角膜地形图引导的个体化切削术对不规则散光和高阶像差的影响  

Topography guided customized ablation on irregular astigmatism and higher order aberration

作　　者：宋德禄[1] 钟勇[1] 施维[1] 金玉梅[1] 

机构地区：[1]中国医学科学院北京协和医学院,北京协和医院眼科,北京市100730

出　　处：《眼科新进展》2009年第7期522-525,共4页Recent Advances in Ophthalmology

基　　金：科技部973国际合作项目基金资助(编号:2004CB720-304)~~

摘　　要：目的评价角膜地形图引导的个体化切削(topography guided customized ablation,TOGCA)手术治疗近视及近视散光的效果,并分析比较术前和术后不同时间角膜不规则状态及高阶像差的变化。方法收集53例(106眼)曾行TOGCA手术治疗的近视及近视散光患者的临床资料。所有患者在术前和术后10d、1个月、3个月和6个月均行角膜地形图和波前像差图检查。并对手术前后所有患者的裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(bestcorrected visual acuity,BCVA)、柱镜屈光度(cylinder,CYL)、角膜表面规则指数、角膜表面不对称指数、角膜陡峭轴屈光度(kera-tometer value of steep meridian,Ks)及角膜平坦轴屈光度(keratometer value of flat meridian,Kf)等进行分析比较。结果UCVA由术前0.10±0.01变为术后6个月1.24±0.16。大多数患者能保持BCVA水平。角膜地形图分析Ks术前为(44.68±1.35)D(42.03～48.38D),术后6个月降低至(37.67±1.89)D(33.94～40.53D);Kf术前为(43.36±1.03)D(41.15～45.82D),术后6个月降为(37.01±1.75)D(33.45～39.09D);CYL由术前(1.35±0.79)D(0.21～3.64D),术后6个月降至(0.70±0.34)D(0.27～1.62D);3者术前与术后6个月相比,差异均具有统计学意义(P<0.05),且CYL在术后不同的随访时间点之间差异均无统计学意义(P均>0.05)。高阶像差的均方根值术前为0.641±0.089(0.480～0.800),术后6个月为0.384±0.160(0.150～1.220),差异具有统计学意义(P<0.05)。结论TOGCA手术能显著提高UCVA,降低CYL,整体上改善角膜不规则状态,同时降低高阶像差。Objective To assess curative effects of topography guided customized ablation（TOGCA） for myopia and myopic astigmatism, and to analyze the differences about irregular status of cornea and higher order aberration before operation and at different times after operation. Methods Clinical data of 53 cases （ 106 eyes） underwent TOGCA for myopia and myopic astigmatism were collected. All patients were detected corneal topography and wave-front aberration graph before operation and at 10 days, 1 month, 3 months, and 6 months after operation, respectively. Uncorrected visual acuity（ UCVA）, best corrected visual acuity （ BCVA）, cylinder （ CYL）, corneal surface regularity index（SRI） ,surface asymmetry index（ SAI）, keratometer value of steep meridian（Ks） and keratometer value of fiat meridian（Kf） were analyzed and compared between before and after operation. Results UCVA changed significantly from 0. 10 ± 0. 01 before operation to 1.24± 0. 15 at 6 months after operation. Most patients maintained their BCVA. Topographic analysis showed that Ks reduced from （44.68 ± 1.35）D （ range from 42.03 D to 48.38 D） to （ 37.67 ±1.89 ） D （ range from 33.94 D to 40.53 D） （P〈0.05） ,Kf reduced from （43.36 ± 1.03）D （range from 41. 15 D to 45.82 D） to （ 37.01 ± 1.75 ） D （ range from 33.45 D to 39.09 D） （P 〈 0.05 ）, and CYL decreased from （ 1.35 ± 0.79 ） D （ range from 0.21 D to 3.64 D） to （0.70 ± 0. 34 ） D （ range from 0.27 D to 1.62 D） （ P 〈 0. 05 ）. CYL at different postoperative time points were no statistically significant（ all P 〉 0.05 ）. Root mean square of higher order aberration was changed from 0.641 ±0. 089 （range from 0. 480 to 0. 800） before operation to 0. 384±0. 160 （ range from 0. 150 to 1. 220 ） at 6 months after operation （ P 〈 0.05 ）. Conclusion TOGCA shows significant increase of UCVA, reduction of CYL, improvement of regular status of cornea and decrease of higher order aberration.

关 键 词：角膜地形图 个体化切削 不规则散光 高阶像差 

分 类 号：R779.6[医药卫生—眼科]