非球面优化单眼视准分子激光手术治疗近视合并老视的应用

目的:探讨非球面优化单眼视准分子激光手术治疗老视的安全性、有效性及视觉质量。方法:前瞻性临床研究。收集2018年1─12月在柳州市工人医院视光科行非球面优化单眼视准分子激光手术患者50例(100眼),术后1周、1个月、3个月、6个月随访观察患者远近距离裸眼视力、电脑验光、角膜地形图、角膜Q值、球差、对比敏感度、立体视锐度等,并使用屈光矫正者生命质量量表(QIRC)评估手术对生存质量的影响。采用 t检验、重复测量的方差分析进行数据分析。 结果:术前双眼各项指标基本匹配,术后6个月主视眼logMAR远视力达0.0的患者有94%,非主视眼logMAR近视力均达到0.5,96%的患者达到0.3。主视眼术后6个月Q值与非主视眼相比,差异有统计学意义( t=2.142, P=0.03)。等效球镜度(SE)、Q值与球差呈正相关( r=0.496, P<0.001;r=0.197, P=0.05)。患者双眼术后1周对比敏感度在各空间频率均低于术前,术后6个月除18 cpd以外,均达到术前水平(均 P<0.05)。大部分患者反映视觉质量良好;2例诉夜间眩光、重影。患者术后6个月立体视与术前相比差异无统计学意义。 结论:非球面优化单眼视准分子激光手术治疗近视合并老视是安全有效的,且不损害视觉质量。

Clinical Effects of Q-Value-Guided Non-Linear Aspherical Monocular LASIK for Myopic and Presbyopic Patients

Objective: To evaluate the safety, efficacy and visual outcomes in myopic and presbyopic patients, after Q-value-guided non-linear aspherical monocular LASIK. Methods: A prospective study was performed based on 50 patients (100 eyes) who underwent Q-value-guided non-linear aspherical LASIK. They were recruited in Liuzhou Worker's Hospital from January to December 2018. One week, 1 month, 3 months and 6 months after the operation, the patients' postoperative follow-up included assessments of visual acuity, auto-refraction, Q-value, spherical aberration, contrast sensitivity, corneal topography, stereoacuity and so on. The impact of the operation at 6 months was evaluated with the Chinese quality-of-life impact of refractive correction scale (QIRC). A t-test and repeated measurement analysis of variance were used for data analysis. Results: The demographic information was matched preoperatively between the two eyes. Six months postoperatively, 47 patients achieved an uncorrected distance visual acuity of 0.0 or better in the dominant eye, an uncorrected near visual acuity of 0.3 or better in 48 patients (96%), and 0.33 in the non-dominant eye of all patients. At 6 months, there was a significant difference in Q-value between the dominant eye and the non-dominant eye (t=2.142, P=0.03). Refractive error and Q-value were positively correlated with spherical aberration (r=0.496, P<0.001; r=0.197, P=0.05). At one week postoperatively, all contrast sensitivity spatial frequencies were lower than that before surgery, and gradually reached the preoperative level at 6 months postoperatively (all P<0.05). Most of the patients reported good visual quality, but 2 of them complained of night glare and ghosting. There was no significant difference in stereopsis 6 months postoperatively. Conclusions: Q-value-guided non-linear aspherical monocular LASIK is safe and effective to treat myopia and presbyopia.