低度近视眼准分子激光角膜屈光手术后视觉及相关角膜参数与飞行员正视眼的对比分析

目的检测中国歼击机飞行员视觉及相关角膜参数,并与低度近视眼行准分子激光角膜屈光手术后的数据进行对比分析,评估准分子激光角膜屈光手术在我空军应用的前景。方法选取进行准分子激光原位角膜磨镶术（LASIK）或角膜表面切削手术（PRK）的低度近视眼,分别观察裸眼视力、屈光状态、Astramax角膜地形图获得的波阵面像差,即总高/低阶像差、垂直彗差、水平彗差和球差,以及角膜前表面Q值、角膜曲率等角膜参数,与歼击机飞行员正视眼数据进行对比分析。结果PRK和LASIK治疗≤-3.00D轻度近视眼,术后裸眼视力达到飞行员的标准;屈光状态,即球镜度数、柱镜度数、等效球镜三组差异无统计学意义;手术组角膜的Q值没有改变;中央角膜曲率显著下降;术后总高/低阶像差和球差与飞行员组差异有统计学意义。LASIK术后球差的增加显著高于PRK。结论 低度近视眼行PRK或LASIK术后裸眼视力、屈光状态、角膜的Q值可以达到飞行员的标准。但总高阶像差、彗差和球差的增加可能严重影响视觉质量,LASIK较PRK对球差的影响更大。在选拔飞行员时,对做过角膜屈光手术的患者应该慎重。同时在屈光手术中如何减少和避免波阵面像差的改变,如何通过手术保持和提高视觉质量也是我们今后的课题。

Comparative analysis of vision and related corneal parameters between pilot emmetropia and low myopia after excimer laser keratorefractive surgery

Objective To compare the vision and related corneal parameters of Chinese fighter pilot emmetropia and low myopia after excimer laser keratorefractive surgery,and evaluate the possible application in Chinese Air Force.Methods Low myopia after photorefractive keratectomy（PRK） or laser in-situ keratomileusis（LASIK） and fighter pilot emmetropia were included in this study.Uncorrected visual acuity,refraction,ocular wavefront aberrations（i.e.total higher/lower-order wavefront aberration,vertical coma,horizontal coma,and spherical aberration）,Q-value of corneal anterior surface,and central corneal power with Astramax corneal topographer were observed and analyzed.Results Postoperatively uncorrected visual acuity in ≤-3.00 D myopia treated by PRK or LASIK was equal to that in fighter pilot emmetropia.No statistic difference was found in refractive status,i.e.spherical,cylindrical and spherical equivalent degree among three groups;No changes of Q values in treatment groups were observed compared with pilot eyes.Then the central corneal powers in operative eyes were decreased significantly.And postoperatively total higher/lower-order wavefront aberration and spherical aberration in both treatment groups were significantly different from those in pilot group.The change of postoperatively spherical aberration in LASIK group was more than that in PRK group.Conclusion Uncorrected visual acuity,refractive status and Q value in low myopia after PRK or LASIK could reach the pilot eye criteria,but the increasing of total higher-order wavefront aberration,coma and spherical aberration maybe greatly affect quality of vision.Compared with PRK,LASIK increased spherical aberration more.It should be prudent to select Chinese pilot from post-corneal refractive surgery patients.Further problem is to keep and improve the quality of vision,decrease and avoid the changes of wavefront aberration after the excimer laser keratorefractive surgery.