虹膜定位联合波前像差引导前弹力层下角膜磨镶术治疗近视的临床疗效分析

目的分析虹膜定位联合波前像差引导前弹力层下角膜磨镶术（SBK）实行个体化切削手术治疗近视的临床疗效及安全性。方法近视患者行虹膜定位联合波前像差引导的SBK治疗者32例（64只眼）（试验组）,同期行常规SBK治疗的患者42例（84只眼）（对照组）,两组患者等效球镜-2.0 D～-8.0 D,术后随访6个月观察两术式的治疗效果。观察指标包括术后裸眼视力（UCVA）、屈光状态、裂隙灯检查、眼压、角膜地形图、波前像差、对比敏感度及角膜并发症。结果术后6个月两组所有患者UCVA≥1.0,较术前BCVA提高一行者分别为34.4%（22只眼）和19.0%（16只眼）,两组相比较差异有统计学意义（P〈0.05）;试验组和对照组患者术眼的残留屈光度球镜分别为（0.31±0.22）D和（0.44±0.29）D,两组比较差异有显著性（P〈0.05）;试验组残留散光为（0.12±0.07）D,小于对照组（0.24±0.05）D,两组比较差异有显著性（P〈0.05）;试验组和对照组患者等效球镜在±0.5 D以内者分别为29只眼（45.3%）和20只眼（23.8%）,试验组明显多余对照组（P〈0.05）。试验组切削中心位于角膜中心0.2 mm以内为60只眼（93.8%）,对照组为67只眼（79.8%）,两组比较差异有显著性（P〈0.05）;两组患者术后高阶像差均较术前增高,试验组和对照组患者总高阶像差的RMS分别为0.418±0.26和0.651±0.37,试验组明显小于对照组（P〈0.05）;高频对比敏感度（12cd/deg和18cd/deg）试验组为1.347±0.274和1.094±0.289,明显高于对照组1.239±0.212和0.896±0.251（P〈0.05）;术中和术后两组患者均无严重并发症;术后试验组满意度高于对照组（P〈0.05）。结论虹膜定位联合波前像差引导SBK治疗近视术后视力提高理想、残留屈光度低,高阶像差增加幅度少、视觉质量好,并发症少、安全性高,是近视患者的理想选择手术方式。

Clinical analysis of iris location combined wavefront guided SBK in myopia

Objective To analyze the iris location combined with wavefront guided Sub-Bowman’s Keratomileusis(SBK) for myopia treatment.Methods Iris location combined with wavefront guided SBK was performed in 64 eyes of 32 patients with myopic(experimental group) and 84 eyes of 42 patients were received routine SBK(control group).The patients’ equivalent spheric was-2.0 D ~-8.0 D.Uncorrected visual acuity(UCVA),refrative,split-lamp examination,intraocular pressure(IOP),topography examination,wavefront aberration and complication was examined in these patients and follow-up was 6 months.Results At 6 months after surgery in experimental group and control group,all the patients achieved a UCVA better than 20/20.There was significant difference of UCVA better than preoperative BCVA between experimental group(34.4%) and control group(19.0%)(P<0.05).The remainder sphere and astigmatism in experimental group was 0.31±0.22 D and 0.12±0.07 D.Control group was 0.44±0.29 D and 0.24±0.05 D.Experimental group was obviously better control group(P<0.05).There was significant difference of remainder refractive within ±0.5 D between experimental group(45.3%)and control group(23.8%).The center of optical zone within 0.2 mm from corneal center was 93.8% in experimental group and 79.8% in control group.There was significant difference between two groups(P<0.05).The RMS of high order wavefront aberration was 0.418±0.26 in experimental group and 0.651±0.37 in control group.There was significant difference of RMS between two groups(P<0.05).Experimental group’ Contrast sensitivity of high frequency was 1.347±0.274 and 1.094±0.289 respectively in 12cd/deg and 18cd/deg.It was better than 1.239±0.212 and 0.896±0.251 in control group(P<0.05).There was no serious complication in preoperation and post operation.Degree of satisfaction in experimental group was better than control group.Conclusion For most myopia patients,iris location combined with wavefront guided SBK is safe and effective.