改良单眼视LASIK手术矫正老视的疗效

目的 评价Custom-Q引导的改良单眼视准分子激光角膜磨镶术(LASIK)治疗患有近视、散光的老视患者的疗效.方法 前瞻性系列病例研究.收集2009年6月至2010年2月在华西医院近视中心实施改良单眼视LASIK手术的老视患者10例,主视眼屈光度全矫,实施传统LASIK切削；非主视眼保留-1.50 D球镜度数,实施“Custom-Q”引导的非球面性切削,实现改良的单眼视,分别于术后1周、1个月、3个月、6个月及1年进行随访,观察非主视眼和双眼的远、近视力,通过问卷调查,评估患者手术前后用眼舒适度、眼镜的依赖程度及术后满意度.分别对结果进行单因索方差分析、配对t检验和Wilcoxon秩和检验.结果 ①视力:与术前相比,术后非主视眼单眼的裸眼远、近视力差异均有统计学意义(P＜0.01),双眼同时视的裸眼远、近视力差异均有统计学意义(P均＜0.01).②稳定性:非主视眼的单眼和双眼裸眼视力在术后各时间点,差异均无统计学意义.③安全性:术中、术后无严重并发症发生,非主视眼最佳矫正视力术后较术前差异无统计学意义.④满意度:术后主观评分8.40±0.88,问卷调查显示用眼舒适度和眼镜依赖度评分术前和术后差异具有统计学意义(Z=-2.527、-2.609,P＜0.05).结论 运用Custom-Q改良的高级单眼视可用于矫正患有近视、散光的老视人群,可同时获得较好的远、近视力,患者满意度较高.

Clinical analysis of modified monocular presbyLASIK

Objective To evaluate the visual outcome of modified monocular presbyLASIK （laser in situ keratomileusis） for myopia, astigmatism and presbyopia using Custom-Q software. Methods It was a prospective case series study. Ten myopic patients with presbyopia, 40 years or older, underwent monocular presbyLASIK from June 2009 to February 2010, whereby the dominant eyes were corrected for distance with conventional wavefront optimized LASIK and the non-dominant eyes were corrected for near vision with individually adjusted aspheric, Q-value guided ablations. The visual results were described at each postoperative visit （1 week, 1 month, 3 months, 6 months and 1 year）. Questionnaires were used to characterize patient ocular conditions before surgery and satisfaction with improved monocular presbyLASIK postoperatively. Analysis of variance, paired t test and Wilcoxon-rank sum test were used for data statistics. Results ①Both postoperative distance uncorrected visual acuity （UCVA） and near UCVA in the non-dominant eye and binocular vision were better after surgery, and the differences were significant （P〈0.01）. ②Stability： after surgery, the differences in postoperative distance UCVA and near UCVA in the binocular vision at the different time points were not significant. ③ Safety： the operations were successful and there were no complications. Postoperative best corrected visual acuity （BCVA） in the non-dominant eye did not decrease. ④Satisfaction： the patient subjective satisfaction score was 8.40±0.88. The questionnaire indicated that preoperative and postoperativ satisfaction with spectacle dependency differed （Z=-2.527, -2.609, P〈0.05）. Conclusion This improved monocular presbyLASIK procedure using Custom-Q ablation may be a valuable option for presbyopic individuals considering refractive surgery. Visual results, safety, stability and satisfaction were excellent.