智能脉冲技术辅助的TransPRK手术矫正中高度散光

doi:10.3760/cma.j.issn.1674-845X.2019.10.002

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摘要

评价角膜波前像差引导的经上皮准分子激光切削术（TransPRK）在智能脉冲技术（SPT）辅助下矫正中高度散光的临床疗效。方法：回顾性系列病例研究。分析2016年7月至2017年12月于运城市眼科医院行TransPRK矫正近视合并中、高度散光的患者29例（54眼），术眼于术前及术后1、3、 6个月检查裸眼视力（UCVA）、最佳矫正视力（BCVA），并进行显然验光、裂隙灯显微镜、眼压及 Pentacam角膜地形图测量。术前球镜度-6.00～-1.25（-3.57±1.19）D，柱镜度1.50～4.00 （2.06± 0.55）D。评估该术式矫正近视合并中、高度散光的临床疗效及对术后散光矢量分析。手术前后的指标采用重复测量的方差分析，散光矢量数采用Pearson相关分析。结果：术后6个月时，98%眼的UCVA达到0（LogMAR）或更好，87%眼等效球镜度介于±0.50之间。预期矫正散光（IRC）是（2.03±0.51）D，手术矫正散光（SIRC）是（2.02±0.69）D，误差矢量（EV）是（0.49±0.35）D，角度误差（EA）是-1.37°±7.62°，屈光度数误差（EM）是（0.23±0.40）D，误差比（ER）是0.25±0.19，矫正比（CR）是0.99±0.21。IRC与SIRC之间存在显著相关性（r=0.95，P<0.001）。EM和IRC之间存在相关性（r= 0.55，P<0.001）。EV和ER之间存在显著相关性（r=0.92，P<0.001）。EA结果提示散光呈逆时针方向变化，在5°和15°范围内眼的百分比是65%（35眼）和96%（52眼）。CR结果提示术后散光有轻微的欠矫。结论：角膜波前像差引导SPT辅助的TransPRK矫正近视合并中、高度散光可获得较好的临床疗效，并有较高的安全性和预测性。术前和术中应重点关注矫正散光大小和轴向的准确性。

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关键词 ：散光, 矢量分析, 经上皮准分子激光切削术, 智能脉冲技术

Abstract：

To evaluate the clinical efficacy of corneal wavefront aberration-guided TransPRK surgery in the correction of moderate to high astigmatism with the help of smart pulse technology (SPT). Methods: In this retrospective study, TransPRK- corrected myopia in 29 patients (54 eyes) with high astigmatism in Yuncheng City Eye Hospital during July 2016 to December 2017 were examined. The eyes were examined before treatment and 1 month, 3 months and 6 months after treatment for uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and manifest refraction, slit lamp microscopy, intraocular pressure measurements, and Pentacam corneal topography measurements. The preoperative spherical scope ranged from -6.00 to -1.25 D (mean -3.57±1.19 D), and the cylinder range was 1.50 to 4.00 D (mean 2.06± 0.55 D). The clinical outcomes and evaluation of the postoperative astigmatism vector in the correction of myopia with moderate and high astigmatism were evaluated. Preop and postop indexes were analyzed by repeated measurement analysis of variance, and Pearson correlation coefficients were used to assess the correlation between different variables. Results: Six months after surgery, 98% of the eyes had a UCVA of 1.0 or better, and an 87% equivalent spherical value of between ±0.50. The intended refractive correction (IRC) was 2.03±0.51 D, the mean of the surgically induced refractive correction (SIRC) was 2.02±0.69 D, the mean of the error vector (EV) was 0.49±0.35 D, the mean of the error angle (EA) was -1.37±7.62°, the mean of error magnitude (EM) was 0.23±0.40 D, the mean of error ratio (ER) was 0.25±0.19, and the mean of correction ratio (CR) was 0.99±0.21. There were significant correlations between IRC and SIRC (r=0.95, P<0.001), between EM and IRC (r=0.55, P<0.001) and between EV and ER (r=0.92, P<0.001). The EA results suggested that astigmatism changes counterclockwise, with the percentage of eyes in the range of 5° and 15° being 65% (35 eyes) and 96% (52 eyes). The CR results suggested a slight under correction of postoperative astigmatism. Conclusions: Corneal wavefront-guided TransPRK and the smart pulse technology assisted TransPRK show safe, predictable results in the correction of myopia with moderate and high astigmatism. It is necessary to improve the accuracy of astigmatism power and its axial direction before and during the surgery

Key words： astigmatism vector analysis transepithelial photorefractive keratectomy smart pulse technology

收稿日期: 2019-04-07

基金资助:

山西省重点研发计划项目（201803D31018）

通讯作者: 卫晶仙（ORCID：0000-0002-9776-7966），Email：weijxian@163.com

引用本文:

赵博卫晶仙付明山. 智能脉冲技术辅助的TransPRK手术矫正中高度散光[J]. 中华眼视光学与视觉科学杂志, 2019, 21(10): 727-733. Bo Zhao, Jingxian Wei, Mingshan Fu. Clinical Outcomes of Smart Pulse Technology Assisted TransPRK to Treat Moderate to High Astigmatism. Chinese Journal of Optometry Ophthalmology and Visual science, 2019, 21(10): 727-733. DOI: 10.3760/cma.j.issn.1674-845X.2019.10.002

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https://www.cjoovs.com/CN/10.3760/cma.j.issn.1674-845X.2019.10.002 或 https://www.cjoovs.com/CN/Y2019/V21/I10/727

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