Q值优化Micro-Monovision矫正近视合并老视的短期临床效果

doi:10.3760/cma.j.issn.1674-845X.2019.09.004

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摘要探讨Q值优化Micro-monovision准分子激光手术矫正近视合并老视的安全性、有效性及预测性。方法：前瞻性临床研究。收集2017 年8 月至2018 年5 月在青岛大学附属医院行Q值优化Micro-monovision准分子激光手术的近视合并老视患者35例（70眼）。术后3个月观察单眼和双眼的远、近视力（logMAR视力）、屈光状态、对比敏感度（CS）及立体视，并进行近距离工作视觉疲劳问卷及满意度调查。采用配对t检验对手术前后数据进行分析。结果：35例患者术前双眼视远最佳矫正视力（BCVA）为0.01±0.06，术后3个月为-0.04±0.21，且术后无一眼BCVA下降1行及以上。术后主视眼裸眼视力（UCVA）为-0.04±0.19，非主视眼UCVA为0.04±0.13。所有患者主视眼视近UCVA 均达20/25及以上，非主视眼均达20/20。所有术眼实际获得等效球镜度（SE）与预期切削SE的差值均在±1.00 D以内，而差值在±0.50 D以内为60眼（86%）。术后3个月CS在昼+周边眩光条件下18.0 c/d频段较术前显著提高（t=-2.504，P=0.017）；在昼1.5、6.0、18.0 c/d频段，昼+周边眩光6 c/d频段，夜1.5 c/d频段，夜+周边眩光18.0 c/d频段CS均较术前显著下降（P<0.05），其他各条件频段CS均恢复至术前水平。立体视术后3个月与术前比较差异均无统计学意义。所有患者术后均未出现近距离工作后头痛、恶心、阅读模糊及视近困难。所有患者对手术效果均表示满意，满意度为100%。结论：Q值优化Micro-monovision准分子激光手术矫正近视合并老视，可同时获得较好的双眼远、近视力及双眼视功能，是一种安全、有效且预测性好的手术方法。

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关键词 ：近视, Q值, 老视, 准分子激光原位角膜磨镶术, 对比敏感度, 立体视

Abstract： To evaluate the safety, effectiveness and predictability of Q-value-guided micro-monovision laser in situ keratomileusis (LASIK) in the treatment of myopia and presbyopia. Methods: A prospective study was performed based on 35 patients (70 eyes) with myopia and presbyopia, who underwent Q-valueguided micro-monovision LASIK in the Affiliated Hospital of Qingdao University from August 2017 to May 2018. At the 3-month postoperative visit, examinations were performed that included binocular and monocular distance and near visual acuity (logMAR), manifest refraction, contrast sensitivity (CS)and stereopsis. In addition, questionnaires of asthenopic symptoms due to near-distance work were also included for all the patients 3 months postoperatively. The data before and after surgery were analyzed using a paired t test. Results: Binocular distance best-corrected visual acuity (BCVA) was 0.01±0.06 before surgery and was -0.04±0.21 at 3 months after surgery. Thus, none of the eyes lost one line after the operation. Uncorrected visual acuity (UCVA) of the dominant eye and the non-dominant eye were -0.04±0.19 and 0.04±0.13, respectively. In all patients, near distance UCVA of the dominant eye was equal to 20/25 or above, and that of the non-dominant eye was 20/20. In addition, the difference between the actually obtained spherical equivalent (SE) and target SE was in the range of ±0.50 D and ±1.00 D for 60 eyes (86%) and 75 eyes (100%), respectively. At 3 months after surgery, CS had a significant improvement of 18.0 c/d spatial frequency under day+peripheral glare (t=-2.504, P=0.017). The spatial frequencies for day 1.5 c/d, 6.0 c/d and 18.0 c/d, day+peripheral glare 6 c/d, night 1.5 c/d and night+peripheral glare 18.0 c/d had significantly decreased compared to that before surgery (P<0.05). All other conditions were restored to preoperative levels. There was no significant difference in stereopsis before and after surgery. No patients suffered from headache, nausea, blurred reading or difficulty with nearsightedness after near-distance work at 3 months postoperatively. All patients (100%) were satisfied with the results of the operation. Conclusions: The Q-value-guided micro-monovision LASIK protocol is a safe, effective and predictable method for the treatment of myopic patients with presbyopia. Patients can obtain better binocular distance, near vision and visual function simultaneously.

Key words： myopia Q value presbyopia laser in situ keratomileusis contrast sensitivity stereopsis

收稿日期: 2019-04-03

基金资助:山东省自然科学基金（ZR2019MH115）；国家自然科学基金（81300790）

通讯作者: 王青（ORCID：0000-0003-1341-6104），Email：wangqing6836@sina.com

引用本文:

李慧1 王青2 马玉娜2 李江峰1. Q值优化Micro-Monovision矫正近视合并老视的短期临床效果[J]. 中华眼视光学与视觉科学杂志, 2019, 21(9): 661-667. Hui Li1,Qing Wang2,Yuna Ma2,Jiangfeng Li1. A Short-Term Clinical Analysis of Q-Value-Guided Micro-Monovision LASIK for Myopic Astigmatism and Presbyopia. Chinese Journal of Optometry Ophthalmology and Visual science, 2019, 21(9): 661-667. DOI: 10.3760/cma.j.issn.1674-845X.2019.09.004

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https://www.cjoovs.com/CN/10.3760/cma.j.issn.1674-845X.2019.09.004 或 https://www.cjoovs.com/CN/Y2019/V21/I9/661

[1]	Dubbelman M, Van der Heijde GL, Weeber HA. Change in shape of the aging human crystalline lens with accommodation. Vision Res, 2005, 45(1): 117-132. DOI: 10.1016/j.visres.2004.07.032.
[2]	Ostrin LA, Glasser A. Accommodation measurements in a prepresbyopic and presbyopic population. J Cataract Refract Surg, 2004, 30(7): 1435-1444. DOI: 10.1016/j.jcrs.2003.12.045.
[3]	Lindstrom RL, Macrae SM, Pepose JS, et al. Corneal inlays for presbyopia correction. Curr Opin Ophthalmol, 2013, 24(4): 281-287. DOI: 10.1097/ICU.0b013e328362293e.
[4]	Seyeddain O, Bachernegg A, Riha W, et al. Femtosecond laser-assisted small-aperture corneal inlay implantation for corneal compensation of presbyopia: Two-year follow-up. J Cataract Refract Surg, 2013, 39(2): 234-241. DOI: 10.1016/j.jcrs.2012.09.018.
[5]	李莹. 老视矫正手术的临床应用于展望. 中华眼视光学与视觉科学杂志, 2015, 17(9): 513-517. DOI: 10.3760/cma.j.issn. 1674-845X.2015.09.001.
[6]	Cheng AC, Lam DS. Monovision LASIK for pre-presbyopic and presbyopic patients. J Cataract Refract Surg, 2005, 21(4): 411-412.
[7]	Garcia-Gonzalez M, Teus MA, Hernandez-Verdejo JL. Visual outcomes of LASIK-induced monovision in myopic patients with presbyopia. Am J Ophthalmol, 2010, 150(3): 381-386. DOI: 10.1016/j.ajo.2010.03.022.
[8]	Wright KW, Guemes A, Kapadia MS, et al. Binocular function and patient satisfaction after monovision induced by myopic photorefractive keratectomy. J Cataract Refract Surg, 1999, 25(2): 177-182.
[9]	Goldberg DB. Laser in situ keratomileusis monovision. J Cataract Refract Surg, 2001, 27(9): 1449-1455.
[10]	Reinstein DZ, Couch DG, Archer TJ. LASIK for hyperopic astigmatism and presbyopia using micro-monovision with the Carl Zeiss meditec mel80 platform. J Refract Surg, 2009, 25(1): 37-58. DOI: 10.3928/1081597X-20090101-07.
[11]	Reinstein DZ, Archer TJ, Gobbe M. Lasik for myopic
	astigmatism and presbyopia using non-linear aspheric micromonovision with the Carl Zeiss meditec mel 80 plataorm. J Refract Surg, 2011, 27(1): 23-37. DOI: 10.3928/1081597X-20100212-04.
[12]	Reinstein DZ, Carp GI, Archer TJ, et al. LASIK for presbyopia correction in emmetropic patients using aspheric ablation profiles and a micro-monovision protocol with the Carl Zeiss meditec mel 80 and visumax. J Refract Surg, 2012, 28(8): 531-541. DOI: 10.3928/1081597X-20120723-01.
[13]	唐静, 邓应平, 邱乐梅. 改良单眼视LASIK手术矫正老视的疗效. 中华眼视光学与视觉科学杂志, 2012, 14(6): 360-364. DOI: 10.3760/cma.j.issn.1674-845X.2012.06.010.
[14]	陈松. 现代眼科检查方法与进展. 北京: 中国协和医科大学出版社, 2000: 49-63.
[15]	李力, 黄一飞. Monovision LASIK治疗中年近视的临床研究. 眼科新进展, 2009, 29(4): 278-280. DOI: 10.13389/j.cnki.rao. 2009.04.015.
[16]	邓国涛, 贡雅洁. LASIK术后眼调节状态的改变及其与视疲劳的关系. 中华眼视光学与视觉科学杂志, 2012, 14(3): 169-172. DOI: 10.3760/cma.j.issn.1674-845X.2012.03.011.
[17]	周玲婕, 贾沁, 梁静, 等. 非球面性优化单眼视准分子激光手术治疗近视合并老视的疗效评价. 宁夏医学杂志, 2015, (5): 436-438. DOI: 10.13621/j.1001-5949.2015.05.0436.
[18]	Cao ZY, Xia LK, Lu Y, et al. Postoperative visual outcomes and analysis of Q value guided non-linear aspheric monovision LASIK for myopic astigmatism and presbyopia. Int Eye Sci, 2012, 12(4): 604-608. DOI: 10.3969/j.issn.1672-5123.2012. 04.02.
[19]	Alió JL, Chaubard JJ, Caliz A, et al. Correction of presbyopia by technovision central multifocal LASIK (presbyLASIK). J Refract Surg, 2006, 22(5): 453-460.
[20]	林颖, 张霞, 袁牧之. 非球面优化单眼视准分子激光手术治疗近视合并老视的短期临床观察. 临床眼科杂志, 2018, 26(4): 343-346. DOI: 10.3969/j.issn.1006-8422.2018.04.016.
[21]	Ghaith AA, Daniel J, Stulting RD, et al. Contrast sensitivity and glare disability after radial keratotomy and photorefractive keratectomy. Arch Ophthalmol, 1998, 116(1): 12-18. DOI: 10.
10	01/archopht.116.1.12.
[22]	毛崇溶, 吕帆, 王勤美. 中低度近视眼PRK治疗后的对比敏感度变化及眩光现象. 眼科新进展, 2002, 22(3): 191-194. DOI: 10.13389/j.cnki.rao.2002.03.015.
[23]	Shimizu K, Amano S, Tanaka S. Photorefractive keratectomy for myopia: One-year follow-up in 97 eyes. J Refract Corneal Surg, 1994, 10(2 Suppl): S178-187.