LASIK术后特殊设计硬性透气性角膜接触镜再矫正前后的视觉质量探讨

目的观察逆几何形特殊设计的硬性透气性角膜接触镜（RGDRGPCL）改善准分子激光原位角膜磨镶术（LASIK）后视觉质量下降的临床效果并探讨其机制。方法前瞻性病例对照研究。2010年1月至2010年10月期间因LASIK术后视觉质量下降要求验配RGDRGPCL的患者20例（28眼）．采用Pentacam三维眼前节分析仪、CGT-1000对比敏感度测量仪测量角膜波前像差、对比敏感度．询问并记录主观症状。并选择同期普通近视患者15例（30眼），比较两组对象的角膜波前像差。对相关数据进行独立样本t检验、配对样本t检验及直线相关性分析。结果LASIK术后患者总像差、总高阶像差、球差、角膜后表面球差的均方根（RMS）值与普通近视患者比较，差异有统计学意义（t=-7．684、-5．658、-5．342、4．039，P〈0．05）：与自身配戴RGDRGPCL状态下比较，差异也有统计学意义（t=4．510、4．520、3．826、-4．672，P〈0．05）；彗差（水平、垂直）差异无统计学意义。LASIK术后角膜前表面球差值与配戴RGDRGPCL状态下比较，差异有统计学意义（t=4．361，P〈0．01）；配戴RGDRGPCL时的角膜前表面像差与普通近视比较，差异无统计学意义；普通近视患者的总三叶草与LASIK术后（t=-7．464．P〈0．01）及戴镜状态下比较差异有统计学意义（￡=-7．027，P〈0．01）；LASIK术后与配戴RGDRGPCL时的总三叶草比较，差异无统计学意义。患者配戴框架眼镜矫正与配戴RGDRGPCL比较，两者的对比敏感度、眩光对比敏感度差异无统计学意义。LASIK术后配戴RGDRGPCL时的矫正视力与角膜总像差RMS值成负相关关系（r=-0．469，P=0．037），患者戴镜时主观视觉症状改善满意度为95％。结论角膜高阶像差的增加是引起LASIK术后患者视觉质量下降的主要原因之-，术后患者配戴RGDRGPCL时角膜总像差、球差均方根值等明显降低，有利于改善术后患者视觉质量。

Visual quality analysis of post-LASIK patients wearing reverse geometry design rigid gas permeable contact lenses

Objective To investigate the clinical effect of reverse geometry design rigid gas permeable contact lenses （RGDRGPCLs） for improving postoperative visual quality in the patients who had undergone laser in situ keratomileusis （LASIK） and discuss reasons for the decline in visual quality. Methods In this prospective study, 20 patients （28 eyes） who wore RGDRGPCLs after LASIK surgery to improve defective visual quality were chosen during the period of 2010.01-2010.10. A Pentacam three-dimensional anterior segment analyzer and CGT-1000 contrast sensitivity measuring instrument were used to obtain corneal wavefront aberrations, contrast sensitivity and subjective symptoms in patients. Meanwhile, the corneal wavefront aberrations of 15 myopic patients （30 eyes） who were wearing spectacles were compared to those of the postoperative patients with and without RGDRGPCLs. SPSS 13.0 statistical software was used for an independent samples t test, paired samples t test and linear correlation analysis of the related data. Results Comparative root mean square （RMS） values of total aberration, total higher-order aberrration, spherical aberration and posterior corneal spherical aberrations for post-LASIK patients were significantly different when spectacle （t=-7.684, -5.658, -5.342, 4.039, P〈0.05） and RGDRGPCL wearers were compared （t--4.510, 4.520, 3.826, --4.672, all P〈0.05）. No significant difference was found for coma （horizontal, vertical）. Corneal anterior aberrations of postoperative patients were different from RGDRGPCL wearers （t=4.361, P〈0.01）, but there was no significant change found when patients who wore RGDRGPCLs were compared to myopic patients. The total trefoil aberration between myopic and postoperative patients with （t=-7.464, P〈0.01 ） or without RGDRGPCLs wear was statistically significant （t=-7.027, P〈0.01）; however, no difference was found within the postoperative patient group. No difference between contrast sensitivity or glare contrast sensitivity was found among postoperative patients who wore either glasses or RGDRGPCLs. The best corrected visual acuity of postoperative patients wearing RGDRGPCLs negatively correlated to RMS value of corneal total aberration （r=-0.469, P=0.037）. RGDRGPCL wear improved the patient satisfaction rate for visual quality as much as 95%. Conclusion Severe corneal higher-order aberrations caused by LASIK surgery is a major reason for the decline in visual quality. The values of total aberration, spherical aberration and others were reduced by wearing RGDRGPCLs, which can help to improve postoperative visual quality.