四种角膜屈光手术后角膜后表面高阶像差的变化  

The changes of posterior corneal higher-order aberrations in myopia eyes after four refractive surgeries

作　　者：潘善刚 廖荣丰[1] 高健[1] 刘才远 叶敏捷[1] Pan Shangang;Liao Rongfeng;Gao Jian(Dept of Ophthalmology,The First Affiliated Hospital of Anhui Medical University,Hefei 230022)

机构地区：[1]安徽医科大学第一附属医院眼科,合肥230022 [2]中国科学技术大学医院眼科,合肥230026

出　　处：《安徽医科大学学报》2021年第3期486-489,共4页Acta Universitatis Medicinalis Anhui

基　　金：国家自然科学基金(编号:81700856)。

摘　　要：比较准分子激光原位角膜磨镶术(LASIK),飞秒制瓣LASIK(FS-LASIK),波前引导LASIK(WF-LASIK)以及全飞秒激光基质内透镜取出术(SMILE)4种手术后近视患者角膜后表面高阶像差(HOA)的变化。共收集近视患者242例,其中46例行LASIK,38例行FS-LASIK,68例行WFLASIK及90例行SMILE。分别在术前与术后6个月使用Pentacam测量每位患者右眼的HOA。高阶像差以zernike多项式进行描述,并着重分析患者角膜后表面6 mm直径中央区域的总HOA、球差(SA)、彗差、水平彗差和垂直彗差。LASIK组中,术前与术后总HOA、SA和水平慧差差异无统计学意义,但术后慧差及垂直慧差较术前增加(P<0.01)。FS-LASIK和WF-LASIK组中,术前与术后角膜后表面总HOA、SA及慧差之间差异有统计学意义(P<0.05),水平慧差及垂直慧差差异无统计学意义。此外,在SMILE术后各HOA均较术前改变。4种术式术后各HOA及变化值之间比较发现:水平慧差与垂直慧差差异有统计学意义(P<0.01)。与FS-LASIK和WF-LASIK相比,SMILE引起水平慧差负移(P<0.01),垂直慧差增加(P<0.01)。LASIK与其他组各HOA变化值的比较中差异无统计学意义。SMILE手术患者角膜后表面水平慧差及垂直慧差变化较大,因此FSLASIK与WF-LASIK在中心切削准确性方面可能优于SMILE。To compare the change of posterior corneal higher-order aberrations(HOA)of myopic eyes after four refractive surgeries including laser in situ keratomileusis(LASIK),femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK),wavefront-guided LASIK with iris registration(WF-LASIK),and small incision lenticule extraction(SMILE).A total of 242 subjects(46 subjects underwent LASIK,38 subjects underwent FS-LASIK,68 subjects underwent WF-LASIK,and 90 subjects underwent SMILE)were involved.HOAs of each patient's right eye were measured with Pentacam device preoperatively and 6 months after surgery.The aberrations were described as zernike polynomials,and analysis was focused on total HOAs,spherical aberration(SA),coma,horizontal coma,and vertical coma over 6 mm diameter central corneal zone.In LASIK group,pre-and postoperative total HOA,SA and horizontal coma were not statistically significantly different,but postoperative coma and vertical coma were significantly different(P<0.01).In FS-and WF-LASIK groups,significant differences were found in the total HOA,SA and coma(P<0.05)while no difference was found in the horizontal coma and vertical coma.In addition,all HOAs were found to have significantdifferences between pre-and postoperative SMILE procedure(P<0.01).The result showed that SMILE induced significantly negative shift in horizontal coma compared with FSLASIK and WF-LASIK(P<0.01).Meanwhile,SMILE group also had a significant increase in vertical coma compared with FS-LASIK and WF-LASIK(P<0.01).In LASIK and the other groups,induced total HOAs,SA,coma,horizontal coma and vertical coma were all comparable.SMILE induced more horizontal coma and vertical coma compared with FS-LASKandWF-LASIK,indicating that the centration of SMILE procedure is probably less precise.

关 键 词：屈光手术 角膜磨镶术 飞秒 高阶像差 

分 类 号：R779.63[医药卫生—眼科]