Comparison of visual quality after corneal surface ablation and stromal ablation surgeries and analysis of the relationship between visual quality and wavefront aberrations
目的 比较角膜表层与基质层屈光手术后高阶像差等客观指标以及主观视觉主诉,并分析术后主观视觉感受与视觉质量检查的相关性.方法 选择61例行准分子激光治疗的患者(116眼)进行分析,接受准分子激光原位角膜磨镶术(LASIK)患者45例(84眼),接受新型表层手术(ASA)16例(32眼).LASIK组术前等效球镜度(SE)范围为-1.25～-8.75 D,平均为(-5.85±1.77)D;ASA手术组术前SE范围为-2.00～-9.25 D,平均为(-5.38±1.83)D.术前及术后第1、第3、第6个月检查裸眼视力(UC-VA)、最佳矫正视力(BCVA)、球镜及柱镜度数、SE以及波前像差(WA)等.术后第1、第3、第6个月,由同一名医师询问患者术后总体评价、术后与术前最佳矫正视力时的视觉质最及视觉症状.采用独立样本t检验、配对样本t检验、Pearson相关性分析及一元线性回归分析等对所得数据进行统计学分析.结果 术后第1个月时,ASA组C7绝对值、RMSh、RMS3、RMS6均显著小于LASIK组(0.17 vs0.32,0.39 vs 0.50,0.29 vs 0.38,0.07 vs 0.09,P均<0.05),但RMSh的差异更为显著(0.39 vs 0.50,P<0.01);术后第3个月、第6个月时差异项减少.术后早期,LASIK组白天及夜间开车容易程度、白天远视力、夜间视力、夜间眩光、总体视力的评分显著高于ASA组,两组评分差异有统计学意义(P<0.05);术后第6个月,两组评分差异无统计学意义.同术前戴镜相比,白天远视力是患者认为优于术前的最显著项目,眩光和夜视质量下降是患者手术后早期的主诉.术后早期SE和球镜度变化值越大,夜间开车容易程度、夜间眩光、夜间视力评分越差.夜视症状随时间延长明显好转.术后早期总高阶像差、彗差和球差增大程度越大,患者夜间眩光越显著.结论 术后早期,ASA组患者视觉质量评分稍差于LASIK组,但第6个月时差异不显著.两者手术效果相当.术后早期,SE、球镜度、高阶像差的变化值越大,夜间视觉质量越差,夜间眩光越显著.
Objective To compare higher order aberrations (HOA) and visual quality after corneal surface and stromal ablation surgeries;to evaluate the relationship between subjective visual perception and objective examination results of visual quality. Methods This prospective study in- cluded 116 eyes of 61 patients who underwent refractive surgery;84 eyes of 45 patients underwent laser in situ keratomileusis (LASIK) and 32 eyes of 16 patients underwent advanced surface ablation (ASA). The spherical equivalent (SE) of the LASIK group ranged from -1.25 to -8.75 D, average was (-5.85±1.77)D;the SE of the ASA group was -2.00 to -9.25 D, average was (-5.38±1.83)D. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BCVA), spherical and cylindrical values, SE, and wavefront aberrations of patients were recorded before ablation and 1, 3, and 6 months after ablation. A general evaluation and a comparison of pre- and postoperative visual quality and symptoms were done by the same clinician 1, 3, and 6 months after ablation surgery. Results C7, RMS3, RMS6, and RMSh of the ASA group were significantly smaller than that of the LASIK group 1 month after surgery (0.17 vs 0.32, 0.39 vs 0.50, 0.29 vs 0.38, 0.07 vs 0.09, P<0.05). Differences between the groups were smaller 3 and 6 months after surgery. Early postopera- tive scales of driving (diurnal, 2.92 vs 3.44, P<0.01;nocturnal, 2.92 vs 3.19, P<0.05), diurnal distant sight vision (3.40 vs 4.05, P<0.01), nocturnal vision (3.11 vs 3.60, P<0.01), glare (2.70 vs 2.87, P< 0.01) and general vision (3.40 vs 3.95, P<0.01) were lower in ASA group than in LASIK group, while symptoms for the two groups had no significant differences. The scales between the groups 6 months after surgery had no significant differences. Compared with best spectacle corrected vision preopera- tively, diurnal vision improved in most patients, but most patients complained about glare and noc- turnal vision. Early postoperative changes in SE and spherical values negatively correlated with noc- t
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