飞秒激光制瓣LASIK联合波前优化治疗近视及散光术后的角膜像差

目的 研究飞秒激光制瓣LASIK（飞秒LASIK）联合波前优化治疗近视及散光术后角膜像差的特性.方法 回顾性研究.行飞秒LASIK手术的近视及近视散光患者30例（30眼）,平均年龄（20.9±2.8）岁;术前平均等效球镜度（-6.48±1.61）D.应用Pentacam眼前节分析仪测量角膜前表面6、7、8、9 mm直径下的Q值,采用Keratron角膜波前像差分析仪测量6 mm瞳孔直径下角膜波前像差.随访时间为术后3个月,手术前后数据采用配对t检验,采用Pearson相关分析角膜像差、Q值与其他参数的相关性.结果 6 mm瞳孔直径下角膜高阶像差、总球差、总彗差、水平彗差、垂直彗差、初级球差、x-向次级像散、次级水平彗差、次级垂直彗差、次级球差均较术前增加,差异有统计学意义（t=-8.254、-7.385、-6.108、-5.651、-2.195、-7.565、-4.628、-2.974、-2.748、-7.068,P＜0.05）.角膜前表面4个直径范围内Q值均较术前增加,差异有统计学意义（t=16.999、-19.208、-21.502、-22.197,P＜0.05）.6 mm瞳孔直径下手术前后Q值变化量（△Q6mm）与高阶像差变化量、总球差变化量、初级球差变化量、总彗差变化量呈正相关（r=0.736、0.792、0.788、0.383,P＜0.05）,△Q6mm与总三叶草变化量、次级球差变化量无相关性（r=0.099、-0.348,P＞0.05）.结论 飞秒LASIK联合波前优化治疗近视及近视散光是安全、有效的,但术后角膜高阶像差仍有显著增加.

Corneal aberrations after femtosecond LASIK for myopia and myopia astigmatism with a wavefront optimized profile

Objective To evaluate the corneal aberrations after femtosecond LASIK for myopia and myopia astigmatism with a wavefront optimized profile.Methods Prospective study including 30 eyes from 30 patients （mean 20.9±2.8 years） with myopia （mean spherical equivalent refractive -6.48±1.61 D）.The asphericity （Q value） of the anterior corneal surface for patients with different corneal diameters （6,7,8 and 9 mm） were measured with Pentacam.Higher-order aberrations （HOAs） of the corneal were measured with the Keratron at 6 mm pupil diameter.Postoperative changes in corneal HOAs and corneal asphericity were analyzed during 3 months follow up.Paired t test was used to analysis the pre-and post-operative data.Pearson correlation was used to investigate correlations between Q values,corneal aberrations and other data.Results At 6 mm pupil diameter significant increases in corneal HOAs,whole spherical aberration （WsA）,whole coma （WComa）,C3＋1,C3-1,C40、C4＋2,C5＋1,C5-1,C60 were observed 3 months after surgery （t=-8.254,-7.385,-5.108,-5.651,-2.195,-7.565,-4.628,-2.974,-2.748,-7.068,P〈0.05）.Corneal asphericity for 6,7,8,9 mm also increased significantly （t=16.999,-19.208,-21.502,22.197,P〈0.05）.At 6 mm pupil diameter significant correlations were found between Q change （△Q6mm） and HOA change （△HOA）,WSA change （△WsA）,C40 change （△C40）,WCom change （△WComa） （r=0.736,0.792,0.788,0.383,P〈0.05）.No correlation between △Q6 mm and whole trefoil change （△WTrefoil）,C60 change （△C60）（r=0.099,-0.348,P〉0.05）.Conclusion Femtosecond LASIK using a wavefront optimized ablation profile yielded excellent visual outcomes.A significant induction of corneal HOAs still exists.