發(fā)布時(shí)間：2019-06-06 01:38

【摘要】：背景 前彈力層下準(zhǔn)分子激光原位角膜磨鑲術(shù)(sub-Bowman's keratomileusis, SBK)是2008年新問世的角膜屈光手術(shù),具有術(shù)后視力恢復(fù)快、干眼發(fā)生率低、治療范圍更廣等優(yōu)點(diǎn),但術(shù)后也出現(xiàn)了種種視覺質(zhì)量問題,受到了屈光手術(shù)醫(yī)師的重視。 目的 觀察和分析近視眼患者SBK術(shù)后高階像差(higher order aberration, HO A)、對(duì)比敏感度(contrast sensitivity, CS)、眩光對(duì)比敏感度(glare contrast sensitivity, GS)等參數(shù)的變化,并與準(zhǔn)分子激光原位角膜磨鑲術(shù)(laser in situ keratomileusis, LASIK)相比較,探討SBK術(shù)后高階像差與對(duì)比敏感度的關(guān)系,更加全面綜合地評(píng)價(jià)SBK術(shù)后視覺質(zhì)量,從而為準(zhǔn)分子激光矯正近視眼獲得更良好的視覺質(zhì)量提供臨床依據(jù)。 方法 采用自身前-后對(duì)照及病例-對(duì)照研究設(shè)計(jì)。選取2010年12月～2011年12月就診于解放軍91中心醫(yī)院眼科中心的78名近視眼患者,其中SBK為病例觀察組,LASIK為病例對(duì)照組,術(shù)前行裸眼視力(uncorrected visual acuity, UCVA)、最佳矯正視力(best corrected visual acuity, BSCVA)、電腦驗(yàn)光、眼壓、裂隙燈、角膜地形圖、眼底等常規(guī)檢查。應(yīng)用NIDEK OPD SCAN波前像差分析儀術(shù)前和術(shù)后1周、1月、3月、6月分別測量暗室條件下眼波前像差。應(yīng)用Optec6500視功能檢查儀術(shù)前和術(shù)后1周、1月、3月、6月分別測量暗環(huán)境下對(duì)比敏感度及眩光對(duì)比敏感度。手術(shù)(激光平臺(tái)：NIDEK EC5000CⅩⅡ)均由同一醫(yī)師完成。術(shù)后堅(jiān)持復(fù)查隨訪。詳細(xì)記錄檢查數(shù)據(jù)并采用SPSS13.0軟件進(jìn)行一般性統(tǒng)計(jì)描述、正態(tài)性檢驗(yàn)、方差分析、獨(dú)立樣本t檢驗(yàn)、Pearson相關(guān)分析等統(tǒng)計(jì)學(xué)分析和處理。 結(jié)果 1.術(shù)前SBK組和LASIK組最佳矯正視力、柱鏡、中央角膜厚度、角膜瓣厚度、T.Sph、T.Trefoil、Total和眼壓進(jìn)行比較,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。 2.SBK組和LASIK組不同時(shí)段裸眼視力比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。 3.SBK組和LASIK組術(shù)前兩組柱鏡比較,具有顯著性差異(P=0.004)。 4.SBK組內(nèi)Total、High、T.Coma、T.Trefoil、T.Sph、HitsAig手術(shù)前后進(jìn)行比較,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)；LASIK組內(nèi)Total、T.Trefoil、T.Sph手術(shù)前后進(jìn)行比較,具有顯著性差異(P=0.000,P=0.000,P=0.000);組間比較：T.Sph在術(shù)前、術(shù)后1月和術(shù)后3月進(jìn)行比較,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),T.Trefoil在術(shù)前、術(shù)后3月進(jìn)行比較,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),Total在術(shù)前、術(shù)后1月和術(shù)后3月進(jìn)行比較,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。 5.術(shù)后兩組高階像差增幅：T.Sph在術(shù)后1周、術(shù)后1月進(jìn)行比較,具有顯著性差異(P0.05)；Total在術(shù)后1月、術(shù)后6月進(jìn)行比較,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。 6.SBK組1.5c/d、6.0c/d、12.0c/d空間頻率下對(duì)比敏感度術(shù)前后進(jìn)行比較,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。 7.SBK組術(shù)前,球差對(duì)12.0c/d頻段的對(duì)比敏感度有影響,且呈負(fù)相關(guān)(r=-0.391)。術(shù)后1月,彗差對(duì)12.0c/d、18.0c/d頻段的對(duì)比敏感度有影響,且均呈負(fù)相關(guān)(r=-0.366,r=-0.311)；球差對(duì)12.0c/d頻段的對(duì)比敏感度有影響,呈負(fù)相關(guān)(r=-0.381)；而三葉草差與對(duì)比敏感度無明顯相關(guān)。 結(jié)論 1.SBK術(shù)后視覺質(zhì)量優(yōu)于LASIK. 2.SBK術(shù)后高階像差和LASIK術(shù)后高階像差均呈增長趨勢。 3.SBK術(shù)后彗差、球差、三葉草差、總高階像差均方根值增幅小于LASIK。 4.SBK術(shù)前,球差主要影響對(duì)比敏感度；術(shù)后一月,彗差和球差主要影響對(duì)比敏感度。
[Abstract]:background The in-situ keratomileussis (SBK) of the first-layer laser in situ keratomileussis (SBK) is a new corneal refractive surgery in 2008. It has the advantages of fast postoperative visual recovery, low incidence of dry eye and wider treatment scope. The subject is subject to the weight of the refractive surgeon. View. Objective To observe and analyze the changes of high-order aberration (HO A), contrast sensitivity (CS) and glare contrast sensitivity (GS) in patients with myopia and to be combined with laser in situ keratomileussis, LSISI. K) The relationship between the high-order aberration and contrast sensitivity after SBK operation was discussed, and the visual quality of the post-operation of SBK was evaluated in a more comprehensive and comprehensive manner. supply Bed basis. The method uses its own front-back control and A case-control study was designed. From December 2010 to December 2011,78 patients with myopia were seen from the 91 Central Hospital of the PLA, where the SBK was the case observation group, the LASIK was the case control group, and the preoperative visual acuity (UCVA) and the best corrected vision (BS) were the best corrected visual acuity (BS). CVA), computer optometry, intraocular pressure, slit lamp, corneal topography The routine examination of the fundus and the like was performed. The NIDEK OPD SCAN wavefront aberration analyzer was applied before and after the operation for 1 week, January, March and June respectively. The pre-operative and postoperative 1-week,1-,3-and 6-month post-operative contrast sensitivity of the Otec6500 visual function tester were measured in a dark environment, respectively. Contrast sensitivity of degree of glare and glare. (Laser platform: NIDEK EC5000C X II ) is completed by the same physician The follow-up was maintained after the operation. The examination data was recorded in detail and the general statistical description was performed using the SPSS13.0 software, positive and negative, analysis of variance, independent sample t-test, Pearson correlation analysis iso-series Results 1. The best corrected vision, post-lens, central corneal thickness, corneal flap thickness, T. Sph, T. Trefoil, Total and intraocular pressure were compared in the preoperative SBK group and the LASIK group. There was a statistical significance (P 0.05).2. The visual acuity of the naked eyes in the SBK group and the LASIK group was poor and the difference was poor. The comparison of the two groups before and after the operation of the SBK group and the LASIK group There was a significant difference (P = 0.004).4. The total, High, T. Coma, T. Trefoil, T. Sph, and Sweig operations in the SBK group were statistically significant (P = 0.000, P = 0.000, P = 0, P = 0.000, P = 0.000, P = 0). The difference was statistically significant (P0.05). The difference was statistically significant (P0.05), and the difference was statistically significant (P0.05). Total was before operation,1 month after operation and 3 months after operation. The difference was statistically significant (P0.05).5. The increase of higher-order aberration in the two groups after operation: T. Sph compared with one month after the operation, with significant difference (P0.05); Total was 1 month after operation, and 6 months after operation. The difference was statistically significant (P0.05).6. Contrast sensitivity at the spatial frequencies of 1.5 c/ d, 6.0 c/ d, and 12.0 c/ d in the SBK group. The difference was statistically significant (P0.05) before and after the operation. The contrast sensitivity of 12.0c/ d and 18.0 c/ d bands was negatively correlated (r =-0.366, r =-0.311) and negative correlation (r =-0.366, r =-0.311) and negative correlation (r =-0.366, r =-0.311) and negative correlation (r =-0.366, r =-0.311). =- 0.381); and the clover difference and contrast sensitivity were not Conclusion 1. The visual quality of SBK is superior to LASIK. 2. Higher-order aberrations after SBK and higher-order aberrations after LASIK showed a trend of growth. The post-operation coma, spherical aberration, clover difference and total high-order aberration of BK were smaller than that of LASIK.4. SB
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【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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