SMILE术后全眼高阶像差变化及相关因素分析  

Analysis of higher-order aberrations （HOAs） and related factors after small incision lenticule

作　　者：粱刚[1,2] 查旭[1,3] 张丰菊[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室,100730 [2]云南省第二人民医院眼屈光中心,昆明650021 [3]昆明医科大学第二附属医院眼科,650101

出　　处：《中华眼视光学与视觉科学杂志》2015年第11期644-648,共5页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的通过观察飞秒激光小切口基质透镜取出术（SMILE）治疗近视及近视散光眼术后全眼高阶像差的改变，探讨SMILE术后全眼高阶像差的变化特点及其相关因素。方法回顾性研究。选择行SMILE手术治疗近视及近视散光患者共81例（162眼），随访时间3个月。术中眼球定位采用术前kappa角结合术中注视水印居中中心定位法。术前、术后3个月采用WASCA波前像差分析仪测量6mm瞳孔直径下术眼的总高阶像差（HOA）及各单项HOA，同时采用Oculyzer眼前节分析系统测量kappa角及角膜Q值。手术前后数据比较应用配对t检验，运用Spearman秩相关分析法和Pearson相关分析总HOA及各项HOA的变化与术前等效球镜度（SE）、散光度及轴向、kappa角等参数的相关性。结果手术前后总HOA（t=-12．24，P〈0．01）、球差（C4^0）（t=16．60，P〈0．01）、水平彗差（C3^1）（t=-11．06，P〈0．01）、垂直彗差（C3 ^-1）（t=-3．14，P〈0．01）、垂直三叶草（C3^-3）（t=-6．30，P〈0．01）、四阶水平散光（C4^2）（t=5．84，P〈0．01）的均方根（RMS）值差异均有统计学意义。手术前后Q值分别为-0．24±0．13和0．69±0．52，差异有统计学意义（t=-22．55，P〈0．01）。术后3个月总HOA与SE相关（r=-0．23．P〈0．01），△总HOA主要与△C4^0、△C3^1相关（r=-0．40、0．26，P〈0．01），与术前Q值、Kappa角、散光度均无相关性；术后C4^0、△C4^0与术前SE相关（r=0．35、0．29，P〈0．01）；C3^1与术前散光度和Q值相关（r=-0．24、-0．22，P〈0．05），△C3^1与术前散光度相关（r=-0．29，P〈0．01）；术后C3^-1和△C3^-1与术前的SE、Q值、Kappa角、散光度均不相关。结论近视及近视散光眼SMILE手术后总HOA增加，主要与术前SE有关，与散光度无关；手术前后C^40变化量与术前SE有关，C3^1增加量与术前散光度有关。Objective To investigate the changes in higher-order aberrations （HOAs） after small incision lenticule extraction （SMILE） surgery for myopia and myopic astigmatism, and to evaluate the association between the postoperative changes in HOAs and related factors. Methods This was a retrospective study that included 81 patients （162 eyes） who had undergone SMILE for myopia or myopic astigmatism. The follow-up period was 3 months. Ocular HOAs with a 6 mm pupil diameter were measured by a WaveScan aberrometer preoperatively and 3 months postoperatively. The angle kappa and Q value were obtained with an ocular analyzer at same time. Paired t test was used to compare the ocular variables before and after surgery. Spearman rank and Pearson correlation coefficient analysis were used to assess the relationship between changes in total HOA and different HOAs with multiple factors that included pre-SE, astigmatism, angle kappa, etc. Results Statistically significant differences were found in the changes in total HOA （t=-12.24, P〈0.01）, sphericalaberration C4^0 （t=16.60, P〈0.01）, C3^1 （t=-11.06, P〈0.01）; C3^-1 （t=-3.14, P〈0.01）, Q value （t=-22.55, P〈0.01）, C3^-3 （t=-6.30, P〈0.01） and C4^2 （t=5.84, P〈0.01）. There were significant correlations between total HOA at the three-month postoperative visit and preoperative SE （r=-0.23, P〈0.01）. Atotal HOA was correlated with △C4^0 （r=-0.40, P〈0.01） and △C3^1 （r=0.26, P〈0.01） but was not related to pre-operative Q value, angle kappa or astigmatism （P〉0.05）. The three-month postoperative C4^0 and AC4^0 were correlated with pre-SE （r=0.35, 0.29, P〈0.01）; C3^1 was correlated with preoperative cylinder power and Q value （r=-0.24, -0.22, P〈0.05）, and △C3^1 was correlated with preoperative cylinder power （r=-0.29, P〈0.01）. There was no correlation between the postoperative C3^-1 and △C3^-1 and preoperative SE, Q value, angle kappa, or cylinder power （P〉0.05）. Conclusion A significant p

关 键 词：近视 飞秒激光小切口基质透镜取出术 像差 散光 KAPPA角 

分 类 号：R735.37[医药卫生—肿瘤]