Q值引导个体化LASEK与常规LASEK治疗近视及散光的对比研究

目的:探讨非球面因子Q引导准分子激光角膜上皮瓣下磨镶术(laser epithelial keratomileusis,LASEK)治疗近视散光的长期疗效。方法:接受LASEK的近视散光患者138例随机分为2组,接受Q值引导LASEK患者72例72眼为试验组,接受常规LASEK患者66例66眼为对照组。术前2组各项指标均相似,差异无统计学意义。均取右眼进行分析,对两组疗效进行比较。术前及术后检测裸眼远近视力、最佳矫正视力、屈光度、眼压、角膜地形图、K值、Q值、波阵面像差、对比敏感度、超声角膜厚度和haze等。随诊时间为术前、术后0.25,1,2,3,4,6和12mo。结果:术后12mo,试验组的裸眼视力为1.12±0.16,对照组为1.07±0.14,两者差异无统计学意义(t=1.280,P=0.205);试验组的最佳矫正视力为1.16±0.19,对照组为1.12±0.17,两者差异无统计学意义(t=0.885,P=0.380);试验组Q值平均为0.478±0.203,对照组为0.798±0.238,两者差异有统计学意义(t=-5.006,P=0.000);试验组整体高阶像差为0.406±0.103μm,对照组为0.613±0.105μm,两者差异有统计学意义(t=-6.276,P=0.000);试验组球差平均为-0.186±0.108μm,对照组为-0.320±0.159μm,两者差异有统计学意义(t=3.579,P=0.001);两组的高阶像差及球差值均低于术后6mo时;试验组haze平均为0.125±0.275级,对照组为0.375±0.535级,两者差异无统计学意义(t=-1.859,P=0.071);试验组对比敏感度术后3mo恢复至术前水平,对照组术后6mo恢复至术前水平,术后12mo时试验组对比敏感度优于术前水平,除明亮无眩光外,两者差异均有统计学意义,以昏暗状态下为著。结论:非球面因子Q值引导LASEK安全、稳定、有效;减少手术诱导的高阶像差及球差,更好地保持了角膜的非球面性,更多地节约了角膜组织,更快更好地恢复对比敏感度haze更轻,视觉质量更好。     

LASIK术后夜间视觉质量与角膜非球面性关系的研究

目的 分析准分子激光原位角膜磨镶术(LASIK)术后夜间视觉质量与角膜非球面性变化的关系.设计回顾性病例系列.研究对象在2007年9月至12月期间行LASIK手术的患者中,顺序选取术前最佳矫正视力(BCVA)≥1.0,术后裸眼视力≥1.0,随访资料完整患者72例(144眼),等效球镜度数-4.0～-8.0 D,平均(-5.80±1.04)D.方法 术前及术后3个月行Orb-scan检查、K/Q值、Mesotest暗视条件下对比敏感度检查.主要指标暗视下无眩光Mesotest对比敏感度通过等级、Q值.结果 Mesotest对比敏感度检查:无眩光暗视条件下,术后3个月未通过各等级测试的例数比术前增加,72例患者中26例对比敏感度等级比术前降低1-2个等级.Q值的分布:术前平均(-0.16±0.12),术后3个月平均(0.49±0.24),差异有统计学意义.直线相关回归分析:术前与术后Q值差值与对比敏感度等级变化呈正相关(回归方程为y=0.068x+0.5965,pearson系数r=0.476,P=0.000,P<0.01).结论 LASIK术后暗环境下对比敏感度降低与角膜Q值改变有关,角膜前表面非球面性改变是影响LASIK术后夜间视觉质量的重要因素之一.     

不同引导方法LASIK术后角膜非球面性改变及临床分析

目的：探讨不同引导方式LASIK术后角膜非球面性改变及临床分析。 方法：48例95眼行LASIK手术,其中45眼接受Q值引导LASIK,50眼接受非Q值引导的LASIK。术后1,3,6mo分别检查视力（visual acuity,VA）、屈光状态、角膜K值、Q值、球差、对比敏感度(contrast sensitivity function, CSF)等,并行统计分析。 结果：两组术后3,6mo在视力和有效指数方面无差异;术后3mo屈光状态在±0.50D范围Q值组和非Q值组分别为95%和90%,术后6mo,±0.50D两组分别为97%和98%;术后1,3和6mo Q值组CSF均较术前提高,差异有统计学意义（P<0.05）,而非Q值组术前术后差异无统计学意义。Q值组和非Q值组术后1,3和6mo的平均Q值分别为0.50±0.33和0.81±0.51、0.50±0.35和0.80±0.48、0.50±0.34和0.80±0.47,与术前比较差异均有统计学意义。Q值组和非Q值组术后6mo球差较术前平均增加分别为4倍和8.5倍;⊿Q与预矫屈光度高度正相关,与患者年龄、性别、术前角膜K值、Q值、球差无相关性;定量关系非Q值组为y= 0.18e^0.32x ,R²=0.72,Q值组为y=0.04x²-0.19x+0.54,R²=0.75。 结论：非球面引导的LASIK可以有效地减少近视屈光手术对角膜非球面性的影响,从而减少术后球差的增加,有利于术后视觉质量的提高。预计的目标Q值与实际的Q值之间存在较大差异。"     

多焦点准分子激光原位角膜磨镶术治疗老视前近视的对比研究

目的 探讨多焦点准分子激光原位角膜磨镶术(LASIK)治疗老视前近视的可行性.方法 前瞻性对照研究.共32例(64只眼)近视眼患者,平均年龄(38.5 ±2.7)岁;主视眼行常规LASIK,非主视眼行多焦点LASIK.检测项目:远近视力、屈光度、角膜地形图、眼压、超声角膜厚度、对比敏感度、调节幅度、焦深、波阵面像差等.对计量资料计算均数和标准差,检验水准α为0.05,对数据进行双侧检验.将调节增幅和术后角膜多焦点指数、手术前后球差改变进行相关分析.结果 随访6～11个月,平均(7±3)个月.非主视眼术前近视力为(LogMAR-0.082±0.220),术后6个月为(LogMAR-0.004±0.213),术后较术前提高(t=4.108,P=0.009);主视眼术前近视力(LogMAR-0.055±0.218),术后6个月为(LogMAR-0.034±0.187),差异无统计学意义(t=1.051.P=0.334).术后6个月6 mm拟合球面Q值,非主视眼平均为(0.08±0.27),主视眼平均为(0.46±0.27),两组差异有统计学意义(t=4.301,P=0.000).非主视眼术后角膜中央区出现高屈光力范围(手术预期视近区域),平均为(5.64±3.05)mm2;术后6个月,非主视眼4只眼(12.5%)出现正球差,平均均方根值为(-0.204±0.195)μm,与术前比较差异无统计学意义(t=0.532,P=0.600);主视眼无正球差出现,均方根值为-0.791～-0.083μm,平均(-0.470±0.208)μm,和术前相比负球差明显增加,差异有统计学意义(t=12.622,P=0.000),术后两组的差异有统计学意义(t=9.214,P=0.000).非主视眼术后6个月调节幅度较术前增加(0.84±0.61)D,主视眼较术前降低(0.10±0.67)D.非主视眼手术后调节力增幅和术后角膜多焦点指数、球差改变具有相关关系.结论 多焦点准分子激光原位角膜磨镶术治疗老视前近视安全、有效.多焦点准分子激光原位角膜磨镶术后能够得到一定程度的伪调节,角膜多焦点性质和非球面性是手术后伪调节产生的根源,伪调节和术后负球差的减少有关.     

Q值调整的准分子激光原位角膜磨镶术治疗近视临床观察

目的:评价目标Q值=-0.9引导的准分子激光原位角膜磨镶术(LASIK)治疗近视的临床疗效。方法:应用美国雷赛LSX准分子激光机(5.3版),采用AstraPro Planner2.2Q个体化软件,术中目标Q值设定为-0.9,行LASIK手术共治疗53例(106眼)近视患者,同时随机选取2005年常规LASIK手术患者51例(102眼)做为对照组。观察手术前及术后6mo的视力、屈光度、As-tramax角膜地形图测量的Q值的变化(瞳孔中心4.5mm直径范围),并进行分析。结果:在Q值优化组,术前裸眼视力为0.11±0.05,平均等效球镜(SE)为-6.57±1.81D(-3.49~-11.80D),术前Q值为-0.14±0.15(-0.56~0.26),术后6mo裸眼视力为1.14±0.15,平均等效球镜(SE)为0.37±0.58D,术后Q值为0.20±0.40(-0.80~1.48)。标准切削对照组:术前裸眼视力为0.13±0.06,平均等效球镜(SE)为-5.99±2.53D(-1.44~-12.31D),术前的Q值为-0.16±0.14(-0.50~0.21),术后裸眼视力为1.13±0.20,平均等效球镜为-0.46±0.87D,术后Q值为0.56±0.45(-0.53~2.03)。所有术眼术中术后未见威胁视力的并发症发生。两组术后裸眼视力无显著性差异,但是Q值优化组术后Q值显著低于对照组。结论:应用美国雷赛SLX型(5.3版)激光机,AstraProPlanner2.2Q个体化软件,进行目标Q值为-0.9引导的LASIK个体化切削术治疗近视安全、疗效确切、稳定,效果满意。Q值优化的LASIK较常规切削可减少术后Q值的增加,更好的维持角膜表面生理形态。     

个性化植入非球面人工晶状体术后视觉质量的临床观察

目的 观察根据患者角膜球差植入不同球差的非球面人工晶状体术后患者的视觉质量.方法 选择年龄相关性白内障患者62例(62眼)行白内障超声乳化吸出联合人工晶状体植入术,随机分为试验组及对照组,其中试验组32例(32眼)术前根据角膜球差植入非球面人工晶状体,对照组30例(30眼)随机植入非球面人工晶状体.术后3个月进行两组患者的视力、角膜球差、对比敏感度检查和生活问卷调查.结果 术后3个月,患者裸眼视力为4.89±0.57,与术前的4.00±0.31相比,差异有统计学意义(P=0.00),其中试验组裸眼视力为4.91±0.02,对照组为4.89±0.37,差异无统计学意义(P=0.48);最佳矫正视力试验组和对照组分别为4.97±0.21和4.97±0.18,差异亦无统计学意义(P=0.91);两组总角膜球差术后为(0.271±0.222) μm,与术前的(0.262±0.213) μm相比差异无统计学意义(P=0.47);对比敏感度检查在暗光及暗眩光状态下1.5c·d-1、3.0c·d-1、6.0c·d-1、12.0 c·d-、18.0c·d-1 15个不同空间频率下试验组均显著高于对照组(均为P＜0.05),在明光及明眩光状态5个空间频率下对比敏感度两组间差异均无统计学意义(均为P＞0.05);术后不良视觉症状发生率试验组少于对照组,患者满意度好于对照组(均为P＜0.05).结论 根据角膜球差植入非球面人工晶状体,术后均能够获得较满意的视觉质量,为个性化植入非球面人工晶状体这一方法的可行性提供了临床依据.     

Q值引导SBK与LASIK术后对比敏感度及高阶像差对照观察

目的 探讨Q值引导的前弹力层下角膜磨镶术(Sub-Bowman's Keratomileusis,SBK)与角膜原位磨镶术(Laser In Situ Keratomileusis,LASIK)矫正近视患者术后高阶像差、对比敏感度的变化.方法 采用非随机对照临床研究,将2012年1～6月在浙江丽水市中心医院眼科接受Q值引导个性化准分子激光治疗的近视散光患者分为2组.A组36例(72只眼)患者接受SBK;B组28例(56只眼)患者接受LASIK.所有患者术前及术后检测高阶像差及暗环境下无眩光干扰检测对比敏感度,并将结果进行比较.随诊复查时间为术后1、3、6、12个月.结果 术前两组各项指标比较,差异无统计学意义(均P ＞0.05).SBK组对比敏感度术后3～6个月恢复至术前水平,LASIK组术后6～12个月恢复至术前水平;术后12个月,SBK组各空间频率对比敏感度均优于LASIK组,以低、中频率段较为显著.术后12个月,SBK组平均高阶像差为(0.476±0.137)μm,LASIK组为(0.83±0.154) μm,两者差异有统计学意义(P =0.001).结论 Q值引导个性化切削下,SBK与LASIK相比可减少手术诱导的高阶像差,更快地恢复低、中、高空间频率的对比敏感度.     

虹膜定位波前像差引导的LASIK术后视觉质量观察

目的探讨虹膜定位波前像差引导的准分子激光原位角膜磨镶术(laser in situ keratomilensis,LASIK)个体化切削治疗近视术后的视觉质量。方法行虹膜定位波前像差引导LASIK手术近视患者78例(156眼)为试验组,同期行标准LASIK手术近视患者82例(164眼)为对照组,对2组患者术后6个月的视力、残留屈光度、对比敏感度、波前像差进行比较。结果术后6个月,两组裸眼视力均达到或高于术前最佳矫正视力,但2组比较差异无统计学意义(P>0.05)。术后6个月残留屈光度:试验组(0.50±0.38)D,对照组(0.64±0.49)D,2组比较差异有统计学意义(P<0.05);明视状态下,在中频区(6.0c·d-1、12.0c·d-1)试验组对比敏感度优于对照组(P<0.05),在暗视加眩光状态下,在低频区(1.5c·d-1、3.0c·d-1)试验组对比敏感度明显高于对照组(P<0.05)。试验组与对照组总高阶像差均方根值分别为0.548±0.340和0.745±0.380,差异有统计学意义(P<0.05);两组均方根值较术前均有增加,增幅分别为20.21%和37.48%,试验组增幅明显小于对照组(P<0.05)。结论虹膜定位波前像差引导LASIK在术后残留屈光度、对比敏感度、波前像差增幅及均方根值方面均优于对照组,提高了患者术后的视觉质量。     

高度近视准分子激光原位角膜磨镶术过矫再治疗

目的 观察高度近视眼准分子激光原位角膜磨镶术(laser in-situ keratomileusis,LASIK)后过矫的再治疗效果和安全性.方法 采用掀开角膜瓣后再次激光切削的方式治疗高度近视眼LASIK术后过矫的患者7例(13眼).分别在术前和术后1 d,1周,1、3、6个月检查患者视力和屈光度.结果 术后角膜瓣平整、复位良好.视力:术前及术后第1天、1周、3个月分别为1.02±0.25、0.95±0.26、0.98±0.25、1.03±0.26,差异无统计学意义(P>0.05).屈光度:术前(+2.75±0.75)DS,术后3个月(-0.37±0.50)DS;散光:术前(+1.05±0.35)DC,术后3个月(-0.50±0.37)DC,术后术前差异均有统计学意义(屈光度:t=12.48,P=0.000;散光:t=10.972 8 ,P=0.000).结论 掀开角膜瓣后再次激光切削治疗高度近视LASIK术后过矫安全有效,无明显并发症.     

Q值引导与标准FS-LASIK术后角膜形态及对比敏感度比较

目的 比较Q值引导个体化与标准飞秒激光辅助制瓣准分子激光原位角膜磨镶术（FS-LASIK）前后角膜形态及不同条件下对比敏感度的差异,评价2种手术方式治疗近视的疗效。方法 前瞻性队列研究。随机选取2017年9月至2018年4月于安徽医科大学第一附属医院激光中心行近视激光矫正的中低度近视患者64例（126眼）,其中Q值引导组33例（64眼）,标准组31例（62眼）。于术前,术后1、3个月对患者的视力、Q值、角膜像差及对比敏感度值进行检测,比较2组手术前后各数据的差异性。采用重复测量方差分析、t检验和秩和检验对数据进行分析。结果 术前2组各项指标基本匹配,术后1、3个月2组裸眼视力差异无统计学意义（P>0.05）。角膜直径6.0 mm范围,术后3个月2组间角膜Q值、球差和彗差差异无统计学意义（P>0.05）;角膜直径4.5 mm范围,术后3个月Q值引导组球差、Q值小于标准组,差异有统计学意义（t_球差=2.00,P=0.04;t_Q值=2.28,P=0.03）。术后1个月,2组不同环境下各空间频率的对比敏感度基本恢复至术前水平,术后3个月趋于稳定。术后3个月,在暗环境+眩光条件下,Q值引导组中频区对比敏感度高于标准组,差异有统计学意义（Z_{3 c/d}=-2.0,P=0.044;Z_{6 c/d}=-2.1,P=0.034）。结论 Q值引导个性化手术具有良好的安全性、有效性,能够提高暗环境眩光条件下的视觉质量。     

实时虹膜识别联合波前引导LASIK治疗中高度近视性散光

目的:评价实时虹膜识别技术应用在波前引导准分子激光原位角膜磨镶术（laser in situkeratomileusis, LASIK）治疗中高度近视性散光中的准确性、稳定性。方法:采用随机对照研究,接受实时虹膜识别联合波前引导LASIK手术的近视性散光患者57例104眼作为试验组,接受常规波前引导LASIK手术的近视性散光患者58例107眼作为对照组,对两组患者术后1,3,6mo的裸眼视力、最佳矫正视力、散光度、散光轴向、波前像差等进行比较。结果:静态虹膜识别检测出眼球旋转偏移角度为2.61°±2.08°,动态虹膜识别检测眼球旋转变化范围为0°～5°。术后6mo时,试验组裸眼视力≥术前最佳矫正视力的患者（96眼,92.3%）多于对照组（78眼,72.9%）,差异有统计学意义(P＜0.01);试验组的平均散光（-0.28±0.26D）低于对照组(-0.44±0.35D),差异有统计学意义(P＜0.05)。术后6mo,试验组无散光眼（49眼,47.1%）多于对照组（31眼,29.0%）, 差异有统计学意义(P＜0.01)。当瞳孔直径为6mm时,试验组彗差的增加少于对照组,差异有统计学意义(P＜0.01)。结论:实时虹膜识别技术能够有效校正LASIK术前和术中的眼球旋转偏差及瞳孔中心移位,使散光度数和轴向的治疗更加精确,同时提高视觉质量。     

Size of corneal topographic effective optical zone: comparison of standard and customized myopic laser in situ keratomileusis

PURPOSE: To investigate the corneal topographic effective optical zone (EOZ) in eyes after wavefront-guided myopic laser in situ keratomileusis (LASIK) and to compare them with the EOZ after standard LASIK. DESIGN: Retrospective, case-control study. METHODS: We evaluated the corneal topographic maps of 41 eyes of 25 consecutive patients who had CustomVue LASIK (CV LASIK) and 41 eyes of 23 patients who had standard LASIK with correction up to -7 diopters using the VISX Star S4 laser (VISX Inc, Santa Clara, California, USA). On the refractive map of the Humphrey Topography System, we defined the EOZ as the area outlined by a change of corneal power of 0.5 diopters from the power at the center of the pupil. We analyzed the differences in EOZs of the two ablation patterns and the correlation between EOZ and magnitude of refractive correction. RESULTS: The mean postoperative EOZs were 17.9 +/- 3.7 mm(2) and 11.4 +/- 3.4 mm(2) after CV and standard LASIK, representing 60% and 40% of the laser-programmed optical zones, respectively (both P < .0001). There was no correlation between the postoperative EOZs and the magnitude of refractive correction for both ablations (all P > .05). In eyes with spherical correction (cylinder < or =0.25 diopters), CV LASIK increased the preoperative EOZ by 3.8 +/- 5.6 mm(2) (P = .018), whereas standard LASIK decreased EOZ by 4.5 +/- 5.2 mm(2) (P = .005). CONCLUSION: CV LASIK created larger corneal topographic EOZs than standard ablation. In eyes with spherical correction, the preoperative EOZ was expanded by CV LASIK and reduced by standard LASIK.     

ORK-CAM角膜像差引导与传统切削模式近视LASIK手术比较研究

目的 探讨ORK-CAM角膜波阵面像差引导的近视LASIK手术的临床效果并与传统近视切削模式相比较.方法 回顾性分析接受近视LASIK手术的患者75例149只眼的临床资料.其中ORK-CAM角膜像差引导切削组4l例81只眼,常规切削组34例68只眼.统计患者术前和术后6个月的临床资料并进行手术前后以及两组间对比.主要观察指标包括裸眼视力、屈光度、角膜非球而系数、RMSh、RMS3-RMS7、球差、慧差以及三叶草像若值等.结果 两组术后角膜形态均由术前的长椭圆形变为扁椭圆形,ORK-CAM组角膜非球面系数改变较常规IASIK组小.两组术后角膜高阶像差均较术前显著增加.术后ORK-CAM组RMSh、RMS3、RMS4、球差以及三叶草像差值较常规IASIK组低,差异有统计学意义;术后ORK-CAM组6阶像差值较常规LASIK组高,二次球差是影响RMS6变化的主要因素.角膜Q值与球差值成正相关.结论 ORK-CAM角膜像差引导的个体化切削能够减小近视LASIK手术后角膜高阶像差的异常增加,术后角膜非球面性更接近于术前,有利于患者获得更好地术后视觉质量.     

Q值引导LASIK术后对比敏感度的变化

目的:对比Q值引导的LASIK与常规LASIK治疗近视术后术眼对比敏感度的变化差异。方法:选择27例近视度数在-2.50～-9.25D,散光度<-2.00D,无屈光参差的患者做LASIK,每名患者随机选择1眼行Q值引导LASIK(F-CAT组),另眼行常规LASIK(对照组)。Q引导值取术眼角膜Q20的平均值加上-0.5。术后随访1mo,比较F-CAT组和对照组的对比敏感度(contrast sensitivity,CS)的差异。结果:分别比较两组术后UCVA和残余的度数均无统计学差异。F-CAT组Q20的增加量比对照组增加量减少(P<0.05),并且术后球差增加量<对照眼(P<0.05)。两组术后各空间频率CS均无降低(P>0.05)。术后1mo,F-CAT组Q值引导眼在3c/d时对比敏感度高于对照组(P<0.05)。结论:用Q值引导的LASIK矫正近视,在提高术后CS方面比常规LASIK有优势。     

个性化波前引导的LASIK矫正中度以上近视散光的初步观察

目的探讨个性化波前引导的LASIK矫正中、高度散光的效果和安全性。方法接受LASIK治疗的近视散光患者76例（145只眼），随机分为波前组和对照组：波前组39例（73只眼），对照组37例（72只眼）；两组性别，散光度数大致相同。波前组行波前和虹膜识别引导的LASIK，对照组行普通LASIK，对比观察两者的治疗效果。结果术后3个月时，波前组裸眼视力1．0以上者为69只眼（94．5％）；对照组为63只眼（87．5％）。波前组最佳矫正视力提高1行以上的患者比例为36只眼（49．3％），对照组为19只眼（26．4％），两者比较有显著性差异（P〈0．01）。当瞳孔直径为6mm时，对照组术后高阶像差RMS平均增幅为107％，波前组平均增幅明显小于对照组，为41％，两组间比较有显著性差异（P〈0．01）。对照组有16只眼（22．2％）暗环境下有眩光主述，波前组有5只眼（6．8％），两组眩光症状比较，有统计学意义（P〈0．05）。结论波前引导与虹膜识别相结合的LASIK在治疗近视散光时，矫正的精确性明显优于常规LASIK，视觉质量更好。     

Laser in situ keratomileusis for the correction of myopia and myopic astigmatism

PURPOSE: To evaluate the efficacy, safety, predictability, and surgically induced astigmatism (SIA) of laser in situ keratomileusis (LASIK) for the correction of myopia and myopic astigmatism. SETTING: Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan. METHODS: This retrospective study comprised 69 eyes that had LASIK to correct myopia and 74 eyes that had LASIK to correct myopic astigmatism. The excimer laser keratectomy was performed using a Summit Apex Plus machine. Refraction, visual acuity, and computerized corneal videokeratography data from the preoperative and postoperative examinations were collected. The astigmatic change was calculated by the Alpins vector analysis method. RESULTS: The preoperative spherical equivalent at the glasses plane in the myopia and myopic astigmatism groups was -8.08 diopters (D) and -9.73 D, respectively. At 6 months, the spherical equivalent and residual corneal astigmatism were -0.25 D and 0.85 D, respectively, in the myopia group and -0.71 D and 0.82 D, respectively, in the myopic astigmatism group. In the myopia group, 88% of eyes were within +/-1.0 D of the intended myopia correction and in the myopic astigmatism group, 85% were within +/-1.0 D of the targeted spherical equivalent and 90% were within +/-1.0 D of the intended astigmatism correction. The uncorrected visual acuity was 20/40 or better in 94.1% of eyes in the myopia group and 92.5% of eyes in the myopic astigmatism group. The SIA magnitude was 0.66 D with the axis randomly distributed in the myopia group. The mean astigmatism correction index was 0.97, the mean magnitude of error was 0.13 D +/- 0.62 (SD), and the mean angle of error was -3.70 +/- 13.73 degrees in the myopic astigmatism group. CONCLUSION: Laser in situ keratomileusis had similar predictability, safety, and efficacy in the treatment of myopia and myopic astigmatism. The astigmatism correction was effective, but the results suggest that subjective astigmatism of less than 1.0 D need not be treated with the Summit Apex Plus laser.     

Comparison of Collamer toric implantable [corrected] contact lens implantation and wavefront-guided laser in situ keratomileusis for high myopic astigmatism

PURPOSE: To compare the postoperative visual outcomes after implantation of a Collamer toric implantable contact lens (ICL) and after wavefront-guided laser in situ keratomileusis in high myopic astigmatism. SETTING: Department of Ophthalmology, Kitasato University, Kanagawa, Japan. METHODS: This study comprised 30 eyes (18 patients) having toric ICL implantation and 24 eyes (17 patients) having wavefront-guided LASIK (Technolas 217z) to correct high myopic astigmatism (manifest spherical equivalent [SE] or=1.0 D). The safety, efficacy, predictability, stability, and adverse events were assessed preoperatively and 1 week and 1, 3, and 6 months postoperatively. RESULTS: At 6 months, the mean safety index was 1.28+/-0.25 (SD) in the ICL group and 1.01+/-0.16 in the LASIK group and the mean efficacy index, 0.87+/-0.15 and 0.83+/-0.23, respectively. All eyes in the ICL group and 71% of eyes in the LASIK group were within +/-1.00 D of the targeted SE correction at 6 months. The mean change in manifest refraction from 1 week to 6 months was -0.04+/-0.24 D in the ICL group and -0.60+/-0.49 D in the LASIK group. There were no significant complications in the ICL group; 2 eyes (8.3%) in the LASIK group required enhancement ablations. CONCLUSION: Toric ICL implantation was better than wavefront-guided LASIK in eyes with high myopic astigmatism in almost all measures of safety, efficacy, predictability, and stability, suggesting that toric ICL implantation may become a viable surgical option to treat high myopic astigmatism.     

The LADAR6000: results in highly myopic and highly astigmatic eyes

PURPOSE: To investigate the early clinical outcomes of the Alcon LADAR6000 system in treating two difficult patient populations: those with high myopia and those with high astigmatism. METHODS: Two series of eyes were of interest and subsequently enrolled in the study. Thirty-three eyes with preoperative manifest refraction spherical equivalent (MRSE) > -6.00 diopters (D) (high myopia group) and 25 eyes with preoperative myopic astigmatism > -1.50 D (high myopic astigmatism group) were enrolled. Mean patient age was 35 years in the high myopia group and 33 years in the astigmatism group. For the high myopia group, the mean preoperative MRSE was -8.13 D (range: -6.25 to -12.5 D). For the high myopic astigmatism group, the mean preoperative astigmatism was -1.89 D (range: -1.50 to -4.50 D). All LASIK flaps were made using a femtosecond laser with superior hinge position. Stromal ablation was performed using the LADAR6000 system for conventional treatment. All eyes were targeted for emmetropia. RESULTS: Both groups of eyes experienced excellent clinical outcomes with 100% of eyes within +/-1.00 D of attempted correction at 1 month. For the high myopia group, mean postoperative MRSE was -0.10 D at 1 month. For the high myopic astigmatism group, mean postoperative MRSE was -0.06 D at 1 month. CONCLUSIONS: The LADAR6000 system produced excellent early clinical outcomes in two challenging patient groups using LASIK with femtosecond laser flaps.     

波前像差引导的LASIK手术的临床效果观察

目的观察波前像差引导的LASIK手术矫正近视性散光的效果。方法28例35只眼，平均术前球镜屈光度为（-4.8±2.3）D，柱镜屈光度为（-1.1±0.9）D。手术前和手术后均使用Tscherning像差计测量,分析波前像差。应用1.0mm光斑、频率200Hz的飞点扫描准分子激光进行屈光手术。结果术后3个月，68.0%的眼屈光度在±0.5D（正视眼）内，93.5%眼在±1.0D内。93.5%的裸眼视力为20/20或更好。裸眼超常视力(BSCVA在20/10或更好)占16.0%。高阶像差(球差，彗差)矫正不足，而波前像差全部均方根增加值为1.44±0.74，彗差的矫正好于球差。结论波前像差引导的LASIK手术是一种很可靠的技术，可有效地矫正屈光不正，改善视觉敏感度，提高视觉质量，尤其是提高夜间视力的视觉质量。