ORK程序中两种切削模式治疗近视术后角膜像差变化及对视觉功能的影响  

Changes of corneal wavefront aberrations and effects of two scan models of ORK on visual functions after LASIK

作　　者：刘太祥[1] 李海祥[2] 石容[2] 王铮[1] 

机构地区：[1]中山大学中山眼科中心,广东省广州市510060 [2]遵义医学院附属医院眼科中心,贵州省遵义市563000

出　　处：《眼科新进展》2013年第1期68-70,73,共4页Recent Advances in Ophthalmology

摘　　要：目的比较优化角膜切削(optimized refractive keratectomy,ORK)程序中非球面切削模式(ORK-A)和角膜波前像差引导的切削模式(ORK-W)治疗近视术后角膜像差的变化及对视觉功能的影响。方法 65例(130眼)行LASIK患者,按自愿非随机原则,接受ORK-A患者38例,接受ORK-W患者27例。记录患者术后3个月、6个月的屈光状态、垂直彗差、水平彗差、初级球差、彗差、球差、总高阶像差均方根值、三阶像差均方根值、四阶像差均方根值等,对术后视觉功能进行评价并完成调查表填写。结果两组患者术后除外预留屈光度数后的残留屈光度数均在±1.00D内;术后两组有效性指数、安全性指数差异均无统计学意义(均为P>0.05)。术后3个月,ORK-A组和ORK-W组角膜高阶像差均增加,其中彗差(0.13±0.09,0.23±0.15,P<0.01)、初级球差(0.46±0.20,0.68±0.26,P<0.01)、球差(0.57±0.30,0.80±0.39,P=0.02)、总高阶像差均方根值(0.56±0.30,0.90±0.53,P<0.01)、四阶像差均方根值(0.56±0.30,0.81±0.40,P=0.02)等增加值两组间的差异有统计学意义;术后6个月两组间高阶像差增加值的差异均无统计学意义(均为P>0.05)。术后3个月、6个月两组视觉功能评分差异均无统计学意义(均为P>0.05),且视觉功能评分与角膜高阶像差变化均无相关性(均为P>0.05)。结论术后早期ORK-A角膜高阶像差变化小于ORK-W,但随角膜的修复,两种切削模式对角膜高阶像差变化的影响一致,推测角膜高阶像差的变化并不一定能真实地反映人们日常生活中视觉功能的主观感受。[眼科新进展,2013,33(1):68-70,73]Objective To compare the changes of corneal wavefront aberrations and visual functions after LASIK guided by aspherical ablation （ORK-A） and corneal wavefront aberrations （ORK-W） of optimized refractive keratectcmy （ORK）. Methods This study included 130 eyes of 65 patients, divided into ORK-A group （76 eyes,38 ca- ses） and ORK-W group （54 eyes, 27 cases）. The refraction Coma, SphA, RMSh, RMS3, RMS4 were recorded before ablation and 3 months,6 months after ablation. The evaluation of daily visual functions was done after surgery. Results The residual re- fraction （ except for expectant refraction） in two groups was from - 1.0 D to ＋ 1.0 D. There was no statistical difference in effect index and safety index after surgery be- tween two groups （ all P 〉 0. 05 ）. There were statistical differences in changes of （0.13±0.09,0.23±0.15,P 〈0.01） ,（0.46±0.20,0.68 ±0.26,P〈0.01） ,SphA （0.57±0.30,0.80±0.39 ,P =0.02） ,RMSh （0.56± 0.30,0.90±0.53 ,P 〈 0. 01 ）, RMS4 （0.56±0. 30,0. 81±0.40,P =0.02） between ORK-A group and ORK-W group at 3 months after surgery,but there was no statistical difference in high order aberration between two groups at 6 months after ablation （ all P 〉 0.05 ）. There was no statistical difference in scales of daily visual function between two groups at 3 months,6 months after surgery（ all P 〉 0.05 ）, and the scales had no significant relationship with the changes of corneal wavefront aberrations （ all P 〉 0.05 ）. Cone｜usion Early postoperative changes of corneal aberrations of ORK-A are smaller than those of ORK-W,how- ever, with the corneal recovery develop, the two scan models have the similar effect on corneal high order aberration, which indicate that the changes of corneal aberrations may not reflect the real subjective feeling of daily visual function.

关 键 词：近视 LASIK 角膜像差 非球面 角膜地形图 

分 类 号：R77[医药卫生—眼科]