应用Fourier分析法对比FS-LASIK与TPRK矫正散光的准确性

doi:DOI:10.3760/cma.j.issn.1674-845X.2017.07.006

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摘要

目的：应用Fourier分析法对比飞秒激光制瓣准分子激光原位角膜磨镶术（FS-LASIK）与经上皮准分子激光角膜切削术（TPRK）矫正近视散光的准确性。方法：回顾性病例对照研究。选取2015 年6 月至2016 年6 月在温州医科大学附属眼视光医院行FS-LASIK及TPRK手术的近视散光患者共267例（453 眼），其中FS-LASIK组137 例（228 眼），TPRK组130 例（225 眼）。分别收集术前及术后3～6个月间最早的一次随访数据，包括裸眼视力（UCVA）、最佳矫正视力（BCVA）、主觉验光度数、角
膜地形图等。应用Fourier分析法将术前、术后屈光度转换成术前总散光（TJ0、TJ45），术前角膜散光（CJ0、CJ45），术后总散光（RJ0、RJ45）及散光矫正率（CRJ0、CRJ45），比较2 组散光矫正的准确性。2 组间数据比较采用协方差及Mann-Whitney U秩和检验，组内数据比较采用Wilcoxon符号秩和检验。结果：FS-LASIK组散光分量及矫正率为TJ0=0.369 D，TJ45=-0.043 D，CJ0=0.695 D，CJ45=-0.018 D，RJ0=0.000 D，RJ45=0.000 D，CRJ0=100%，CRJ45=100%，TPRK组的散光分量及矫正率为TJ0=0.369 D，TJ45=0.000 D，CJ0=0.600 D，CJ45=0.003 D，RJ0=0.000 D，RJ45=0.000 D，CRJ0=100%，CRJ45=100%。2 组间相比，TJ0TJ45、CJ45、RJ45、CRJ45 的差异无统计学意义；FS-LASIK组CJ0、RJ0 大于TPRK组（Z=-2.615，P=0.009；Z=-2.419，P=0.016）；TPRK组CRJ0 大于FS-LASIK组（Z=-1.978，P=0.048）。组内参数相比，FS-LASIK组TJ0大于TJ45，CJ0大于CJ45（Z=-10.886、-12.926，P＜0.001），RJ0与RJ45、CRJ0
与CRJ45 差异无统计学意义；TPRK组TJ0 大于TJ45，CJ0 大于CJ45（Z=-10.539、-12.735，P＜0.001），RJ0与RJ45、CRJ0 与CRJ45 差异无统计学意义。结论：FS-LASIK及TPRK手术矫正近视散光的垂轴成分及斜轴成分的散光都具有较高的准确性。

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	江露
	谢文
	胡中立
	周海涛
	徐鹏
	胡亮
	吕帆

关键词 ： Fourier分析法, 飞秒激光, 准分子激光原位角膜磨镶术, 经上皮准分子激光角膜切削术, 散光

Abstract：

Objective: To use Fourier analysis to evaluate the accuracy of myopic astigmatism correction in femtosecond laser in situ keratomileusis (FS-LASIK) and transepithelial photorefractive keratectomy(TPRK). Methods: A total of 267 myopic astigmatism patients (453 eyes) were included in this retrospective case group study. Patients were treated with either FS-LASIK (n=137, 228 eyes) or TPRK (n=130,225 eyes) at the Eye Hospital of Wenzhou Medical University from June, 2015 to June, 2016. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction, and corneal topography were measured preoperatively and postoperatively at 3 to 6 months. Fourier analysis was used to transform the preoperative astigmatism to TJ0 and TJ45, the preoperative corneal astigmatism to CJ0 and CJ45, the postoperative residual astigmatism to RJ0 and RJ45, and the astigmatism correction rate to CRJ0 and CRJ45.Covariance rank sum test, Mann-Whitney U test, and Wilcoxon signed rank sum test were used for statistical analyses. Results: For the FS-LASIK group, TJ0=0.369 D, TJ45=-0.043 D, CJ0=0.695 D, CJ45=-0.018 D,RJ0=0.000 D, RJ45=0.000 D, CRJ0=100%, CRJ45=100%. For the TPRK group, TJ0=0.369 D, TJ45=0.000 D,CJ0=0.600 D, CJ45=0.003 D,RJ0=0.000 D, RJ45=0.000 D, CRJ0=100%, CRJ45=100%. Comparing betweenFS-LASIK and TPRK, the values for TJ0, TJ45, CJ45, RJ45, CRJ45 were not statistically significant (P>0.05).CJ0 and RJ0 in the FS-LASIK group were higher than in the TPRK group (Z=-2.615, P=0.009; Z=-2.419,P=0.016). CRJ0 in the TPRK group was significantly higher than in the FS-LASIK group (Z=-1.978,P=0.048). For intra-group comparisons, TJ0 and CJ0 were statistically higher than TJ45 and CJ45 in the FSLASIK group (Z=-10.886, -12.926, both P<0.001). RJ0 and RJ45, and CRJ0 and CRJ45 were not significantly different. TJ0 and CJ0 were statistically higher than TJ45 and CJ45 in the TPRK group (Z=-10.539, -12.735, both P<0.001). RJ0 and RJ45, and CRJ0 and CRJ45 were not significantly different. Conclusions: Both FS-LASIK and TPRK have high accuracy in the correction of cartesian astigmatism and oblique astigmatism.

Key words： Fourier analysis femtosecond laser laser in situ keratomileusis transepithelial photorefractivekeratectomy astigmatism

收稿日期: 2017-05-12

基金资助:

浙江省自然科学基金（LY17H120005）；温州市公益性科技计划项目（Y20160442）

通讯作者: 吕帆，Email：lufan@mail.eye.ac.cn

引用本文:

江露,谢文,胡中立,周海涛,徐鹏,胡亮,吕帆. 应用Fourier分析法对比FS-LASIK与TPRK矫正散光的准确性[J]. 中华眼视光学与视觉科学杂志, 2017, 19(7): 413-420. Lu Jiang,Wen Xie,Zhongli Hu,Haitao Zhou,Peng Xu,Liang Hu,Fan Lu.. Fourier Analysis for Comparing the Accuracy of Myopic AstigmatismCorrection by FS-LASIK and TPRK. Chinese Journal of Optometry Ophthalmology and Visual science, 2017, 19(7): 413-420. DOI: DOI:10.3760/cma.j.issn.1674-845X.2017.07.006

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