【摘要】： 目的：比較角膜地形圖引導(dǎo)個性化切削(Topography Supported Customized Ablation, TOSCA)與Q值優(yōu)化準(zhǔn)分子激光原位角膜磨鑲術(shù)(Aberration Smart Ablation, ASA)治療無散光近視眼的療效。 方法：將散光在0.50D以下的近視患者隨機(jī)分為TOSCA組和ASA組,使用Carl Zeiss MEL80準(zhǔn)分子激光機(jī)分別進(jìn)行TOSCA模式切削和ASA模式切削,記錄手術(shù)切削量,隨訪3個月。分別于手術(shù)前、術(shù)后2周,1月及術(shù)后3月檢查視力、最佳矯正視力、波前像差和角膜地形圖視覺對比敏感度,術(shù)后3月復(fù)查角膜厚度,應(yīng)用SPSS 15.0統(tǒng)計軟件對數(shù)據(jù)進(jìn)行分析,P0.05為有統(tǒng)計學(xué)意義。 結(jié)果：分析了60例111眼。術(shù)前、術(shù)后3月兩組間等效球徑均無顯著性差異。術(shù)后3月裸眼視力TOSCA組46眼(92.00%)≥1.0,ASA組39眼(95.12%)≥1.0,兩組間比較無顯著性差異(P=0.550)。至術(shù)后3月二組最佳矯正視力較術(shù)前均無丟失。兩組術(shù)后各階段的水平彗差較術(shù)前無顯著性差異,RMSh (Root Mean Square of Higher Order Aberrations)、球差和垂直彗差較術(shù)前均顯著增加,其中TOSCA組術(shù)后各階段球差穩(wěn)定(p=0.233),ASA組球差至術(shù)后1月趨于穩(wěn)定。組間比較顯示兩組在術(shù)前、術(shù)后各階段的RMSh、球差、彗差均無顯著性差異。兩組術(shù)后對比敏感度在1.0cpd明視下較術(shù)前下降,至術(shù)后3月尚未恢復(fù),余頻率較術(shù)前無明顯下降。術(shù)前、術(shù)后各階段兩組間對比敏感度比較均無顯著性差異。兩組術(shù)后各階段CIM (Corneal Irregularity Measurement)較術(shù)前增大,SF (Shape Factor)、TKM (Mean Reference Toric K)較術(shù)前減小,術(shù)后各階段間不具顯著性差異,組間比較顯示兩組在術(shù)前、術(shù)后各階段的CIM、SF、TKM均無顯著性差異。理論切削值TOSCA顯著小于ASA組(13.61±2.42μm/D Vs.19.40±5.23μm/D, p＜0.001),實際切削值TOSCA組平均值小于ASA組,但二者相比較無顯著性差異(11.54±2.81μm/DVs.12.12±3.18μm/D, p=0.180). 結(jié)論：TOSCA模式與ASA模式治療無散光近視眼均安全、有效、穩(wěn)定,TOSCA切削模式能提供更準(zhǔn)確、穩(wěn)定的預(yù)期切削量,ASA模式需進(jìn)一步改進(jìn),提高預(yù)期切削量的準(zhǔn)確性,以更好地應(yīng)用于臨床。
[Abstract]:Objective: to compare the efficacy of keratographic guided personalized (Topography Supported Customized Ablation, TOSCA) and Q value optimization excimer laser in situ keratomileusis (Aberration Smart Ablation, ASA) in the treatment of myopia without astigmatism. Methods: myopia patients with astigmatism below 0.50D were randomly divided into TOSCA group and ASA group. Carl Zeiss MEL80 excimer laser was used for TOSCA mode and ASA mode respectively. Visual acuity, best corrected visual acuity, wavefront aberration and visual contrast sensitivity of corneal topography were examined before, 2 weeks, 1 month and 3 months after operation, and corneal thickness was reexamined 3 months after operation. SPSS 15.0 statistical software was used to analyze the data. Results: 111 eyes of 60 cases were analyzed. There was no significant difference in the equivalent spherical diameter between the two groups before and 3 months after operation. The visual acuity of 46 eyes (92.00%) in the group of TOSCA 鈮，

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