飞秒制瓣准分子激光原位角膜磨镶术和前弹力层下激光角膜磨镶术术后角膜前表面高阶相差变化的比较
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摘要
目的比较飞秒制瓣准分子激光原位角膜磨镶术(FS-LASIK)和机械刀辅助的前弹力层下激光角膜磨镶术(SBK)术后角膜前表面高阶像差的变化情况。方法选择2015年9月至2016年8月在宣城市中心医院行角膜屈光手术病人112例,通过随机数字表法分为FS-LASIK的54例病人(54只眼)和行SBK术的58例病人(58只眼),其中每例病人随机数字表法选择1只眼。于术前及术后3个月利用眼前节全景仪(Pentacam HR)测量病人角膜前表面的高阶像差(主要包括总的高阶像差、水平彗差、垂直彗差及球差),高阶像差的描述采用Zernike多项式表示。结果 FS-LASIK组和SBK组术前病人在年龄、等效球镜度数(SE)、角膜前表面各高阶像差的比较均差异无统计学意义(P> 0. 05)。FS-LASIK组术后3个月的角膜前表面总的高阶像差和球差较术前差异有统计学意义(P <0. 001),水平及垂直彗差较术前均差异无统计学意义(P值分别为0. 558和0. 325)。SBK组术后3个月角膜前表面总的高阶像差、球差(P <0. 001)及垂直彗差(P=0. 001)较术前差异有统计学意义,水平彗差较术前差异无统计学意义(P=0. 428)。FS-LASIK组和SBK组在术后3个月时的总的高阶像差、水平慧差及球差值均差异无统计学意义(P值分别为0. 487、0. 373和0. 063),然而两组之间的垂直彗差差异有统计学意义[FS-LASIK:(-0. 03±0. 48)μm,SBK:(-0. 21±0. 42)μm; P=0. 030]。结论 FS-LASIK术组与SBK术组在角膜前表面的总高阶像差、水平慧差和球差之间均差异无统计学意义,然而FS-LASIK术后3个月的角膜前表面垂直彗差显著低于SBK组,可能表明在对称性、偏中心、倾斜等方面,飞秒激光制瓣优于机械板层角膜刀制瓣。
Objective To make a comparison of higher-order aberration changes in anterior corneal surface between femtosecond laserassisted keratomileusis(FS-LASIK) and sub-bowman-keratomileusis(SBK surgery). Methods One hundred and twelve patients were randomly divided into FS-LASIK gourp and SBK group according to the random number table method. FS-LASIK was performed in 54 eyes of 54 patients,and 58 eyes of 58 patients received mechanical SBK(selected eye was chosen from each of the patients by random number table method). HOAs(included total HOAs,horizontal coma aberration,vertical coma aberration,and spherical aberration)were measured preoperatively,after 3 months postoperatively by Pentacam. The aberrations were described as Zernike polynomials. Results There was no significant difference between FS-LASIK group and SBK preoperative patients in age,spherical equivalent(SE),higher-order aberrations of corneal surface(P > 0. 05). Total HOAs and SA increased significantly in 3 months after FS-LASIK(P <0. 001). However,no significant difference was found in postoperatively vertical coma and horizontal coma(P = 0. 558 & 0. 325). Total HOAs,SA(P < 0. 001),and vertical coma(P = 0. 001) showed a significant growth in SBK group. However,there was no significant change in horizontal coma. No significant difference was found between FS-LASIK group and SBK group in postoperatively total HOAs,SA and horizontal coma(P = 0. 487,0. 063 and 0. 373,respectively). However,signifcant difference was found in postoperatively vertical coma(FS-LASIK:-0. 03 ± 0. 48μm; SBK:-0. 21 ± 0. 42μm; P = 0. 030). Conclusion FS-LASIK increased less vertical coma than SBK after 3 months postoperatively which may illustrated that Flaps created by femtosecond laser has more advantages than microkeratome in irregular,decentration,and tilt.
Objective To make a comparison of higher-order aberration changes in anterior corneal surface between femtosecond laserassisted keratomileusis(FS-LASIK) and sub-bowman-keratomileusis(SBK surgery). Methods One hundred and twelve patients were randomly divided into FS-LASIK gourp and SBK group according to the random number table method. FS-LASIK was performed in 54 eyes of 54 patients,and 58 eyes of 58 patients received mechanical SBK(selected eye was chosen from each of the patients by random number table method). HOAs(included total HOAs,horizontal coma aberration,vertical coma aberration,and spherical aberration)were measured preoperatively,after 3 months postoperatively by Pentacam. The aberrations were described as Zernike polynomials. Results There was no significant difference between FS-LASIK group and SBK preoperative patients in age,spherical equivalent(SE),higher-order aberrations of corneal surface(P > 0. 05). Total HOAs and SA increased significantly in 3 months after FS-LASIK(P <0. 001). However,no significant difference was found in postoperatively vertical coma and horizontal coma(P = 0. 558 & 0. 325). Total HOAs,SA(P < 0. 001),and vertical coma(P = 0. 001) showed a significant growth in SBK group. However,there was no significant change in horizontal coma. No significant difference was found between FS-LASIK group and SBK group in postoperatively total HOAs,SA and horizontal coma(P = 0. 487,0. 063 and 0. 373,respectively). However,signifcant difference was found in postoperatively vertical coma(FS-LASIK:-0. 03 ± 0. 48μm; SBK:-0. 21 ± 0. 42μm; P = 0. 030). Conclusion FS-LASIK increased less vertical coma than SBK after 3 months postoperatively which may illustrated that Flaps created by femtosecond laser has more advantages than microkeratome in irregular,decentration,and tilt.
引文
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[11]MEDEIROS FW,STAPLETON WM,HAMMEL J,et al.Wavefront analysis comparison of LASIK outcomes with the femtosecond laser and mechanical microkeratomes[J].J Refract Surg,2007,23(9):880-887.
[12]TRAN DB,SARAYBA MA,BOR Z,et al.Randomized prospective clinical study comparing induced aberrations with Intra Lase and Hansatome flap creation in fellow eyes:potential impact on wavefront-guided laser in situ keratomileusis[J].J Cataract Refract Surg,2005,31(1):97-105.
[13]ZHANG ZH,JIN HY,SUO Y,et al.Femtosecond laser versus mechanical microkeratome laser in situ keratomileusis for myopia:Metaanalysis of randomized controlled trials[J].Journal of Cataract&Refractive Surgery,2011,37(12):2151-2159.
[14]CALVO R,MCLAREN JW,HODGE DO,et al.Corneal aberrations and visual acuity after laser in situ keratomileusis:femtosecond laser versus mechanical microkeratome[J].Am J Ophthalmol,2010,149(5):785-793.
[15]ALIJL,PIERO DP.Very high-frequency digital ultrasound measurement of the LASIK flap thickness profile using the Intra Lase femtosecond laser and M2 and Carriazo-Pendular microkeratomes[J].J Refract Surg,2008,24(1):12-23.
[16]LOMBARDO M,LOMBARDO G.Wave aberration of human eyes and new descriptors of image optical quality and visual performance[J].Journal of Cataract&Refractive Surgery,2010,36(2):313-331.
[17]POTGIETER FJ,ROBERTS C,COX IG,et al.Prediction of flap response[J].Journal of Cataract&Refractive Surgery,2005,31(1):106-114.
[18]于志强,许烨,姚佩君,等.准分子激光手术不同制瓣方式角膜瓣厚度的研究[J].中华眼科杂志,2010,46(3):203-208.
[19]CHAN A,OU J,MANCHE EE.Comparison of the femtosecond laser and mechanical keratome for laser in situ keratomileusis[J].Arch Ophthalmol,2008,126(11):1484-1490.
[2]BINDER PS.One thousand consecutive lntra Lase laser in situ keratomileusis flaps[J].Cataract Refract Surg,2006,32(6):962-969.
[3]MUOZ G,ALBARRN-DIEGO C,FERRER-BLASCO T,et al.Longterm comparison of corneal aberration changes after laser in situ keratomileusis:mechanical microkeratome versus femtosecond laser flap creation[J].J Cataract Refract Surg,2010,36(11):1934-1944.
[4]SEILER T,MROCHEN M,KAEMMERER M.Operative correction of ocular aberrations to improve visual acuity[J].Journal of Refractive Surgery,2000,16(5):S619-S622.
[5]HE JC,GWIAZDA J,THORN F,et al.Wave-front aberrations in the anterior corneal surface and the whole eye[J].Journal of the Optical Society of America A Optics Image Science&Vision,2003,20(7):1155-1163.
[6]PORTER J,MACRAE S,YOON G,et al.Separate effects of the microkeratome incision and laser ablation on the eye's wave aberration[J].American Journal of Ophthalmology,2003,136(2):327-337.
[7]OSHIKA T,KLYCE SD,APPLEGATE RA,et al.Comparison of corneal wavefront aberrations after photorefractive keratectomy and laser in situ keratomileusis[J].American Journal of Ophthalmology,1999,127(1):1-7.
[8]KEZIRIAN GM,STONECIPHER KG.Comparison of the Intra Lase femtosecond laser and mechanical keratomes for laser in situ keratomileusis[J].J Cataract Refract Surg,2004,30(4):804-811.
[9]STONECIPHER K,IGNACIO TS,STONECIPHER M.Advances in refractive surgery:microkeratome and femtosecond laser flap creation in relation to safety,efficacy,predictability,and biomechanical stability[J].Curr Opin Ophthalmol,2006,17(4):368-372.
[10]ORTIZ D,ALIO JL,PI~NERO DP.Measurement of corneal curvature change after mechanical laser in situ keratomileusis flap creation and femtosecond laser flap creation[J].J Cataract Refract Surg,2008,34(2):238-242.
[11]MEDEIROS FW,STAPLETON WM,HAMMEL J,et al.Wavefront analysis comparison of LASIK outcomes with the femtosecond laser and mechanical microkeratomes[J].J Refract Surg,2007,23(9):880-887.
[12]TRAN DB,SARAYBA MA,BOR Z,et al.Randomized prospective clinical study comparing induced aberrations with Intra Lase and Hansatome flap creation in fellow eyes:potential impact on wavefront-guided laser in situ keratomileusis[J].J Cataract Refract Surg,2005,31(1):97-105.
[13]ZHANG ZH,JIN HY,SUO Y,et al.Femtosecond laser versus mechanical microkeratome laser in situ keratomileusis for myopia:Metaanalysis of randomized controlled trials[J].Journal of Cataract&Refractive Surgery,2011,37(12):2151-2159.
[14]CALVO R,MCLAREN JW,HODGE DO,et al.Corneal aberrations and visual acuity after laser in situ keratomileusis:femtosecond laser versus mechanical microkeratome[J].Am J Ophthalmol,2010,149(5):785-793.
[15]ALIJL,PIERO DP.Very high-frequency digital ultrasound measurement of the LASIK flap thickness profile using the Intra Lase femtosecond laser and M2 and Carriazo-Pendular microkeratomes[J].J Refract Surg,2008,24(1):12-23.
[16]LOMBARDO M,LOMBARDO G.Wave aberration of human eyes and new descriptors of image optical quality and visual performance[J].Journal of Cataract&Refractive Surgery,2010,36(2):313-331.
[17]POTGIETER FJ,ROBERTS C,COX IG,et al.Prediction of flap response[J].Journal of Cataract&Refractive Surgery,2005,31(1):106-114.
[18]于志强,许烨,姚佩君,等.准分子激光手术不同制瓣方式角膜瓣厚度的研究[J].中华眼科杂志,2010,46(3):203-208.
[19]CHAN A,OU J,MANCHE EE.Comparison of the femtosecond laser and mechanical keratome for laser in situ keratomileusis[J].Arch Ophthalmol,2008,126(11):1484-1490.