角膜地形图引导的准分子激光手术提高RK术后视觉质量的研究

doi:10.3760/cma.j.issn.1674-845X.2016.07.006

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摘要目的评价角膜地形图引导的准分子激光个体化切削（T-CAT）手术治疗放射状角膜切开术（RK）后角膜表面不规则形态的临床疗效，并客观评估术后的视觉质量。方法回顾性病例研究。选择第三军医大学大坪医院野战外科研究所眼科2013年3月至2015年11月RK术后角膜重度不规则行T-CAT治疗的患者23 例（38 眼）的临床资料，其中4眼行T-CAT引导的准分子激光角膜表面切削术（PRK），其余34眼均行T-CAT引导的前弹力层下准分子激光角膜磨镶术（SBK）。行T-CAT引导的PRK患者于术前、术后1个月、3个月、6个月以及行T-CAT引导的SBK患者在术前，术后1 d、1周、1个月、3个月、6个月均行裸眼视力（UCVA）、最佳矫正视力（BCVA）、屈光状态、裂隙灯显微镜、角膜地形图、Pentacam眼前节分析及眼压等检查；其中22眼在术前和术后3个月行OQAS视觉质量客观检查。观察术中、术后并发症的发生情况，并对手术前后所有术眼的UCVA、BCVA、等效球镜度（SE）及其中22眼的视觉质量客观指标进行分析比较。术前与术后6个月的数据比较采用配对t检验。结果术后6个月时38只术眼无一眼发生视力下降，BCVA为4.8～5.0（4.9±0.1），UCVA为4.8～5.0（4.9±0.1），实际与计划SE值各点围绕拟合线波动幅度<1.00 D，行T-CAT引导SBK的34眼术后1 d至术后6个月屈光状态的平均变化为（-0.51±1.10）D，术后1 d与术后6个月SE差值小于0.5 D的有20眼（53%），小于1.0 D的有31眼（91%）。其中22眼术后6个月时的Holiday EKR Detail Report分布图宽度（D）、OQAS散射指数（OSI）和调制传递函数（MTF）截止频率（cutoff）值与术前比较，差异有统计学意义（t=-1.70、-2.45、3.24，P<0.05）。结论 T-CAT引导的准分子激光个性化手术对于RK术后角膜表面不规则形态的患者不仅具有良好的安全性、有效性、可预测性和稳定性，而且在提高患者视力的同时能够明显改善其视觉质量。

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	刘莛
	朱小敏
	阚秋霞
	余婷
	白继

关键词 ：角膜地形图, 激光, 准分子, 角膜切开术, 放射状, 视觉质量

Abstract：Objective To evaluate the clinical efficacy of topography-guided, customized ablation (T-CAT) in the treatment of corneal surface irregularity, and to objectively evaluate the visual quality of the patients who underwent radial keratotomy (RK). Methods This was a retrospective analysis. Clinical data of 23 cases (38 eyes) of severe irregular morphology of the corneal surface after RK surgery were collected. Among them, four eyes underwent topo-guided PRK and the remaining 34 eyes underwent topo-guided SBK. Patients were tested for uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical equivalent (SE), topography, and intraocular pressure (IOP) before surgery and at 1 day, 1 week, 1 month, 3 months and 6 months after surgery for those underwent topography-guided SBK. Patients underwent topography-guided PRK were tested before surgery and 1 month, 3 months, 6 months after surgery. And there were 22 eyes also tested for objective visual quality analysis index (OQAS) before surgery and 3 months after the procedure. The intra- and postoperative complications were examined, and the SE, UCVA, BCVA and OQAS of 22 eyes were also analyzed. The data were analyzed with a paired sample t test. Results During the 6-month follow-up, no eye experienced a decrease in visual acuity. BCVA was 4.8-5.0(4.9±0.1) and UCVA was 4.8-5.0(4.9±0.1). Achieved SE refractions were less than ±1.00 D. The mean SE refractive change between 1 day and 6 months postoperation was -0.51±1.10 D for those underwent topography-guided SBK. The difference in SE refraction between postoperative day 1 and postoperative 6 months was less than 0.5 D in 20 eyes (53%) and less than 1.0 D in 31 eyes (91%). There was a statistically significant difference in the objective visual quality indices at 6 months after surgery compared with preoperative indices (t=-1.70, -2.45, 3.24, P<0.05) for the 22 eyes tested with OQAS. Conclusion T-CAT can provide an effective, safe, predictable and stable improvement for patients with an initial decline in visual quality after RK.

Key words： Corneal topography Laser, excimer Keratotomy, radial Visual quality

通讯作者: 白继，Email：baiji_liujing@163.com

引用本文:

刘莛,朱小敏,阚秋霞, 余婷,白继. 角膜地形图引导的准分子激光手术提高RK术后视觉质量的研究[J]. 中华眼视光学与视觉科学杂志, 2016, 18(7): 405-408. Liu Ting, Zhu Xiaomin, Kan Qiuxia, Yu Ting, Bai Ji. Improvement of visual quality using corneal topography-guided, customized ablation treatment for patients after radial keratotomy. Chinese Journal of Optometry Ophthalmology and Visual science, 2016, 18(7): 405-408. DOI: 10.3760/cma.j.issn.1674-845X.2016.07.006

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https://www.cjoovs.com/CN/10.3760/cma.j.issn.1674-845X.2016.07.006 或 https://www.cjoovs.com/CN/Y2016/V18/I7/405

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