Q值优化非球面切削单眼视LASIK术后视觉效果分析

目的：评价利用Q值优化的非球面切削单眼视LASIK手术方式矫正近视散光联合老视的单眼及双眼视觉效果。方法：选择2006-08-01/2009-03-31之间在我院利用Carl Zeiss Meditec CRS-Master软件及MEL80准分子激光进行Q值优化的非球面切削单眼视LASIK手术的近视或者近视散光联合老视的40名连续随访患者（80眼），术后1d;1wk;1,3,6mo及1a进行验光、单眼及双眼视近及视远裸眼视力、角膜曲率、像差检查，术后1wk;1,3,6mo及1a进行对比敏感度及立体视觉检查进行视觉质量评估， 并在术后6mo进行患者近距离工作视觉疲劳问卷调查。结果：Q值优化的非球面切削单眼视LASIK术后视觉质量研究结果如下：术后6mo等效球镜屈光度与目标屈光度相比92%在±0.50D以内，99%在±1.00D，术后3mo~1a的屈光值的变化为-0.06±0.37D。术后1mo主视眼的裸眼远视力95%达到20/20；双眼裸眼近视力87.5%达到J2，100%达到J5。术后1wk, 双眼对比敏感度与术前矫正后相比有下降趋势,术后1~3mo逐渐恢复。术后1wk时,近立体视锐度有所降低(P<0.05),其他立体视锐度均无明显改变(均为P>0.05)。术后患者近距离工作视疲劳症状明显改善。结论：Q值优化的非球面切削单眼视LASIK手术方式，对于中度近视至高度近视及散光联合老视患者，是一种耐受性好，稳定安全有效的治疗方法。

Postoperative visual outcomes and analysis of Q value guided non-linear aspheric monovision LASIK for myopic astigmatism and presbyopia

AIM: To evaluate the monocular and binocular visual outcomes in myopic astigmatism and presbyopia patients, after laser in situ keratomileusis (LASIK) with a Q value guided non-linear aspheric monovision protocol. METHODS: A retrospective and non-comparative study was performed based upon 80 eyes of 40 consecutive patients with myopic astigmatism and presbyopia, who underwent Q value guided non-linear aspheric monovision LASIK by the Carl Zeiss Meditec CRS-Master software and MEL 80 excimer laser, from August 2006 to March 2009. At the 1 day, 1 week, 1 month, 3, 6 months, 1 year postoperative visits, the examinations were carried out in terms of distance and near, monocular and binocular visual acuity, manifest refraction, topography and keratometry, wavefront assessment, contrast sensitivity, and stereopsis. In addition, questionnaires of asthenopic symptoms due to near-distance work were also implemented for all the patients preoperatively and 6 months postoperatively. RESULTS: Six months postoperatively 92% and 99% of the differences between spherical equivalent(SE) and target SE were in the ranges of 0.50D and 1.00D, respectively. 3 months to 1 year postoperatively, the variation of SE was -0.06±0.37D. 1 month postoperatively, achieved monocular uncorrected distance visual acuity of 20/20 was in 95% of distance eyes, and binocular uncorrected near visual acuity of J2 in 87.5%, and J5 in 100% of patients. 1 week postoperatively, a slight decrease in contrast sensitivity and stereopsis(P<0.05) was observed in binocular. 1 to 3 months later contrast sensitivity increased, but there was no change in stereopsis 1 month postoperatively. The average change in refraction between 3 months and 1 year was -0.06±0.31D. Asthenopic symptoms due to near-distance work were improved. CONCLUSION: Q value guided non-linear aspheric monovision LASIK is a valid,well-tolerated, stable, and effective option for myopic patients with presbyopia in moderate to high myopic astigmatism. Good visual outcomes could be obtained with this procedure. 