个体化准分子激光上皮瓣下角膜磨镶术矫治角膜不规则散光的临床研究

目的评价眼前节全景仪引导的个体化准分子激光上皮瓣下角膜磨镶术(laser subepithelial keratomileusis,LASEK)治疗偏中心切削所致不规则散光的效果,并比较术前和术后不同时间角膜不规则状态的变化。方法收集10例(18眼)因行屈光手术而发生偏中心的患者,伴有严重的不良视觉症状,行眼前节全景仪引导的个体化LASEK治疗。所有患者在术前和术后1个月、3个月和6个月均行眼前节全景仪检查,并对手术前后所有患者的裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)、角膜表面非球面性(Q值)、角膜表面变异指数、角膜表面垂直不对称指数等进行比较。结果 UCVA由术前0.26±0.15变为术后6个月0.85±0.11,BCVA术前0.69±0.20变为术后6个月1.02±0.04,UCVA、BC-VA与术前相比差异均有显著统计学意义(均为P=0.00)。Q值术前为0.56±0.29,术后1个月、3个月时分别为0.21±0.52、0.36±0.42,差异均有统计学意义(均为P<0.05);术后6个月为0.54±0.48,与术前相比差异无统计学意义(P>0.05)。角膜表面变异指数术前为65±11,术后6个月降低为59±8,差异有统计学意义(P<0.05)。角膜表面垂直不对称指数术前为0.78±0.12,术后6个月降低为0.24±0.18,差异也有统计学意义(P=0.04)。术后切削区中心偏移明显改善,光学区居中,并且光学区较术前有所扩大。结论眼前节全景仪引导的个体化LASEK手术矫治偏中心所致的角膜不规则散光安全、有效,能整体上改善角膜不规则状态。

Customized LASEK for corneal irregular astigmatism

Objective To evaluate the clinical effect of oculyzer-guided customized laser subepithelial keratomileusis(LASEK) for corneal irregular astigmatism induced by decentered ablation,and analyze the differences about corneal irregular status before operation and at different times after operation.Methods Clinical data of 10 cases(18 eyes) with severe adverse visual symptoms underwent oculyzer-guided LASEK for irregular astigmatism were collected.All patients were detected by oculyzer before operation and at 1 month,3 months,and 6 months after operation,respectively.Uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),Q value,index of surface variance(ISV) and index of vertical asymmetry(IVA) were analyzed and compared between before and after operation.Results UCVA changed significantly from 0.26 ± 0.15 before operation to 0.85 ± 0.11 at 6 months after operation.BCVA changed significantly from 0.69 ± 0.20 before operation to 1.02 ± 0.04 at 6 months after operation.There were significant differences in UCVA and BCVA between before and after operation(both P = 0.00).Q value changed significantly from 0.56 ± 0.29 before operation to 0.21 ± 0.52 at 1 month and 0.36 ± 0.42 at 3 months after operation,respectively,there were statistical differences(both P < 0.05),but it changed 0.54 ± 0.48 at 6 months after operation,there was no statistical difference(P > 0.05).ISV changed significantly from 65 ± 11 be fore operation to 59 ± 8 at 6 months after operation,there was statistical difference(P < 0.05).IVA changed significantly from 0.78 ± 0.12 before operation to 0.24 ± 0.18 at 6 months after operation,there was statistical difference(P < 0.05).The decentered status was improved after operation,the optical zone centered and was wider than that before operation.Conclusion Oculyzer-guided customized LASEK is a safe and effective surgery for corneal irregular astigmatism induced by decentered ablation,and can improve the corneal irregular status in whole.