摘要
[目的]比较虹膜定位引导的个性化准分子激光原位角膜磨镶术(IR-LASIK)与传统准分子激光原位角膜磨镶术(LASIK)治疗中高度散光的临床效果。
[方法]将符合入选条件的2.0DC以上的近视性散光患眼随机分组,分别使用Carl Zeiss Mel80准分子激光机进行IR-LASIK和LASIK手术,随访3个月,观察术后裸眼视力、最佳矫正视力、球镜度、残留散光度、高阶像差及对比敏感度,对两组在安全性、有效性、稳定性及可预测性等方面进行比较；结果应用SPSS 16.0统计软件进行分析处理,P<0.05为有统计学意义。
[结果]对50例63眼进行统计分析。术后三个月：IR-LASIK组安全指数(SI)1.14,高于LASIK组(1.07),两者比较无显著性差异(P=0.321)；裸眼视力IR-LASIK组54眼(93.55%)≥1.0,LASIK组25眼(78.13%)≥1.0,两者比较有显著性差异(P=0.049)；80.96%眼残留散光在±0.5D以内(其中IR-LASIK组30眼、LASIK组23眼),两者比较有显著性差异(P=0.009)；IR-LASIK组2周与1月、1月与3月的平均等效球镜差值分别为0.12D、0.18D,LASIK组则均为0.19D,两组比较无显著性差异(P=0.373)；两组获得的等效球镜矫正度数与术前的等效球镜拟矫正度数呈高度线性相关,两者比较无显著性差异(P=0.241)；高阶像差(HOA)、彗差、三叶草和球差的均方根值IR-LASIK组分别为0.47μm,0.74μm,0.48μm,0.53μm,LASIK组则为0.54μm,0.93μm,0.48μm,0.73μm,两组比较无显著性差异(P>0.05)；各空间频率对应的眩光对比敏感度均值明显超过术前,高空间频率(6.6,10.4 cpd)对应的对比敏感度均值恢复至术前水平,低空间频率(1.0,1.7,2.6,4.2 cpd)的对比敏感度均值仍未恢复至术前水平,两组比较无显著性差异(P>0.05)。【结论】虹膜定位引导的个性化准分子激光原位角膜磨镶术治疗中高度散光安全有效,与传统的准分子激光原位角膜磨镶术相比术后残留散光更少,裸眼视力更佳,可以获得更好的术后视觉质量。
Objective To compare the clinical outcomes of LASIK with and without iris registration to correct 2.00D or higher myopic astigmatism with or without myopia.
Methods LASIK with or without iris registration (IR) was performed on 67 myopic eyes of 53 patients, with-2.00 diopters (D) astigmatism or higher. LASIK with the assist of iris registration technology was performed on 31 eyes (IR-LASIK group) while LASIK without iris registration was performed on 33 eyes (LASIK group). Uncorrected vision acuity (UCVA), best-spectacle corrected visual acuity (BSCVA),manifest refraction and higher order aberrations (HOAs) and contrast sensitivity were measured and recorded preoperatively and at two weeks, one month and three months postoperatively for each eye.
Results The related results at 3 months were reported. The safety index (SI) in IR-LASIK group and LASIK group was 1.14 and 1.07. respectively (P=0.321).93.55% of eyes in the IR-LASIK group and 78.13%in the LASIK group gained UCVA of or above 1.0 (P=0.049).80.96% of eyes in total (30 eyes of IR-LASIK group and 23 eyes of LASIK group) were within±0.50 (D) of emmetropia. There was statistically significant difference between the two groups (P=0.009). The mean change of manifest refractive spherical equivalent (MRSE) between two weeks and one month, one month and three months were 0.12D、0.18D in the IR-LASIK group and 0.19D in the LASIK group (P=0.373). There was close correlation between attempted and achieved MRSE for both groups, but no statistically significant difference between the two groups (P=0.241). The mean values of total RMS higher order aberrations, coma, trefoil and spherical aberration in the IR group increased to 0.47μm,0.74μm,0.48μm,0.53μm, respectively. And the figures in the non-IR group were 0.54pμm,0.93μm,0.48μm. 0.73μm, respectively. There was no statistically significant difference between the two groups (P>0.05). Mean contrast sensitivity with glare reached a higher level than that of preoperative. Mean contrast sensitivity without glare was still at low levels at low spatial frequencies (1.0,1.7,2.6,4.2 cpd) but almost returned to preoperative levels at high spatial frequencies (6.6,10.4 cpd). There was no statistically significant difference between the two groups (P>0.05).
Conclusion LASIK with the assist of iris registration technology was safe and effective for the treatment of moderate to high myopic astigmatism. It achieved reduced residual astigmatism, better UCVA. and improved visual quality compared to the conventional LASIK.
引文
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