本文選題：光學切削區(qū) + 暗適應瞳孔直徑��； 參考：《昆明醫(yī)學院》2011年碩士論文

【摘要】：目的：通過對臨床患者行準分子激光角膜原位磨鑲術術前、術后視覺質量的數(shù)據(jù)收集、對比分析。研究角膜光學切削區(qū)直徑與暗適應下瞳孔直徑關系,探討個性化LASIK手術光學切削區(qū)大小的選擇,以改善患者術后的視覺質量。 方法：選擇2010年5月一2010年12月于我院行非球面LASIK手術并能堅持隨訪復查的患者242人共450眼,男122人(232眼)、女120人(220眼),年齡：18-24歲、平均年齡：(21.6±1.4),暗適應下瞳孔直徑：5.0—8.0 mm,角膜曲率：40.045.0 D角膜光學區(qū)厚度：(540.67±29.56)μm等效柱鏡度數(shù)區(qū)域0～-2.00D,等效球鏡度數(shù)區(qū)域：-0.50～-9.00D。按屈光度分為三組：輕度近視組(-0.50～-3.00D)、中度近視組(-3.25～-6.00D)、高度近視組(-6.25～-9.00D)。三組中分別隨機分配相對等量的手術患者,再將各組患者按光學切削區(qū)與暗適應下瞳孔直徑大小關系分為：A組：光學切削區(qū)大于暗適應下瞳孔直徑區(qū)域0.1mm—0.5mm。B組：光學切削區(qū)等于暗適應下瞳孔直徑區(qū)域。C組：光學切削區(qū)小于暗適應下瞳孔直徑區(qū)域O.1mm—1.0mm。D組：光學切削區(qū)小于暗適應下瞳孔直徑區(qū)域1.1mm—2.0mm。E組：光學切削區(qū)小于暗適應下瞳孔直徑區(qū)域2.1 mm—3.0mm。各組中分別記錄下于患者術前矯正視力、裸眼視力,術后次日、術后1月、術后3月、術后6月的裸眼視力、常規(guī)LASIK術后的�？茩z查和術后術后1月、術后3月、術后6月視覺對比敏感度。 結果：LASIK術后242人(450眼),術后次日裸眼視力68.44%的患者視力達到術前矯正視力,術后一月裸眼視力85.78%的患者達到術前矯正視力,術后三月裸眼視力90.67%的患者達到術前矯正視力,術后六月的裸眼視力91.78%達到術前矯正視力。三組屈光度術后的視覺質量：各組患者的光學切削區(qū)大于暗適應瞳孔直徑0.1mm—0.5mm區(qū)域(A組)和光學切削區(qū)等于暗適應下瞳孔直徑區(qū)域(B組)的術后中間視覺和眩光對比敏感度均較術前顯著提高,視覺質量明顯改善,有統(tǒng)計學顯著性差異(P0.05)。各屈光度患者的光學切削區(qū)小于暗光瞳孔區(qū)域0.1mm—1.0mm(C組)和光學切削區(qū)小于暗光瞳孔區(qū)域1.1mm—2.0mm(D組)的術后中間視覺和眩光對比敏感度均較術前顯著提高,視覺質量明顯改善。各屈光度患者的光學切削區(qū)小于暗適應下瞳孔直徑區(qū)域2.1mm—3.0mm(E組)的術后中間視覺和眩光對比敏感度及視覺質量均較術前顯著提高,但對比同組屈光度光學切削區(qū)與暗適應瞳孔直徑關系的C組、D組術后中間視覺和眩光對比敏感度則明顯下降,有統(tǒng)計學顯著性差異(P0.05)。 各組屈光度患者術后三月的中間視覺及眩光對比度的視覺質量比術前和術后一月的明顯提高,與術后六月的視覺質量基本一致,無統(tǒng)計學差異(P0.05)。各組患者術后次日、一月、三月、六月的裸眼視力平均達到術前矯正視力的超過90%。 術后有9例患者(18眼)的中間視覺和眩光對比敏感度和術前無明顯統(tǒng)計學差異。 結論：準分子激光角膜原位磨鑲術術后視覺質量、裸眼視力均有提高,且手術是安全可靠的。首次得出各屈光度組術后中間視覺及眩光對比敏感度在光學切削區(qū)暗適應瞳孔2.1-3.0mm區(qū)域時,有明顯的視覺質量下降趨勢。為確保滿意的術后視覺質量,建議手術光學切削區(qū)暗適應瞳孔直徑2mm范圍為最佳手術區(qū)域。
[Abstract]:Objective: To study the relationship between the diameter of the optical cutting area of the cornea and the pupil diameter under the dark adaptation, and to discuss the selection of the size of the optical cutting area for the individual LASIK operation in order to improve the visual quality of the patients after the excimer laser in situ keratomileusis.
Methods: 450 eyes, 122 men (232 eyes), 120 women (220 eyes), age: 18-24 years old: (21.6 + 1.4), dark adapted to the lower pupil diameter: 5 - 8 mm, corneal curvature: 40.045.0 D corneal optical area thickness: (540.67): (540.67), 242 men, 122 men (232 eyes) and 120 women (220 eyes), who were able to follow up the follow-up review in our hospital in May 2010. The degree area of the equivalent cylindrical mirror was 0 ~ -2.00D, and the degree area of the equivalent sphere mirror was divided into three groups according to the diopter of -0.50 to -9.00D.: mild myopia group (-0.50 to -3.00D), moderate myopia group (-3.25 to -6.00D), and high myopia group (-6.25 to -9.00D). The three groups were randomly assigned to the operation patients with relative equal quantities, and then the patients were cut by optical cutting in each group. The relationship between the area and the dark adapted pupil diameter is divided into A group: the optical cutting area is larger than the dark adapted pupil diameter area 0.1mm 0.5mm.B group: the optical cutting area is equal to the dark adapted pupil diameter area.C group: the optical cutting area is smaller than the dark adapted pupil diameter region O.1mm 1.0mm.D group: the optical cutting area is smaller than the dark adaptation pupil. The hole diameter area 1.1mm - 2.0mm.E group: the optical cutting area is less than the dark adapted pupil diameter area 2.1 mm - 3.0mm. respectively recorded in the patients' corrected visual acuity, naked eye vision, the next day after operation, January after operation, March after operation, June postoperative naked eyesight, routine LASIK postoperative specialist examination and postoperative January, March postoperative, 6 after operation. Month vision contrast sensitivity.
Results: 242 people (450 eyes) after LASIK, the visual acuity of 68.44% of the bare eyesight of the next day after the operation, the visual acuity was achieved before the operation, and the visual acuity of 85.78% of the naked eye one month after the operation was achieved. The postoperative corrected visual acuity was achieved in 90.67% of the naked eye in March. 91.78% of the naked eyes after the operation reached the preoperative corrected visual acuity. Three groups of visual acuity were reached before the operation. Three groups of visual acuity were reached before the operation. Visual quality after refractive surgery: the optical cutting area in each group was greater than that of the dark adapted pupil diameter 0.1mm - 0.5mm region (group A) and the optical cutting area was equal to the dark adapted pupil diameter region (group B), and the contrast sensitivity of the middle vision and glare was significantly higher than that before the operation, and the visual quality was significantly improved (P 0.05). The optical cutting area of each diopter is less than the dark pupil area 0.1mm - 1.0mm (group C) and the optical cutting area is less than the dark pupil area 1.1mm 2.0mm (D group), and the contrast sensitivity of the middle vision and the glare is significantly higher than that before the operation, and the visual quality is obviously improved. The optical cutting area of each diopter is less than the dark adaptive pupil. The contrast sensitivity and visual quality of 2.1mm - 3.0mm (group E) in the hole diameter area were significantly higher than those before the operation, but compared with the group C with the relationship between the optical cutting area and the dark adapted pupil diameter in the same group, the contrast sensitivity of the middle vision and the glare after the D group was significantly decreased, and there was a statistically significant difference (P0.05).
The visual quality of the contrast of the middle vision and glare of the diopter in each group of diopter in March was significantly higher than that before and after the operation. The visual quality was basically consistent with the visual quality in June after the operation. There was no statistical difference (P0.05). The average visual acuity of the patients in each group was more than 90%. on the day after the operation, one month, March, and June.
There was no significant difference in the contrast sensitivity between the intermediate vision and glare in 9 patients (18 eyes).
Conclusion: the visual quality of the excimer laser in situ keratomileusis is improved and the operation is safe and reliable. It is the first time that the contrast sensitivity of the middle vision and glare of the refractive index group has obvious visual quality decline when the optical cutting area is dark adapted to the pupil 2.1-3.0mm area. In terms of visual quality, it is suggested that the range of 2mm of dark adaptation to pupil diameter should be the best operative area.
【學位授予單位】：昆明醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R779.63

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