive value, and there was significant difference compared with preoperative (Pall 0.05). Q value of three groups changed from negative value to positive value after operation. There was significant difference between PTA group and PT group in each period after operation (Pall 0.05). Compared with AS group, there was significant difference in early postoperative (1 week, 1 month), late postoperative (Pall 0.05). The difference was not statistically significant (March, June) (Pall0.05).
High-order aberration: There was no significant difference in total high-order aberration and coma between PTA group and preoperative group. There was significant difference in spherical aberration between PTA group and preoperative group at 1 month, 3 months and 6 months after operation. At 6 months after operation, there was significant difference in total high-order aberration and spherical aberration between PTA group and PT group (Pall 0.05), and there was no significant difference between AS group (P 0.05). Pall0.05).
5 Contrast sensitivity and glare sensitivity: The spatial frequency of each stage after operation in the PTA group was not lower than that before operation under the condition of bright/dark vision, and the postoperative contrast sensitivity was not affected by glare stimulation in the condition of bright/dark vision. There was statistical significance (Pall 0.05), and there was no significant difference between the three groups (Pall 0.05) and AS group (Pall 0.05). At 6 months after surgery, there was no significant difference among the three groups in all spatial frequencies (Pall 0.05). In dark vision, PTA group and PT group at 1 week after surgery were significantly different at 1.5 cpd, 3.0 cpd, 6.0 cpd spatial frequencies (Pall 0.05). There was no significant difference between the high frequency group (12.0 cpd, 18.Ocpd) (Pall 0.05); at 6 months after operation, there was significant difference between PTA group and PT group at 1.5 cpd, 3.0 cpd, 12 cpd and 18.0 cpd spatial frequencies (Pall 0.05), and there was significant difference between the 18.0 cpd spatial frequencies and AS group (P 0.05).
conclusion
1. The wavefront aberration guided non-spherical individualized LASIK has good security, effectiveness, predictability and stability.
2. Wavefront aberration-guided non-spherical individualized LASIK can effectively reduce the increase of higher-order aberration and spherical aberration, and maintain the non-spherical shape of cornea. Compared with other two groups, it can obtain good postoperative visual quality.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R779.63
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