采用不同切削中心的准分子激光原位角膜磨镶术治疗近视眼的效果对比分析  

Comparison of visual effects after LASIK in myopia between centered on the coaxially sighted corneal light reflex and line of sight

作　　者：成琼[1] 廉井财 张静 姚文琴 张士胜 叶盛 

机构地区：[1]武汉科技大学医院眼科,430070 [2]上海新视界中兴眼科医院 [3]上海瑞视眼科

出　　处：《中华眼科杂志》2016年第7期499-506,共8页Chinese Journal of Ophthalmology

摘　　要：目的探讨LASIK分别以视轴角膜反光点和瞳孔中心为切削中心，对术后视力、屈光度、高阶像差、对比敏感度和主觉症状的影响。方法前瞻性双盲随机对照试验。接受LASIK的近视眼患者均以右眼为研究对象，按照分层随机法分为两组，视轴角膜反光点组210只近视眼以视轴角膜反光点为切削中心，瞳孔中心组210只近视眼以瞳孔中心为切削中心，比较两组间术后视力、屈光度数、切削中心偏移量、角膜高阶像差、主觉症状和对比敏感度的差异，随访时间为6个月。正态分布计量资料采用成组￡检验，非正态分布计量资料采用成组Wilcoxon秩和检验；计数资料采用χ2检验。结果随访至术后6个月，裸眼视力、最佳矫正视力、屈光度、有效系数、安全系数视轴角膜反光点组和瞳孔中心组差异均无统计学意义；最佳矫正视力（BCVA）下降1行或以上的百分比视轴角膜反光点组（3％）小于瞳孔中心组（9％）（χ2=6．38，P=0．01）；视轴角膜反光点组切削中心偏移量为（0．19±0．15）mm，小于瞳孔中心组的（0．43±0．22）mm（t=-2．59，P〈0．01）。术后角膜总高阶像差的增加量视轴角膜反光点组（0．150μm）低于瞳孔中心组（0．193μm）（Z=3．21，P=0．03）；角膜垂直彗差增加量视轴角膜反光点组（0．321μm）小于瞳孔中心组（0．464μm）（z=4．33，P〈0．01）、角膜水平彗差增加量视轴角膜反光点组（0．242μm）小于瞳孔中心组（0．353μm）（Z=4．54，P〈0．01）；眩光和叠影的发生率视轴角膜反光点组（8．5％）低于瞳孔中心组（17．5％）（χ2=7．16，P〈0．01）。18c／d空间频率对比敏感度术后1个月时视轴角膜反光点组（1．157±0．253）高于瞳孔中心组（0．797±0．218）（t=-2．55，P=0．01），在3个月和6个月时差异无统计学意义。结论相对于以瞳孔中心为切削中心，LASIK治�Objective To compare visual acuity, refractive outcome, high order aberrations, contrast sensitivity and subjective symptom of myopia with laser in situ keratomileusis （LASIK）centered on the coaxially sighted corneal light reflex （CSCLR group）and the conventional ablation of line of sight （LOS group）. Methods With prospective, double-blind, randomized, controlled trial, the right eyes of patients were included and divided into two groups according to random stratified grouping. Two hundred and ten myopic eyes were treated with centration on the coaxially sighted corneal light reflex and 210 myopic eyes treated with eentration on pupil center（line of sight）. The parameters of visual acuity, refractive outcome, ablation center distance from visual axis, corneal high order aberrations, subjective discomfort glare and shadowing incidence rate, contrast sensitivity between the two groups were measured and compared up to 6months post operation. Consistent with the rueasurement data, normal distribution using the group t-test, non-normal distribution of measurement data using the group wileoxon rank-sum test and count data usingchi-square test. Results The data of postoperative UCVA, BCVA, MRSE efficacy index and safety index showed no statistical difference between the CSCLR and the LOS group up to 6months post operation（P〉 0.05）. 3% lost one line or more of BCVA in the CSCLR group,and 9% in the LOS group postoperatively,χ2= 6.38, P=0.01. The ablation center deviation was （0.19±0.15）mm from visual axis（pentacam system default setting） in CSCLR group and （0.43±0.22）mm in the LOS group. Ablation center deviation was statistically significantly shorter in the CSCLR group （t=-2.59, P〈0.01）. The postoperative increased total cornea higher order aberrations was 0.150 μm in CSCLR group and 0.193 μm in LOS group, the difference was statistically significant, Z=3.21, P=0.03. The increased cm-neal vertical coma of CSCLR group was 0.321 μm,smaller than in the LOS group（0.464μm）,

关 键 词：角膜磨镶术 激光原位 近视 瞳孔 屈光  眼 角膜波前像差 对比敏感度 治疗结果 

分 类 号：R779.63[医药卫生—眼科]