角膜地形图引导的FS-LASIK与常规FS-LASIK术后视觉质量比较

doi:10.3760/cma.j.cn115909-20190718-00202

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摘要目的：评价角膜地形图引导的飞秒激光制瓣准分子激光原位角膜磨镶术（FS-LASIK）与常规FS-LASIK 矫正近视及散光术后的视觉质量。方法：前瞻性非随机对照研究。选取2018年9─10月在长沙爱尔眼科医院屈光中心接受屈光手术的近视及散光患者60例（120眼），按患者选择的手术方式不同分为角膜地形图引导的FS-LASIK组（TOPO-G组）30例（60眼）和常规FS-LASIK组30例（60眼）。术后随访3个月，比较2组患者术后1 d、1周、1个月、3个月的裸眼视力（UCVA），术后1周、3个月的等效球镜度（SE）、柱镜度，以及术后3个月的角膜像差、调制传递函数（MTF）、斯特列尔比（SR）、 Q值及角膜变异指数（ISV）等。采用重复测量方差分析、单因素方差分析及卡方检验对数据进行分析。结果：TOPO-G组术后1、3个月UCVA均高于FS-LASIK组（t=-2.915，P=0.004；t=-3.377， P=0.001），余时间点2组间UCVA差异无统计学意义。FS-LASIK组术后3个月SE大于TOPO-G组（t=2.004，P=0.047）。术后3个月，TOPO-G组柱镜度为0的眼数百分比高于FS-LASIK组（76% vs. 51%，χ2 =8.154，P=0.004）。术后3个月，FS-LASIK组总高阶像差、球差和彗差均方根值（RMS）值高于TOPO-G组，差异均有统计学意义（t=-2.586、-2.133、-2.088，P<0.05）。TOPO-G组在低空间频率（5 cpd）的MTF值高于FS-LASIK组，差异有统计学意义（t=2.039，P=0.044），余空间频率MTF值差异无统计学意义。TOPO-G组ISV值低于FS-LASIK组，差异有统计学意义（t=-2.123，P=0.036）。2组间SR值与Q值差异均无统计学意义。结论：与常规FS-LASIK相比，角膜地形图引导的FS-LASIK术后视力和角膜表面规则性更好，视觉质量更佳。

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关键词 ：角膜地形图, 近视, 波前像差, 准分子激光原位角膜磨镶术, 视觉质量

Abstract：Objective: To compare visual quality between topography-guided femtosecond laser-assisted laser in situ keratomileusis and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) in treating myopia and astigmatism. Methods: In this prospective non-randomized study, 60 patients (120 eyes) with myopia and astigmatism who wanted refractive surgery were selected in Changsha Aier Hospital from September 2018 to October 2018. The patients were allocated to either one of two groups according to each person's request. The topography-guided FS-LASIK (TOPO-G) group had 30 patients (60 eyes) and the FS-LASIK group had 30 patients (60 eyes). All patients were followed up for 3 months. Uncorrected visual acuity (UCVA) was measured 1 day, 1 week, 1 month and 3 months after surgery. Spherical equivalent (SE) and cylinder diopter were measured 1 week and 3 months after surgery. Corneal higher-order aberrations (HOAs), modulation transfer function (MTF), index of surface variance (ISV), Q-values and Strehl ratio (SR) were measured 3 months after surgery. Repeated measures ANOVA, ANOVA and the Chi-square test were used to analyze and compare the data for the two groups. Results: One month and 3 months after surgery, UCVA in the TOPO-G group was better than that in the FS-LASIK group (t=-2.915, P=0.004; t=-3.377, P=0.001), but there were no significant differences between the two groups in the other periods. The SE in the FS-LASIK group at 3 months after surgery was higher than that in the TOPO-G group (t=2.004, P=0.047). The percentage of eyes with a cylinder diopter of 0 in the TOPO-G group was higher than that in the FS-LASIK group (76% vs. 51%, χ2 =8.154, P=0.004). More HOAs and spherical and coma aberrations were induced in the FS-LASIK group compared to the TOPO-G group at 3 months after surgery (t=-2.586, -2.133, -2.088, P<0.05). The MTFs were significantly higher in the TOPO-G group than in the FS-LASIK group at low spatial frequencies (5 cpd) (t=2.039, P=0.044). There were no significant differences in the MTFs at other spatial frequencies between the two groups. The ISV in the TOPO-G group was significantly lower than that in the FS-LASIK group (t=-2.123, P=0.036). There were also no significant differences in Q-values or SR between the two groups. Conclusions: Compared with FS-LASIK, topography-guided FS-LASIK surgery has better postoperative visual acuity, a better index of corneal surface variance, and better visual quality.

Key words： topography myopia wavefront aberration laser in situ keratomileusis visual quality

收稿日期: 2019-07-18

基金资助:爱尔眼科医院集团科研基金（AF2018001）

通讯作者: 马代金（ORCID：0000-0003-1386-7925），Email：eyemdj@163.com

引用本文:

唐忞1，2 马代金2. 角膜地形图引导的FS-LASIK与常规FS-LASIK术后视觉质量比较[J]. 中华眼视光学与视觉科学杂志, 2020, 22(6): 427-433. Min Tang1, 2, Daijin Ma2. Comparison of Visual Quality after Topography-Guided FS-LASIK and FS-LASIK. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(6): 427-433. DOI: 10.3760/cma.j.cn115909-20190718-00202

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https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20190718-00202 或 https://www.cjoovs.com/CN/Y2020/V22/I6/427

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