Q值引导与标准FS-LASIK术后角膜形态及对比敏感度比较

doi:10.3760/cma.j.issn.1674-845X.2019.07.006

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摘要目的比较Q值引导个体化与标准飞秒激光辅助制瓣准分子激光原位角膜磨镶术（FS-LASIK）前后角膜形态及不同条件下对比敏感度的差异,评价2种手术方式治疗近视的疗效。方法前瞻性队列研究。随机选取2017年9月至2018年4月于安徽医科大学第一附属医院激光中心行近视激光矫正的中低度近视患者64例（126眼）,其中Q值引导组33例（64眼）,标准组31例（62眼）。于术前,术后1、3个月对患者的视力、Q值、角膜像差及对比敏感度值进行检测,比较2组手术前后各数据的差异性。采用重复测量方差分析、t检验和秩和检验对数据进行分析。结果术前2组各项指标基本匹配,术后1、3个月2组裸眼视力差异无统计学意义（P>0.05）。角膜直径6.0 mm范围,术后3个月2组间角膜Q值、球差和彗差差异无统计学意义（P>0.05）;角膜直径4.5 mm范围,术后3个月Q值引导组球差、Q值小于标准组,差异有统计学意义（t_球差=2.00,P=0.04;t_Q值=2.28,P=0.03）。术后1个月,2组不同环境下各空间频率的对比敏感度基本恢复至术前水平,术后3个月趋于稳定。术后3个月,在暗环境+眩光条件下,Q值引导组中频区对比敏感度高于标准组,差异有统计学意义（Z_{3 c/d}=-2.0,P=0.044;Z_{6 c/d}=-2.1,P=0.034）。结论 Q值引导个性化手术具有良好的安全性、有效性,能够提高暗环境眩光条件下的视觉质量。

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	黄学海
	周艳峰

关键词 ：准分子激光原位角膜磨镶术, 飞秒激光, 波前像差, 视觉质量

Abstract：Objective: To compare the differences in corneal asphericity and contrast sensitivity under different conditions before and after Q-value-guided femtosecond laser in situ keratomileusis (FS-LASIK) and standard FS-LASIK for myopia, and evaluation of the efficacy of the two surgical methods for treating myopia. Methods: This was a prospective cohort study. A total of 64 moderate and low myopia patients (33 patients, 64 eyes, in the Q-guided group and 31 patients, 62 eyes, in the standard group) who were treated by FS-LASIK were selected from Laser Center, the First Affiliated Hospital of Anhui Medical University, during the same period. Visual acuity, Q-value, corneal aberration and contrast sensitivity were measured and compared before and after surgery. All the cases were followed up at 1 and 3 months. A repeated measures analysis of variance, t-test and rank sum test were used for data analysis. Results: There was no statistically significant difference for the data before surgery. The uncorrected visual acuity (UCVA) and residual refractive error of all eyes were not significantly different between the two groups after 3 months of follow-up. In the corneal 6 mm range, there was no significant difference in Q-value, spherical aberration or coma between the two groups at 3 months postoperatively. In the corneal 4.5 mm range, the Q-values and spherical aberrations of the Q-value-guided group were significantly less than that for the standard LASIK group (t_SA=2.00, P=0.04; t_Q=2.28, P=0.03). After surgery, contrast sensitivity in the two groups returned to preoperative levels at different spatial frequencies in various environments, and it tended to be stable at 3 months after surgery. At 3 months after surgery, the visual quality of the Q-value-guided group was better than that of the standard group under mesopic circumstances with glare (Z_{3 c/d}=-2.0, P=0.044; Z_{6 c/d}=-2.1, P=0.034). Conclusions: Q-value-guided LASIK for myopia and astigmatism is as safe and effective as standard FS-LASIK. Further more, Q-value-guided LASIK results in better visual quality than standard FS-LASIK under mesopic circumstances with glare.

Key words： laser in situ keratomileusis femtosecond laser wavefront aberration visual quality

收稿日期: 2019-01-30

通讯作者: 周艳峰（ORCID：0000-0001-8573-0966）,Email：lizzhou@163.com

作者简介: 黄学海（ORCID：0000-0002-4063-5831）,Email：2313628086@qq.com

引用本文:

黄学海, 周艳峰. Q值引导与标准FS-LASIK术后角膜形态及对比敏感度比较[J]. 中华眼视光学与视觉科学杂志, 2019, 21(7): 514-520. Xuehai Huang, Yanfeng Zhou. Clinical Study of Corneal Asphericity and Visual Quality after Q-Factor-Guided and Standard FS-LASIK. Chinese Journal of Optometry Ophthalmology and Visual science, 2019, 21(7): 514-520. DOI: 10.3760/cma.j.issn.1674-845X.2019.07.006

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https://www.cjoovs.com/CN/10.3760/cma.j.issn.1674-845X.2019.07.006 或 https://www.cjoovs.com/CN/Y2019/V21/I7/514

[1]	Alió JL, Abdou AA, Soria F, et al.Femtosecond laser cataract incision morphology and corneal higher-order aberration analysis. J Refract Surg, 2013, 29(9): 590-595. DOI: 10.3928/ 1081597X-20130819-01.
[2]	Davis WR, Raasch TW, Mitchell GL, et al.Corneal asphericity and apical curvature in children: A cross-sectional and longitudinal evaluation. Invest Ophthalmol Vis Sci, 2005, 46(6): 1899-1906. DOI: 10.1167/iovs.04-0558.
[3]	徐莉, 钱涛, 李一壮. 非球面个体化切削LASIK与传统LASIK术后视觉效果的比较. 国际眼科杂志, 2007, 7(3): 623-625. DOI: 10.3969/j.issn.1672-5123.2007.03.009.
[4]	Stojanovic A, Wang L, Mirko R, et al.Wavefront optimized versus custom-Q treatments in surface ablation for myopic astigmatism with the waveLight allegretto laser. J Refract Surg, 2008, 24(8): 779-789.
[5]	Koller T, Iseli HP, Hafezi F, et al.Q-factor customized ablation profile for the correction of myopia astigmatism. J Cataract Refract Surg, 2006, 32(4): 584-589. DOI: 10.1016/j.jcrs.2006.01. 049.
[6]	Gatinel D, Malet J, Hoang-Xuan T, et al.Analysis of customized corneal ablations: Theoretical limitations of increasing negative asphericity. Invest Ophthalmol Vis Sci, 2002, 43(4): 941-948.
[7]	Piao J, Li YJ, Whang WJ, et al.Comparative evaluation of visual outcomes and corneal asphericity after laser-assisted in situ keratomileusis with the six-dimension Amaris excimer laser system. PLoS One, 2017, 12(2): e0171851. DOI: 10.1371/journal.pone.0171851.
[8]	Ying J, Cai J, Zhu L, et al.Comprehensive evaluation of anterior corneal change in asphericity calculated by the tangential radius of curvature after LASIK. J Ophthalmol, 2017, 2017: 3874371. DOI: 10.1155/2017/3874371.
[9]	苏小连, 王雁, 吴文静, 等. SMILE和飞秒激光制瓣的LASIK术后角膜前表面非球面性的对比研究. 中华眼科杂志, 2016, 52(9): 681-685. DOI: 10.3760/cma.j.issn.0412-4081.2016.09. 009.
[10]	Wei RH, Lim L, Chan WK, et al.Higher order ocular aberrations in eyes with myopia in a Chinese population. J Refract Surg, 2006, 22(7): 695-702.
[11]	Ciolino JB, Khachikian SS, Cortese MJ, et al.Long-term stability of the posterior cornea after laser in situ keratomileusis. J Cataract Refract Surg, 2007, 33(8): 1366-1370. DOI: 10.1016/j.jcrs.2007.04.016.
[12]	Zhou C, Chai X, Yuan L, et al.Corneal higher-order aberrations after customized aspheric ablation and conventional ablation for myopic correction. Curr Eye Res, 2007, 32(5): 431-438. DOI: 10.1080/02713680701329321.
[13]	Smadja D, Santhiago MR, Mello GR, et al.Corneal higher order aberrations after myopic wavefront-optimized ablation. J Refract Surg, 2013, 29(1): 42-48. DOI: 10.3928/1081597X-20121210-03.
[14]	瞿佳, 吕帆, 毛欣杰, 等. 视觉矫正质量评价研究. 中华眼科杂志, 2003, 39(6): 325-327. DOI: 10.3760/j:issn:0412-4081.2003. 06.003.
[15]	买志彬, 刘苏冰, 聂晓丽, 等. 飞秒激光与机械角膜刀制瓣准分子激光原位角膜磨镶术后视觉质量对比分析. 中华眼视光学与视觉科学杂志, 2013, 15(7): 409-413. DOI: 10.3760/cma.j.issn.1674-845X.2013.07.007.
[16]	魏然, 郑琼芹, 邱乐梅, 等. 高度近视行SMILE与FS-LASIK术后视觉质量比较. 中华眼视光学与视觉科学杂志, 2017, 19(4): 225-230. DOI: 10.3760/cma.j.issn.1674-845X.2017.04. 006.
[17]	Quesnel NM, Lovasik JV, Ferremi C, et al.Laser in situ keratomileusis for myopia and the contrast sensitivity function. J Cataract Refract Surg, 2004, 30(6): 1209-1218. DOI: 10.1016/j.jcrs.2003.11.040.
[18]	雷蕾, 张建华, 郑磊, 等. 正视及低中度、高度近视人群明暗环境对比敏感度分析. 眼科新进展, 2008, 28(8): 604-609. DOI: 10.3969/j.issn.1003-5141.2008.08.013.
[19]	Chan JW, Edwards MH, Woo GC.Contrast sensitivity after laser in situ keratomiliusis one-year follow-up. J Cataract Refract Surg, 2002, 28: 1774-1779.