民航飞行学员角膜屈光术后高阶像差变化及角膜后表面稳定性的研究

目的分析已接受角膜屈光激光手术（CRS）的飞行学员高阶像差的变化及角膜后表面稳定性，探讨民航招收飞行学员对于放开CRS标准后的安全性和稳定性。 方法选取2017年9月至2018年3月在民航总医院和中国民航飞行学院体检鉴定中心参加招飞体检以及年度体检的飞行学员进行调查。随机选取未行CRS且裸眼视力≥1.0的飞行学员50例（100眼）作为正常对照组；选取已行CRS的飞行学员67例（131眼）作为实验组，其中行飞秒激光制瓣的准分子激光原位角膜磨镶术（FS-LASIK）者29例（56眼），行准分子激光上皮瓣下角膜磨镶术（LASEK）者22例（43眼），行飞秒激光小切口角膜基质透镜取出术（SMILE）者16例（32眼）。分别对其进行裸眼远视力、屈光度、对比敏感度、泪膜破裂时间（BUT）以及角膜地形图等检查，同时比较手术前后中央前房深度、眼轴长度、晶状体厚度等变化情况，分析各组间高阶像差及角膜后表面稳定性。 结果正常对照组和实验组对比敏感度、BUT等差异无统计学意义（P>0.05）。实验组术后6个月总高阶像差、球差、彗差、三叶草像差等较术前均增高，差异有统计学意义（P<0.05）。实验组各组间术后总高阶像差、球差、彗差比较差异均有统计学意义（P均<0.05）；三叶草像差比较差异无统计学意义（P>0.05）。FS-LASIK组与LASEK组高阶像差、球差术后比较，差异均有统计学意义（P均<0.05），彗差、三叶草像差等术后比较，差异均无统计学意义（P均>0.05）；与SMILE组高阶像差、球差、彗差、三叶草像差术后比较，差异均有统计学意义（P<0.05）。各组间角膜后表面高度及眼球轴长之间差异均无统计学意义（P均>0.05），而晶状体厚度较术前显著增加，差异有统计学意义（P<0.05），中央前房深度较术前显著下降，差异有统计学意义（P<0.05）。 结论民航飞行学员行CRS安全有效，FS-LASIK可明显提升飞行学员术后的高阶像差。

Visual effects and corneal biological parameters after corneal refractive surgery in civil aviation student pilots

ObjectiveTo compare high order aberrations and analyze corneal posterior surface stability of student pilots who have undergone corneal refractive surgery, and to evaluate the safety and stability of civil aviation student pilots enrolled after lowering the standard of corneal refractive surgery. MethodsStudent pilots who underwent candidate physical examination and annual physical examination at the Civil Aviation General Hospital and Civil Aviation Flight University of China Medical Appraisal Center from September 2017 to July 2018 were investigated. Fifty student pilots (100 eyes) who did not undergo corneal refractive surgery and had uncorrected visual acuity≥1.0 were randomly selected as a normal control group, and 67 student pilots (131 eyes) who had undergone corneal refractive surgery were selected as an experimental group, including 29 (56 eyes) undergoing femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK), 22 (43 eyes) undergoing laser subepithelial keratomileusis (LASEK), and 16 (32 eyes) undegoing small incision lenticule extraction (SMILE). Uncorrected visual acuity, diopter, contrast sensitivity, tear film break-up time (BUT), and corneal topography were examined. The changes of central anterior chamber depth, eye axis length, and lens thickness before and after surgery were compared. The visual effects and corneal biological parameters of the normal control group, those who had undergone corneal refractive laser surgery, and those who chose different surgical procedures were analyzed. ResultsThere was no significant difference between the normal control group and the experimental group in contrast sensitivity or BUT (P>0.05). In the experimental group, the total high-order aberration, spherical aberration, coma, and trefoil aberration significantly increased 6 months after operation (P<0.05). There were significant differences in total high-order aberration, spherical aberration, and coma between groups (P<0.05), but there was no significant difference in trefoil aberration among the three groups. Compared with the LASEK group, the higher-order aberration and spherical aberration differed significantly in the FS-LASIK group (P<0.05), although coma and trefoil aberration were not significantly different (P>0.05). There was no significant difference in corneal posterior surface height or eye axis length between groups, but lens thickness increased significantly (P<0.05) and central anterior chamber depth decreased significantly (P<0.05). ConclusionCRS is safe and effective for civil aviation student pilots. FS-LASIK can significantly improve the higher order aberration of student pilots after surgery, which is worthy of application and promotion.