Q值引导与标准FS-LASIK术后角膜形态及对比敏感度比较

目的:比较Q值引导个体化与标准飞秒激光辅助制瓣准分子激光原位角膜磨镶术(FS-LASIK)前后角膜形态及不同条件下对比敏感度的差异,评价2种手术方式治疗近视的疗效。方法:前瞻性队列研究。随机选取2017年9月至2018年4月于安徽医科大学第一附属医院激光中心行近视激光矫正的中低度近视患者64例(126眼),其中Q值引导组33例(64眼),标准组31例(62眼)。于术前,术后1、3个月对患者的视力、Q值、角膜像差及对比敏感度值进行检测,比较2组手术前后各数据的差异性。采用重复测量方差分析、t检验和秩和检验对数据进行分析。结果:术前2组各项指标基本匹配,术后1、3个月2组裸眼视力差异无统计学意义(P>0.05)。角膜直径6.0mm范围,术后3个月2组间角膜Q值、球差和彗差差异无统计学意义(P>0.05);角膜直径4.5mm范围,术后3个月Q值引导组球差、Q值小于标准组,差异有统计学意义(t球差=2.00,P=0.04;tQ值=2.28,P=0.03)。术后1个月,2组不同环境下各空间频率的对比敏感度基本恢复至术前水平,术后3个月趋于稳定。术后3个月,在暗环境+眩光条件下,Q值引导组中频区对比敏感度高于标准组,差异有统计学意义(Z3c/d=-2.0,P=0.044;Z6c/d=-2.1,P=0.034)。结论:Q值引导个性化手术具有良好的安全性、有效性,能够提高暗环境眩光条件下的视觉质量。

Clinical Study of Corneal Asphericity and Visual Quality after Q-Factor-Guided and Standard FS-LASIK

Objective: To compare the differences in corneal asphericity and contrast sensitivity under different conditions before and after Q-value-guided femtosecond laser in situ keratomileusis (FS-LASIK) and standard FS-LASIK for myopia, and evaluation of the efficacy of the two surgical methods for treating myopia. Methods: This was a prospective cohort study. A total of 64 moderate and low myopia patients (33 patients, 64 eyes, in the Q-guided group and 31 patients, 62 eyes, in the standard group) who were treated by FS-LASIK were selected from Laser Center, the First Affiliated Hospital of Anhui Medical University, during the same period. Visual acuity, Q-value, corneal aberration and contrast sensitivity were measured and compared before and after surgery. All the cases were followed up at 1 and 3 months. A repeated measures analysis of variance, t-test and rank sum test were used for data analysis. Results: There was no statistically significant difference for the data before surgery. The uncorrected visual acuity (UCVA) and residual refractive error of all eyes were not significantly different between the two groups after 3 months of follow-up. In the corneal 6 mm range, there was no significant difference in Q-value, spherical aberration or coma between the two groups at 3 months postoperatively. In the corneal 4.5 mm range, the Q-values and spherical aberrations of the Q-value-guided group were significantly less than that for the standard LASIK group (t_SA=2.00, P=0.04; t_Q=2.28, P=0.03). After surgery, contrast sensitivity in the two groups returned to preoperative levels at different spatial frequencies in various environments, and it tended to be stable at 3 months after surgery. At 3 months after surgery, the visual quality of the Q-value-guided group was better than that of the standard group under mesopic circumstances with glare (Z_{3 c/d}=-2.0, P=0.044; Z_{6 c/d}=-2.1, P=0.034). Conclusions: Q-value-guided LASIK for myopia and astigmatism is as safe and effective as standard FS-LASIK. Further more, Q-value-guided LASIK results in better visual quality than standard FS-LASIK under mesopic circumstances with glare.