不同Kappa角补偿的波前像差引导飞秒激光联合准分子激光原位角膜磨镶术对患者屈光度和视觉质量的影响  

Effect of wavefront aberration-guided femtosecond laser-assisted in situ keratomileusis with different angle Kappa adjustments on diopter and visual quality

作　　者：贾寓洁 汝新宇 林淑华 赵健 王晓伟 贾法力 许文皓 曹婉莹 李英俊 JIA Yujie;RU Xinyu;LIN Shuhua;ZHAO Jian;WANG Xiaowei;JIA Fali;XU Wenhao;CAO Wanying;LI Yingjun(Department of Ophthalmology,the Affiliated Hospital of Yanbian University,Yanji 133000,Jilin Province,China)

机构地区：[1]延边大学附属医院眼科,吉林省延吉市133000

出　　处：《眼科新进展》2021年第12期1133-1137,共5页Recent Advances in Ophthalmology

基　　金：国家自然科学基金(编号81960182)。

摘　　要：目的探讨瞳孔中心与角膜共轴反光点之间的偏移量(P-Dist)分布规律,通过75%、100%的Kappa角补偿值,分析其对中度近视患者的屈光度和视觉质量的影响及相关因素。方法选取2020年5月至8月在延边大学附属医院眼科行飞秒激光联合准分子激光原位角膜磨镶术的中度近视患者322例(右眼)。术中记录患者的P-Dist大小。术前及术后3个月采用角膜地形图仪测量患者瞳孔大小和中心位置,应用视功能检测仪测定患者对比敏感度。波前像差仪测量患者眼球的高阶像差。结果患者P-Dist为0.012~0.610(0.225±0.108)mm。补偿75%组患者P-Dist为(0.215±0.094)mm,补偿100%组患者P-Dist为(0.238±0.122)mm,两组间差异无统计学意义(P=0.458)。P-Dist>0.225 mm时,补偿75%组患者的术后柱镜度(0.29±0.35)D低于补偿100%组(0.44±0.29)D(P=0.041)。彗差方面,补偿100%组患者在不同P-Dist(P-Dist>0.225 mm、P-Dist≤0.225 mm)之间差异有统计学意义(P=0.047)。P-Dist>0.225 mm时,补偿100%组患者的彗差明显高于补偿75%组(P=0.023)。P-Dist>0.225 mm时,明视眩光状态下1.5 cpd空间频率中,补偿100%组患者的术后对比敏感度显著低于补偿75%组(P=0.038)。结论75%、100%的Kappa角补偿均能获得较好的视觉质量。但在P-Dist>0.225 mm的中度近视患者的个性化准分子切削手术中,选择100%补偿量未必获得较75%补偿量更佳的视觉质量效果。瞳孔中心位置的动态变化等可能是形成这种结果的重要影响因素。Objective To investigate the distribution of the offset between the pupil center and the coaxially sighted corneal light reflex point(P-Dist),and to analyze the effect on the diopter and visual quality of patients with moderate myopia by giving 75%and 100%angle Kappa adjustments.Methods A total of 322 patients(322 right eyes)with moderate myopia who underwent femtosecond laser-assisted in situ keratomileusis(LASIK)at the Affiliated Hospital of Yanbian University from May to August in 2020 were selected in this study.The P-Dist of all patients was recorded.Preoperatively and 3 months postoperatively,the pupil size and center position were measured by the corneal topographer,and the contrast sensitivity was measured by the visual function tester.The wavefront aberrometer was used to measure the higher-order aberrations of eyeballs.Results The P-Dist of patients was 0.012-0.610(0.225±0.108)mm.The P-Dist of patients in the 75%adjustment group was(0.215±0.094)mm,while that in the 100%adjustment group was(0.238±0.122)mm,and the difference between the two groups was not statistically significant(P=0.458).When P-Dist>0.225 mm,the postoperative cylinder in the 75%adjustment group was(0.29±0.35)D,lower than that in the 100%adjustment group(0.44±0.29)D(P=0.041).In terms of coma,there was a significant difference when P-Dist>0.225 mm and P-Dist≤0.225 mm in the 100%adjustment group(P=0.047).When P-Dist>0.225 mm,the coma of patients in the 100%adjustment group was significantly higher than that in the 75%adjustment group(P=0.023),while the postoperative contrast sensitivity in the 100%adjustment group was significantly lower than that in the 75%adjustment group under visual glare conditions at the 1.5 cpd spatial frequency(P=0.038).Conclusion Both 75%and 100%angle Kappa adjustments can improve the visual quality of patients.However,when P-Dist>0.225 mm,in the personalized LASIK for those with moderate myopia,the 100%adjustment may not result in better visual quality than the 75%adjustment,which is related to dynamic cha

关 键 词：KAPPA角 瞳孔中心 视轴 高阶像差 

分 类 号：R778[医药卫生—眼科]