虹膜定位波前引导的LASIK与标准LASIK比较治疗近视散光疗效的Meta分析  

Iris-Registration in Wavefront-Guided LASIK versus Conventional LASIK for Correction of Myopia and Myopic Astigmatism: A Meta-Analysis

作　　者：李岩[1] 成拾明[2] 周霞[2] 许玲[2] 

机构地区：[1]湖北医药学院附属东风医院,十堰442000 [2]湖北医药学院附属太和医院,十堰442000

出　　处：《中国循证医学杂志》2013年第3期358-364,共7页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价虹膜定位波前引导的LASIK(IR+WG LASIK)与标准LASIK比较治疗近视散光的疗效。方法计算机检索PubMed、EMbase、e Cochrane Library(2012年第2期)、CBM、CNKI、VIP和WanFang Data,纳入IR+WG LASIK与标准LASIK治疗近视散光的随机和非随机同期对照试验,检索时限均从建库至2012年2月,文种限中、英文。由两位研究者独立进行文献筛选、资料提取和纳入研究的方法学质量评价后,采用RevMan5.1软件进行Meta分析。结果最终纳入9篇文献,共3 903只眼。Meta分析结果显示,与标准LASIK组比较,IR+WG LASIK组术后裸眼视力≥1.0的患者比例更高[RR=1.03,95%CI(1.01,1.05),P=0.002],术后较术前最佳矫正视力提高≥1行的患者比例更高[RR=1.75,95%CI(1.49,2.16),P<0.000 01];术后高阶像差均方根(RMS)增加值[WMD=–0.16,95%CI(–0.21,–0.11),P<0.000 01]、术后球差RMS增加值[WMD=–0.05,95%CI(–0.11,0.00),P=0.07]及术后慧差RMS增加值[WMD=–0.15,95%C(I–0.23,–0.07),P=0.000 2]均更小,残余散光更小[WMD=0.14,95%CI(0.10,0.18),P<0.000 01],眩光症状发生率更低[RR=0.27,95%CI(0.15,0.50),P<0.000 1],患者主观满意度更高[RR=1.08,95%CI(1.04,1.13),P=0.000 3]。结论 IR+WG LASIK较标准LASIK可更有效降低散光、降低术后高阶像差RMS及慧差RMS的增加量,获取更好的视觉质量(裸眼视力、最佳矫正视力等),从而提高患者满意度,但其长期疗效仍需进一步随访证实。Objective To systematically evaluate the etticacy and satety or ms-reglstrauo LASIK （IR＋WG LASIK） versus conventional LASIK for correction of myopia accompanied with astigmatism. Methods Such databases as PubMed, EMbase, The Cochrane library （Issue 2, 2012）, CBM, CNKI, VIP, and WangFang Data were searched to collect the randomized controlled trials （RCTs） and quasi-RCTs about IR＋WG LASIK versus conventional LASIK for correction of myopia accompanied with astigmatism. The retrieval time was from inception to February 2012, and the language was in both Chinese and English. Two reviewers independently screened the literature, extracted the data and assessed the quality of the included studies. Then the meta-analysis was performed by using RevMan 5.1 software. Results A total of 9 studies involving 3 903 eyes were included. The results of meta-analysis showed that, compared with the conventional LASIK group, the IR＋WG LASIK group had a higher ratio in patients with postoperative uncorrected visual acuity no less than 1.0 （RR=I.03, 95%CI 1.01 to 1.05, P=0.002）, as well as in patients with best-corrected visual acuity gained over 1 line （RR=1.75, 95%CI 1.49 to 2.16, P〈0.000 01）; it was smaller in the postoperative high order aberration RMS （WMD=-0.16, 95%CI -0.21 to -0.11, P〈0.000 01）, coma-like RMS （WMD=-0.05, 95%CI -0.11 to 0.00, P=0.07）, spherical-like RMS （WMD=-0.15, 95%CI -0.23 to -0.07, P=0.000 2）, and residual astigmatism （WMD=0.14, 95%CI 0.10 to 0.18, P〈0.000 01）; moreover, it was lower in the incidence of postoperative glare （RR=0.27, 95%CI 0.15 to 0.50, P〈0.000 1）, and it was higher in the subjective satisfaction of patients （RR=I.08, 95%CI 1.04 to 1.13, P=0.000 3）. Condusion Compared with conventional LASIK, IR＋WG LASIK can more effectively reduce astigmatism, postoperative high order aberration RMS and spherical-like RMS. It can also get visual function including uncorrected visual acuityand best-corrected visual acuity, consequently increase pat

关 键 词：虹膜定位 波前引导 LASIK META分析 系统评价 随机对照试验 

分 类 号：R779.63[医药卫生—眼科]