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目的比较常规准分子激光原位角膜磨镶术(LaserinsituKeratomileusis,LASIK)和角膜波前像差引导的个性化准分子激光原位角膜磨镶术(cornealwavefrontaberrationsguidedLASIK,CW-GLASIK)治疗近视眼术后患者视觉质量的变化,探讨角膜波前像差引导的个性化准分子激光原位角膜磨镶术对对比敏感度和眩光以及角膜波前像差的影响,评价其手术的有效性。方法选取拟做LASIK手术的近视眼患者(近视球镜≤-10.00D,散光≤-2.5D)随机分成两组,一组行常规LASIK手术,另一组行角膜波前像差引导的个性化LASIK手术,手术均采用德国Schwind公司EsirisT准分子激光治疗系统,微角膜刀采用MoriaLSK-ONE气动平推刀,对比敏感度检查采用VectorVisionCSV-1000HGT,角膜波前像差分析采用德国OPTIKON2000KeratronScout分析仪。手术光学区直径为(6.0-7.0)mm,波前像差分析为6mm瞳孔直径。术前、术后检查裸眼视力、屈光度、对比敏感度及角膜地形图并进行波前像差分析。结果术后两组的裸眼视力均达到术前矫正视力,无显著性差异(p>0.05)。两组术后1m时对比敏感度及眩光和术前比较均明显下降,差异有显著性(p<0.05),术后3m时各空间频率对比敏感度和眩光均有所恢复,但均未达到术前水平,角膜波前像差引导的个性化LASIK组在各空间频率的对比敏感度和眩光同术前比较,无显著性差异,LASIK组在各空间频率的对比敏感度和眩光和术前比较差异有显著性(p<0.05),角膜波前像差引导的个性化LASIK组在中(6c/d)、高(12c/d、18c/d)空间频率的对比敏感度和眩光明显好于常规LASIK组,有显著性差异(p<0.05)。两组术后1m、3m角膜彗差、球差均比术前增大,但角膜波前像差引导的个性化LASIK组较常规LASIK组增大幅度小,差异有统计学意义(p<0.05)。结论角膜波前像差引导的LASIK手术能有效地矫正近视,改善近视眼患者术后对比敏感度,降低术后彗差和球差,手术效果稳定、安全。
Objective To compare the clinical effects of corneal wave-guided laser stapler LASIK (CW-GLASIK) guided by laser insular keratomileusis (LASIK) and corneal wavefront aberration To investigate the effect of corneal wavefront aberration guided personalized in situ keratomileusis on contrastive sensitivity and glare and corneal wavefront aberration, evaluate the effectiveness of the surgery. Methods The patients with myopia who underwent LASIK surgery (myopic spherical ≤-10.00D, astigmatism ≤-2.5D) were randomly divided into two groups. One group underwent routine LASIK and the other group underwent corneal wavefront aberration-guided individuation LASIK surgery and surgery were performed using the EsirisT excimer laser treatment system from Germany’s Schwind Company. The micro-corneal knife was powered by the MoriaLSK-ONE Pneumatic Flat Knife. VectorVisionCSV-1000HGT was used for the contrast sensitivity test and the German OPTIKON2000 KeratronScout analyzer was used for the analysis of corneal wavefront aberration. The diameter of the surgical optical zone was (6.0-7.0) mm and the wavefront aberration was 6 mm pupil diameter. Preoperative and postoperative uncorrected visual acuity, refraction, contrast sensitivity and corneal topography and wavefront analysis. Results The visual acuity of uncorrected visual acuity reached the preoperative corrected visual acuity in both groups, no significant difference (p> 0.05). The contrast sensitivity and glare at 1m postoperatively decreased significantly compared with that before operation (p <0.05). After 3m postoperatively, the contrast sensitivity and glare of each spatial frequency recovered but did not reach There was no significant difference between the preoperative level and the corneal wavefront aberration-guided LASIK group in each spatial frequency of contrast sensitivity and glare compared with preoperative, LASIK group in each spatial frequency contrast sensitivity and glare and preoperative (P <0.05). Contrast sensitivities and glare in the spatial frequency of (6c / d) and (12c / d, 18c / d) were significantly better in corneal wavefront aberrated LASIK group In the conventional LASIK group, there was a significant difference (p <0.05). The corneal coma and spherical aberration increased at 1m and 3m postoperatively in both groups, but there was a small increase in corneal wavefront aberration-induced LASIK group compared with the conventional LASIK group (p <0.05 ). Conclusions LASIK guided by corneal wavefront aberration can effectively correct myopia, improve contrast sensitivity and reduce postoperative coma and spherical aberration in patients with myopia, and the operation effect is stable and safe.