Q值调整联合单眼视LASIK治疗近视伴老视的疗效

目的：:评价Q值调整联合单眼视LASIK治疗近视伴老视的效果。方法：:回顾性病例对照研究。纳入2017年2月至2018年12月在上海爱尔眼科医院国际屈光中心实施老视手术患者。34例非主视眼采用Q值调整联合单眼视LASIK治疗老视，非主视眼设定目标Q值比术前Q值向更负的方向变化0.3～0.5，保留的屈光度在-1.00～-...

Presbyopic LASIK Using an Improved Monocular Ablation Profile Procedure with Q-Factor Modulation in Myopic Eyes

Objective: To evaluate the effectiveness of an improved monocular ablation profile procedure with Q-factor modulation treatment in myopic eyes of presbyopic patients. Methods: This was a retrospective case control study. Thirty-four presbyopic patients underwent an improved monocular ablation profile procedure with Q-factor modulation for the nondominant eyes: Target Q-factor of 0.3-0.5 more negative than the preoperative Q-factor, and a target refractive error of -1.00- -0.25 D. Another 43 presbyopic patients who underwent monocular treatment for the nondominant eyes during the same period were paired for age and refractive state. The dominant eyes were fully corrected. The uncorrected distance visual acuity (NCDVA),intermediate distance visual acuity (NCIVA), and near distance visual acuity (NCNVA) of the nondominant eye and both eyes were recorded. The corneal curvature in a 3 mm radius, the Q-factor of the corneal surface, total aberrations, higher- and lower-order aberrations, spherical aberrations, corneal spherical aberrations, defocus and coma aberrations were recorded. Independent sample t-test were used to compare the continuous variables between two groups, and Spearman correlation test were used to show the correlation between NCNVA and defocus, postoperative Q value, and the pupil diameter changes. Results: Three months after surgery, NCNVA of the improved monocular ablation group was better than that of the control group (t=0.597, P=0.021), but the differences in NCDVA and NCIVA were not statistically significant. For both eyes, the NCNVA (LogMAR) of 93% of patients in the improved monocular ablation group was 0 or better, while the percentage in the control group was 86% (χ2 =27.127, P<0.001). Compared to the control group, the total aberrations, lower-order aberrations, corneal spherical aberrations, and defocus were higher in the monocular ablation profile group (t=-2.210, P=0.032; t=-2.135, P=0.038; t=-2.108, P=0.038, t=-2.190, P=0.034). For all 77 patients, NCNVA of the nondominant eye was negatively correlated with defocus, postoperative Q-factor of the anterior cornea and the change in pupil diameter when accommodation occurred (r1=-0.251, P1=0.028; r2=-0.543, P2<0.001; r3=-0.417, P3<0.001). Conclusions: The improved monocular ablation profile with Q-factor modulation treatment in myopic eyes of presbyopic patients can improve near vision without compromising far vision. The modulation of the Q-factor to a more negative value can improve near visual acuity by increasing central corneal curvature, defocus, and corneal spherical aberrations.