OQAS對不同制瓣方式的個性化LASIK手術術后視覺質量的評估
發(fā)布時間：2018-12-13 22:32
【摘要】：目的:使用OQAS分別對飛秒激光和角膜板層刀制瓣的個性化準分子激光原位角膜磨鑲術術后患者的視覺質量進行定性及定量的分析,完善個性化手術術后視覺質量的評定方法,進一步探討飛秒激光輔助的優(yōu)勢及原因。 方法:選取2009年3月～2010年9月間于我院準分子激光治療中心擬行個性化LASIK手術,符合手術標準,年齡18歲至40歲之間的患者106例(212只眼)進行回顧分析,術前均由同一指定眼科醫(yī)師對患者進行系統(tǒng)眼部檢查并對檢查結果進行綜合評定入組,兩組術前性別、年齡、瞳孔直徑、裸眼視力及等效球鏡均經過X2或配對T檢驗,差異無統(tǒng)計學意義(P0.05)。分別使用Moria-M2角膜板層刀(106只眼)及Intralase-FS60飛秒激光(106只眼)對兩組患者設計制作相同厚度110μm的角膜瓣,然后使用VISX S4準分子激光治療儀對兩組患者進行相同直徑6.5mm的個性化切削,術后常規(guī)用藥,囑患者分別于術后第1d、1mo、3mo復查,進行視力、眼壓、電腦驗光、裂隙燈、角膜地形圖、WASCA波前像差儀、OQAS視覺質量分析檢查,并對各指標在不同時期的變化進行統(tǒng)計學分析整理。 結果: 1㖞兩組術中及術后均未見明顯并發(fā)癥。 2㖞視力與屈光狀態(tài):術后1mo及3mo兩組患者UCVA均有顯著提高,組間比較Intralase-FS60組優(yōu)于Moria-M2組(P㩳0.05);術后3mo組間BSCVA無明顯統(tǒng)計學差異(P=0.171㧐0.05);兩組的有效性指數(shù)及安全性指數(shù)無明顯統(tǒng)計學差異;1d~3mo間等效球鏡(D)度數(shù)變化分別為Moria-M2組0.73D,Intralase-FS60組0.50D,說明兩組患者術后3個月間屈光狀態(tài)均較穩(wěn)定。 3㖞波前像差:①從增加倍數(shù)上看,術后3mo Moria-M2組的HOA ROM變化不大,基本恢復至術前(1.06倍),而Intralase-FS60組則明顯優(yōu)于術前(0.79倍);②波前像差兩組均以Z7、Z8和Z12增加為主,其中Moria-M2組各值均高于術前和Intralase-FS60組(P=0.019、0.012、0.016㩳0.05),具有統(tǒng)計學差異。 4 ) OQAS參數(shù)變化:①出射瞳孔為4mm下的視網膜二維成像狀態(tài),Intralase-FS60組術后第1d成像效果明顯差于Moria-M2組,散射明顯,到3mo時Moria-M2組已基本同于術前水平,而Intralase-FS60組的成像狀況則優(yōu)于術前,與波前結果一致;②術后第1d Intralase-FS60組50%MTF頻率和熄滅頻率均低于Moria-M2組(P=0.034、0.024㩳0.05),而術后3mo Moria-M2組50%MTF頻率低于術前,熄滅頻率基本同術前水平,Intralase-FS60組50%MTF頻率接近術前,熄滅頻率則優(yōu)于術前,組間比較Intralase-FS60組兩者均高于Moria-M2組(P㩳0.05);③術后第1d Intralase-FS60組各OVs均低于Moria-M2組,第3mo時Intralase-FS60組的OV9%高于Moria-M2組(P=0.015㩳0.05)。 結論: 1.飛秒激光輔助個性化LASIK手術術后晚期效果確切,相對于機械角膜板層刀具有諸多優(yōu)點,患者術后可以獲得更好的生活視覺質量。 2. OQAS可以獲得更多的視網膜成像信息,直觀準確描述球內散射情況,且穩(wěn)定性好,干擾少,是一種客觀的測量視覺質量的方法,與波前像差互相補充,可對視覺質量進行綜合分析。
[Abstract]:Objective: to qualitatively and quantitatively analyze the visual quality of patients with femtosecond laser and lamellar keratoplasty flap after laser in situ keratomileusis (LASIK) with OQAS, and to improve the evaluation method of visual quality after individualized surgery. The advantages and reasons of femtosecond laser assistance are discussed. Methods: from March 2009 to September 2010, 106 patients (212 eyes) aged between 18 and 40 years were selected to perform individualized LASIK operation in our hospital's excimer laser treatment center. The patients were systematically examined by the same ophthalmologist before operation and the results were evaluated comprehensively. The sex, age, pupil diameter, naked vision and equivalent spherical lens were all examined by X2 or paired T test in the two groups before operation. The difference was not statistically significant (P0.05). The corneal flaps with the same thickness of 110 渭 m were designed and fabricated with Moria-M2 lamellar knife (106eyes) and Intralase-FS60 femtosecond laser (106eyes). Then VISX S4 excimer laser therapy instrument was used to carry out individualized ablation of 6.5mm of the same diameter in the two groups. The patients were given routine medication after operation. The patients were asked to recheck their eyesight, intraocular pressure, computer optometry and slit lamp at 1 month and 3 mo after operation, respectively. Corneal topography, WASCA wavefront aberration, OQAS visual quality analysis, and statistical analysis of the changes of each index in different periods. Result: 1? There were no obvious complications during and after operation in both groups. 2? Visual acuity and refractive state: the UCVA of 1mo and 3mo groups were significantly improved after operation, the Intralase-FS60 group was better than the Moria-M2 group (P0. 05), there was no significant difference in BSCVA between the postoperative 3mo group (P0. 171), and there was no significant difference between the two groups (P0. 171- 0. 05). There was no significant difference in efficacy index and safety index between the two groups, and the change of (D) degree of equivalent spherical mirror between 1d~3mo group and Moria-M2 group was 0.73 DX Intralase-FS60 group 0.50D, which indicated that the refractive state of the two groups was stable within 3 months after operation. 3? Wavefront aberration: 1 from the point of increasing multiple, the HOA ROM of 3mo Moria-M2 group changed little, basically recovered to preoperative (1.06 times), but Intralase-FS60 group was obviously superior to pre-operation group (0.79 times); 2 the wavefront aberrations were mainly increased in Z7 + Z8 and Z12 groups, and the values of Moria-M2 group were higher than those of preoperative and Intralase-FS60 groups (P0. 019 ~ 0. 012 0. 016 鹵0. 05), and there was statistical difference between the two groups (P < 0. 019, P < 0. 05). 4) the change of OQAS parameters: 1the ejection pupil was the state of 2-D retinal imaging under 4mm, the imaging effect of Intralase-FS60 group on the first day after operation was obviously worse than that of Moria-M2 group, and the scattering was obvious. By 3mo, the Moria-M2 group was basically the same as the preoperative level. The imaging status of Intralase-FS60 group was better than that of pre-operation, which was consistent with the results of wavefront. 2on the first day after operation, the frequency of 50%MTF and extinguishment in Intralase-FS60 group was lower than that in Moria-M2 group (P0.034 0. 024 0. 05), but the frequency of 50%MTF in postoperative 3mo Moria-M2 group was lower than that before operation, and the extinguishing frequency was basically the same as that before operation. The frequency of 50%MTF in Intralase-FS60 group was close to that before operation, and the extinguishing frequency was higher than that before operation. The frequency of 50%MTF in Intralase-FS60 group was higher than that in Moria-M2 group (P0. 05). 3 on the first day after operation, the OVs of Intralase-FS60 group was lower than that of Moria-M2 group, and the OV9% of Intralase-FS60 group was higher than that of Moria-M2 group at the first day of 3mo (P0. 015 鹵0. 05). Conclusion: 1. The effect of femtosecond laser assisted individualized LASIK surgery is accurate and has many advantages over mechanical lamellar keratectomy. Patients can obtain better quality of life after operation. 2. OQAS can obtain more information of retinal imaging, describe the scattering in sphere directly and accurately, and has good stability and less interference. It is an objective method to measure visual quality and complement the wavefront aberration. Visual quality can be comprehensively analyzed.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R779.63
本文編號：2377368
[Abstract]:Objective: to qualitatively and quantitatively analyze the visual quality of patients with femtosecond laser and lamellar keratoplasty flap after laser in situ keratomileusis (LASIK) with OQAS, and to improve the evaluation method of visual quality after individualized surgery. The advantages and reasons of femtosecond laser assistance are discussed. Methods: from March 2009 to September 2010, 106 patients (212 eyes) aged between 18 and 40 years were selected to perform individualized LASIK operation in our hospital's excimer laser treatment center. The patients were systematically examined by the same ophthalmologist before operation and the results were evaluated comprehensively. The sex, age, pupil diameter, naked vision and equivalent spherical lens were all examined by X2 or paired T test in the two groups before operation. The difference was not statistically significant (P0.05). The corneal flaps with the same thickness of 110 渭 m were designed and fabricated with Moria-M2 lamellar knife (106eyes) and Intralase-FS60 femtosecond laser (106eyes). Then VISX S4 excimer laser therapy instrument was used to carry out individualized ablation of 6.5mm of the same diameter in the two groups. The patients were given routine medication after operation. The patients were asked to recheck their eyesight, intraocular pressure, computer optometry and slit lamp at 1 month and 3 mo after operation, respectively. Corneal topography, WASCA wavefront aberration, OQAS visual quality analysis, and statistical analysis of the changes of each index in different periods. Result: 1? There were no obvious complications during and after operation in both groups. 2? Visual acuity and refractive state: the UCVA of 1mo and 3mo groups were significantly improved after operation, the Intralase-FS60 group was better than the Moria-M2 group (P0. 05), there was no significant difference in BSCVA between the postoperative 3mo group (P0. 171), and there was no significant difference between the two groups (P0. 171- 0. 05). There was no significant difference in efficacy index and safety index between the two groups, and the change of (D) degree of equivalent spherical mirror between 1d~3mo group and Moria-M2 group was 0.73 DX Intralase-FS60 group 0.50D, which indicated that the refractive state of the two groups was stable within 3 months after operation. 3? Wavefront aberration: 1 from the point of increasing multiple, the HOA ROM of 3mo Moria-M2 group changed little, basically recovered to preoperative (1.06 times), but Intralase-FS60 group was obviously superior to pre-operation group (0.79 times); 2 the wavefront aberrations were mainly increased in Z7 + Z8 and Z12 groups, and the values of Moria-M2 group were higher than those of preoperative and Intralase-FS60 groups (P0. 019 ~ 0. 012 0. 016 鹵0. 05), and there was statistical difference between the two groups (P < 0. 019, P < 0. 05). 4) the change of OQAS parameters: 1the ejection pupil was the state of 2-D retinal imaging under 4mm, the imaging effect of Intralase-FS60 group on the first day after operation was obviously worse than that of Moria-M2 group, and the scattering was obvious. By 3mo, the Moria-M2 group was basically the same as the preoperative level. The imaging status of Intralase-FS60 group was better than that of pre-operation, which was consistent with the results of wavefront. 2on the first day after operation, the frequency of 50%MTF and extinguishment in Intralase-FS60 group was lower than that in Moria-M2 group (P0.034 0. 024 0. 05), but the frequency of 50%MTF in postoperative 3mo Moria-M2 group was lower than that before operation, and the extinguishing frequency was basically the same as that before operation. The frequency of 50%MTF in Intralase-FS60 group was close to that before operation, and the extinguishing frequency was higher than that before operation. The frequency of 50%MTF in Intralase-FS60 group was higher than that in Moria-M2 group (P0. 05). 3 on the first day after operation, the OVs of Intralase-FS60 group was lower than that of Moria-M2 group, and the OV9% of Intralase-FS60 group was higher than that of Moria-M2 group at the first day of 3mo (P0. 015 鹵0. 05). Conclusion: 1. The effect of femtosecond laser assisted individualized LASIK surgery is accurate and has many advantages over mechanical lamellar keratectomy. Patients can obtain better quality of life after operation. 2. OQAS can obtain more information of retinal imaging, describe the scattering in sphere directly and accurately, and has good stability and less interference. It is an objective method to measure visual quality and complement the wavefront aberration. Visual quality can be comprehensively analyzed.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R779.63
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