不同切削中心准分子激光原位角膜磨镶术治疗近视的术后视觉效果对比分析  

Visual effects of laser in situ keratomileusis for myopia with different ablation centers

作　　者：成琼[1] 廉井财 张静 姚文琴 张士胜 叶盛 

机构地区：[1]上海交通大学医学院附属瑞金医院眼科,上海200025 [2]上海瑞视眼科,上海200025

出　　处：《上海交通大学学报（医学版）》2012年第7期930-934,共5页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的以不同切削中心准分子激光原位角膜磨镶术(LASIK)治疗近视,对术后视觉质量进行对比分析。方法收集近视且接受LASIK治疗患者的临床资料。190例(380只眼)患者中,以视轴角膜反光点(VACRP)为切削中心90例(VACRP组,180只眼),以瞳孔中心(PC)为切削中心100例(PC组,200只眼)。所有患者均于术后1个月时复诊,检测视觉质量相关指标,对两组视力情况、安全系数、有效系数、屈光度、切削中心偏移量、角膜高阶像差和对比敏感度等指标进行比较分析。结果术后1个月的复查结果显示:VACRP组与PC组的裸眼视力、最佳矫正视力(BSCVA)、等效球镜屈光度(MRSE)、安全系数和有效系数比较,差异均无统计学意义(P>0.05)。对于两组中术前视力>-6.00 D高度近视的患者,VACRP组的BSCVA和安全系数均显著高于PC组(P<0.01)。VACRP组切削中心偏移量为(0.25±0.11)mm,显著小于PC组的(0.51±0.19)mm(P<0.01)。VACRP组的角膜高阶像差和彗差均显著低于PC组(P<0.01)。光亮度85 cd/m2时,VACRP组18 c/d低频空间频率对比敏感度明显优于PC组(P<0.01)。结论与以PC为切削中心比较,以VACRP为切削中心的LASIK治疗近视的视觉质量较高,术后角膜高阶像差较小,对比敏感度显著提高。Objective To compare the visual effects of laser in situ keratomileusis （LASIK） for myopia with different ablation centers. Methods The clinical data of patients with myopia undergoing LASIK were collected. Among 190 patients （380 eyes）, 90 patients （180 eyes） were treated with visual axis corneal reflex point （VACRP） as ablation center （VACRP group）, and the other 100 patients （200 eyes） were treated with pupil center （PC） as ablation center （PC group）. All patients were reexamined one month after operation, the vision-related parameters were measured, and the visual acuity, safety index, efficacy index, refraction, ablation center deviation, corneal higher order aberration and contrast sensitivity were compared between two groups. Results One month after operation, there was no significant difference in uncorrected visual acuity, best spectacle-corrected visual acuity （BSCVA）, manifest refraction spherical equivalent （MRSE）, safety index and efficacy index between VACRP group and PC group （P 〉 0.05）. BSCVA and safety index in patients with preoperative visual acuity 〉 -6.00 D in VACRP group were significantly higher than those in patients with preoperative visual acuity 〉 -6.00 D in PC group （P 〈 0.01）. The ablation center deviation in VACRP group was significantly shorter than that in PC group [（0.25 ±0. 11） mm vs （0.51 ±0.19） ram, P 〈0.01]. The corneal high order aberration and coma in VACRP group were significantly lower than those in PC group （ P 〈 0.01）. Postoperative contrast sensitivity visual acuity in VACRP group was significantly better than that in PC group on 18c/d spatial frequency with 85 cd/m2 intensity （P 〈 0.01）. Conclusion Compared with LASIK with PC as ablation center, LASIK with VACRP as ablation center may achieve better visual acuity, lower higher order aberrations and better contrast sensitivity in treatment of myopia.

关 键 词：角膜磨镶术 激光原位 切削中心 视轴角膜反光点 瞳孔中心 

分 类 号：R779.63[医药卫生—眼科]