常规LASIK与波前像差引导的LASIK治疗中高度近视散光的对比研究

目的 比较常规准分子激光原位角膜磨镶术（简称常规LASIK）和波前像差引导的个体化LISIK（简称波前像差引导LASIK）矫正中高度近视散光后的视觉质量.方法 随机选取2011年1月至2012年12月在我院行准分子激光手术者,其中散光度数≥-2.00 DC作为入选对象共82例（163只眼）.其中选择行波前像差引导的LASIK术者42例（83只眼）,散光（-3.55±1.09） DC;接受常规LASIK术者40例（80只眼）,散光（-3.47±1.23） DC.所有患者术前与术后7 d、1个月、6个月分别进行视力、角膜地形图、波前像差的检查和视疲劳满意度调查,比较两组的差别.结果 （1）术后7 d、1个月、6个月波前像差引导的LASIK术者视力分别优于常规LASIK术者（P＜0.05）.（2）角膜地形图查残余角膜散光度：波前像差组7 d、1个月、6个月分别为（-0.35±0.24） DC、（-0.42±0.13） DC、（-0.51±0.19） DC;常规组7 d、1个月、6个月分别为（-0.75±0.28） DC、（-0.92±0.23） DC、（-1.21±0.21） DC,两组差异有统计学意义（P＜0.05）.（3）波前像差组和常规组高阶像差均呈增加趋势,以彗差和球差增加为主.波前像差组在总高阶像差（HOAROM）、30°三叶草（Z6）、垂直彗差（Z7）和水平彗差（Z8）高阶像差的改变显著优于常规组（P＜0.05）.（4）视疲劳满意度调查：波前像差组明显优于常规组.结论 波前像差引导的个性化LASIK较常规LASIK能更好地矫正中高度近视散光,使患者术后角膜残余散光更少,高阶像差的增加更少,视力恢复更理想,视觉质量更佳,患者的满意度更好.

The comparison of standard LASIK and wavefront aberration guided LASIK in treatment of high myopia astigmatism

Objective To compare the visual quality outcomes of the standard LASIK and wavefront aberration guided LASIK surgery in high myopia astigmatism patients. Methods Totally 82 patients （ 163 eyes ） of high myopia astigmatism （ 92.00 D） who received excimer laser surgeries in our hospital between January 2011 and December 2011 were involved in this .study. Among these subjects, forty-two patients （ 83 eyes） were treated with wavefront aberration guided LSAIK, and forty patients were treated with standard LASIK. The average preoperative astigmatism was -3.55 ± 1.09 DC and -3.47± 1.23 DC respectively. Visual acuity, wavefront corneal topographic map, and visual fatigue were surveyed before and 7 days, 1 month, 6 months after surgery. Results （ 1 ） Visual acuity was significantly better in patients received wavefront guided LASIK than in patients received standard LASIK at 7 days, 1 month and 6 months （ P 〈 0.05 ）. Residual astigmatism was - 0.35 ± 0.24 DC, - 0.42 ± 0.13 DC, and - 0.51 ±0. 19 DC in patients received wavefront aberration guided LASIK at 7 days, 1 month and 6 months, respectively. In contrast, residual astigmatism was much higher （ P 〈 0. 05 ） in patients received standard LASIK at the same time points （ - 0.75 ± 0.28 DC at 7 days, - 0.92 ± 0.23 DC at 1 month, and - 1.21 ±0.21 DC at 6 months, respectively）. （3） Higher order aberrations, particularly, spherical and coma aberrations were found to be increased in beth groups. Total higher order aberrations （ HOAROM）, 30°clover （ Z6）, vertical coma （Z7） and level of coma （ Z8 ） aberrations were significantly smaller in wavefront aberration guided LASIK group （P 〈0.05 ）. 4. The visual fatigue survey returned better responses in wavefront aberration guided IASIK group. Conclu- sion Wavefront aberration guided LASIK was relatively superior to standard LASIK in terms of correcting high myopia astigmatism, less residual astigmatism, less higher-order aberrations, better visual acuity, better visual quality, and better patient satisfaction.