角膜Q值调整的改良单眼视FS-LASIK矫正中低度近视眼合并老视的疗效分析  

Q-value-guided femtosecond laser-assisted in situ keratomileusis for low-to-moderate myopia with age-related accommodation deficiency

作　　者：张瑞钰 袁翌斐 张钰[1] 刘嫣[1] 王岳鑫 陈跃国[1] Zhang Ruiyu;Yuan Yifei;Zhang Yu;Liu Yan;Wang Yuexin;Chen Yueguo(Department of Ophthalmology,Peking University Third Hospital,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve,Beijing 100191,China)

机构地区：[1]北京大学第三医院眼科,眼部神经损伤的重建保护与康复北京市重点实验室,北京100191

出　　处：《中华眼科杂志》2024年第8期658-664,共7页Chinese Journal of Ophthalmology

摘　　要：目的探讨角膜Q值调整的改良单眼视飞秒激光制瓣准分子激光原位角膜磨镶术(Custom-Q FS-LASIK)矫正中、低度近视眼合并老视的疗效。方法前瞻性研究。收集2022年10月至2023年10月在北京大学第三医院眼科屈光中心行Custom-Q FS-LASIK的中、低度近视眼合并老视患者。术后随访时间为3个月,观察主视眼和非主视眼单眼和双眼的远、中、近视力及模拟全程视力(双眼离焦曲线)、屈光状态、角膜前表面Q值、高阶像差等,并进行近视力主观评价及视觉质量问卷调查。以最小分辨角的对数记录视力,采用t检验和Wilcoxon检验进行统计学分析。结果纳入符合标准且完成随访患者45例(90只眼),男性21例(42只眼),女性24例(48只眼);年龄为(42.82±2.72)岁。术后3个月,所有患者的双眼裸眼远视力达到及好于0.00,双眼裸眼近视力达到及好于0.20。离焦曲线显示在离焦度数-1.50~-1.00 D范围,术后3个月双眼视力[0.00(-0.08,0.00),-0.08(-0.08,0.00)]优于术前[0.00(-0.08,0.05),-0.08(-0.08,0.00)],差异有统计学意义(P<0.05);在离焦度数-2.50~0.00 D范围,45例患者双眼视力均保持好于0.10。术后3个月主视眼角膜前表面Q值(0.01±0.26)较术前正向增加(-0.15±0.14),差异有统计学意义(P<0.05);非主视眼角膜前表面Q值和球差(-0.27±0.32和0.08±0.05)较术前(-0.14±0.11和0.12±0.03)负向增加,差异均有统计学意义(均P<0.05)。42例患者(93.3%)对近视力满意,出现频率较高的3种主观视觉干扰症状为视物模糊、眩光、光晕,程度均为轻、中度,对日常生活无干扰。结论Custom-Q FS-LASIK矫正中、低度近视眼合并老视安全、有效,能同时获得良好的双眼远、近视力及视觉质量。Objective To evaluate clinical outcomes and visual quality after femtosecond laser-assisted in situ keratomileusis(FS-LASIK)performed with the Q-value-guided optimized monocular vision protocol(Custom-Q)for correction of low-to-moderate myopia and compensation for age-related accommodation deficiency.Methods A prospective study was performed based on patients with myopia and age-related accommodation deficiency,who underwent Custom-Q FS-LASIK in the Peking University Third Hospital from October 2022 to October 2023.Monocular and binocular distance,intermediate,and near visual acuities,simulated whole-course visual acuity(binocular defocus curve),objective and subjective refractions,anterior corneal Q factor,anterior corneal higher-order aberrations and a subjective questionnaire assessing near visual acuity and visual quality were evaluated at 3 months postoperatively.Visual acuity was recorded using the logarithm of the minimum angle of resolution.The data were analyzed using the t-test and the Wilcoxon rank-sum test.Results A total of 45 patients(90 eyes)who met the inclusion criteria and completed the 3-month follow-up were included in the study.The mean age of the 21 men(42 eyes)and 24 women(48 eyes)was(42.82±2.72)years.During the 3-month follow-up,all the patients achieved binocular uncorrected distance visual acuity not less than 0.00 and uncorrected near visual acuity not less than 0.20.Defocus curves revealed better results at 3 months postoperatively[0.00(-0.08,0.00),-0.08(-0.08,0.00)]at intermediate and near vergence(-1.50 to-1.00 D)compared to the preoperative values[0.00(-0.08,0.05),-0.08(-0.08,0.00)](P<0.05).All the 45 patients maintained 0.10 or better vision at the defocus range from-2.50 to 0.00 D.The Q value in the dominant eyes was more positive postoperatively(0.01±0.26 vs.-0.15±0.14,P<0.05),while in the nondominant eyes,the Q value and corneal spherical aberration coefficient became more negative than those before surgery(-0.27±0.32 vs.-0.14±0.11,P<0.05;0.08±0.05 vs.0.12±0.03,P<0.05).Th

关 键 词：近视 老视 视觉 单眼 角膜磨镶术 激光原位 激光 准分子 视敏度 治疗结果 

分 类 号：R779.6[医药卫生—眼科]