飞秒激光联合LASIK术后视觉质量的变化

目的：对比飞秒激光制瓣的准分子激光原位角膜磨镶术( femtosecond-laser in situ keratomileusis, femto-LASIK )与传统机械板层刀制瓣的准分子激光原位角膜磨镶术( laser in situ keratomileusis,LASIK)治疗屈光不正患者术后视觉质量的变化。
　　方法：回顾性病例研究。选择我院2014-01/2015-12进行屈光手术的患者89例178眼,其中使用飞秒激光制作角膜瓣患者46例92眼,使用显微角膜板层刀制作角膜瓣患者43例86眼。术后随访6mo,观察患者的视力、屈光状态、主观视觉质量评分、高阶像差等情况。
　　结果：所有患者均顺利完成手术,角膜瓣均制作成功,无术中及术后并发症发生。两组患者术后不同时间裸眼视力与术前最佳矫正视力相比较,差异无统计学意义(P>0.05),两组患者术后屈光度与术前预期屈光度比较,差异具有统计学意义(P<0.05)。两组患者术后6mo主观视觉调查质量评分比较,差异有统计学意义(P<0.05)。术后6 mo飞秒激光组和机械板层刀组角膜像差均方根值、球差及彗差较术前增加,差异具有统计学意义(P<0.05),但飞秒激光组增加的幅度比机械板层刀组低,差异有统计学意义(P<0.05)。
　　结论：飞秒激光制作角膜瓣更精确可靠,离散度更小,可以制作更薄的角膜瓣,飞秒激光制瓣的LASIK较传统机械板层刀LASIK术后可以获得更好的视觉质量。

Changes of visual quality after femtosecond laser combined with LASIK

AIM: To compare the change of visual quality of femtosecond-laser in situ keratomileusis(FS-LASIK)and laser in situ keratomileusis(LASIK)for myopia.

METHODS: A retrospective case series. A total of 89 cases 178 eyes were chosen from Jan.2014 to Dec.2015. There were 46 cases(92 eyes)in FS-LASIK and 43 cases 86 eyes in LASIK. The visual acuity, refraction state, subjective visual quality score, high order aberration were measured at 6mo after surgery.

RESULTS: All patients underwent operation smoothly, and no complication was observed during and after surgery; there was no statistically significant difference between two groups at visual acuity(P>0.05). Postoperative diopter compared with preoperative expectations diopter difference is statistically significant between two groups(P<0.05). Subjective visual quality score was compared statistically significant postoperative 6mo in two groups(P<0.05). Six months after surgery in the two groups of patients with corneal aberration RMS values, spherical aberration and coma compared with preoperative increases, more than the expansion of the size of the FS-LASIK group low mechanical plate layer knife group, the difference was statistically significant(P<0.05).

CONCLUSION: Femtosecond laser corneal flap is more accurate and reliable and the discrete degree is smaller. It can make more thin corneal flap. Femtosecond laser disc of LASIK surgery compare with traditional mechanical plate layer knife following LASIK has better visual quality.