老視球差補(bǔ)償性激光切削臨床研究
發(fā)布時(shí)間：2018-08-21 11:41
【摘要】：目的探討老視球差補(bǔ)償性激光切削的有效性、安全性、預(yù)測(cè)性和穩(wěn)定性。 方法2005-2008年在復(fù)旦大學(xué)附屬眼耳鼻喉科醫(yī)院行準(zhǔn)分子激光切削的24名老視患者納入研究(近視患者21名,遠(yuǎn)視患者3名；準(zhǔn)分子激光原位角膜磨鑲術(shù)(laser in situ keratomileusis, LASIK)術(shù)13人23眼,準(zhǔn)分子激光上皮瓣下角膜磨鑲術(shù)(laser subepithelial keratomileusis, LASEK)術(shù)11人19眼),視遠(yuǎn)矯正近視力≤J5。實(shí)驗(yàn)組12名均為女性,平均47.09歲,平均等效球鏡值(spherical equivalent, SE)為-2.98DS。對(duì)照組12名(男5名、女7名,平均48.33歲,術(shù)前平均SE為-5.20DS)與實(shí)驗(yàn)組術(shù)前年齡、SE、ADD值、手術(shù)時(shí)間配對(duì)。實(shí)驗(yàn)組患者主導(dǎo)眼行準(zhǔn)分子激光矯正的目標(biāo)屈光度為-0.25DS,非主導(dǎo)眼的目標(biāo)屈光度為-0.50DS。對(duì)照組患者主導(dǎo)眼目標(biāo)屈光度為-0.25DS,非主導(dǎo)眼目標(biāo)屈光度為-1.OODS。實(shí)驗(yàn)組非主導(dǎo)眼行shotfile軟件補(bǔ)充切削。觀察術(shù)后患者的屈光度、矯正遠(yuǎn)視力(corrected distant visual acuity, CDVA)裸眼遠(yuǎn)視力(uncorrected distant visual acuity, UDVA)、裸眼近視力(uncorrected near visual acuity, UNVA)、視遠(yuǎn)矯正近視力、雙眼同時(shí)視遠(yuǎn)近視力、對(duì)比敏感度(contrast sensitivity, CS)。WFA-1000像差測(cè)量?jī)x測(cè)量全眼像差,觀察球差(spherical aberration, SA)(Z (4,0))術(shù)后早期及遠(yuǎn)期變化。Pentacam測(cè)角膜前表面曲率,計(jì)算2mm及4mm半徑處K值均值(K2mm、K4m),觀察術(shù)后ΔK(K值變化量)的連續(xù)改變即ΔK2(角膜頂點(diǎn)K-K2mm)、ΔK4(K2mm-K4m)的變化。末次隨訪時(shí)間為術(shù)后平均4.5年。SPSS13.0統(tǒng)計(jì)軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析,P0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果實(shí)驗(yàn)組非主導(dǎo)眼術(shù)后3月UNVA為0.20,術(shù)后4.5年為0.40,較術(shù)后3月下降2行(p=0.019)。術(shù)后4.5年非主導(dǎo)眼UNVA優(yōu)于主導(dǎo)眼1行(p=0.041)雙眼視遠(yuǎn)矯正近視力無(wú)差異(p=0.365)。實(shí)驗(yàn)組非主導(dǎo)眼術(shù)后3月、4.5年UDVA差異無(wú)統(tǒng)計(jì)學(xué)意義(p=0.298)；術(shù)后4.5年UDVA較術(shù)前平均提高6.5行(p=0.007),較主導(dǎo)眼術(shù)后4.5年UDVA無(wú)差異(p=O.166)。術(shù)后4.5年,實(shí)驗(yàn)組雙眼同時(shí)視UDVA LogMAR均值為-0.03,對(duì)照組為0.01,實(shí)驗(yàn)組雙眼同時(shí)視UNVA LogMAR均值為0.38,實(shí)驗(yàn)組為0.30；實(shí)驗(yàn)組與對(duì)照組UDVA、UNVA均無(wú)差異(p=0.096,p=0.054)。實(shí)驗(yàn)組術(shù)后4.5年非主導(dǎo)眼UDVA較術(shù)前CDVA平均下降0.6行(p=0.009),無(wú)一人下降超過(guò)2行,術(shù)后CDVA較術(shù)前CDVA無(wú)差異(p=1.000)。實(shí)驗(yàn)組非主導(dǎo)眼術(shù)后6月與術(shù)前各個(gè)空間頻率CS差異無(wú)統(tǒng)計(jì)學(xué)意義(n=9)；術(shù)后4.5年較術(shù)前在空間頻率為1.6及0.7視角無(wú)眩光CS輕度提高(p=0.025,p=0.046；n=12),空間頻率為1.0°視角的眩光CS值有輕度提高(p=0.042,n=11)。實(shí)驗(yàn)組非主導(dǎo)眼預(yù)期SE平均為-0.50DS,術(shù)后4.5年SE值為-0.53DS,與預(yù)期SE無(wú)差異(p=0.268)。實(shí)驗(yàn)組ADD值術(shù)前術(shù)后無(wú)差異,對(duì)照組ADD值術(shù)后較術(shù)前增大(p=0.012),術(shù)后實(shí)驗(yàn)組ADD較對(duì)照組小(p=0.041)。實(shí)驗(yàn)組非主導(dǎo)眼術(shù)后6月SA均值為-0.045μm,術(shù)前SA為-0.190μm,差異有統(tǒng)計(jì)學(xué)意義(p=0.022,n=8)；實(shí)驗(yàn)組非主導(dǎo)眼術(shù)后4.5年SA均值為-0.143μm,較術(shù)前無(wú)差異(p=0.359,n=11),較主導(dǎo)眼球差偏正(p=0.002,n=11)；非主導(dǎo)眼術(shù)后早期較術(shù)前球差偏正,后逐漸正值減少,負(fù)值增加。實(shí)驗(yàn)組非主導(dǎo)眼術(shù)前ΔK2均值為-0.022D,術(shù)后4.5年為0.303D,差異有統(tǒng)計(jì)學(xué)意義(p=0.005,n=9),術(shù)前Δk4均值為0.066D,術(shù)后4.5年為0.362D,差異有統(tǒng)計(jì)學(xué)意義(p=0.010,n=9)。術(shù)后早期ΔK較術(shù)前增大明顯,遠(yuǎn)期ΔK減小回退,ΔK4變化較大。 結(jié)論老視球差補(bǔ)償性激光切削短期有效、安全且預(yù)測(cè)性好,其遠(yuǎn)期有效性及穩(wěn)定性有待擴(kuò)大樣本進(jìn)一步探討。
[Abstract]:Objective to explore the effectiveness, safety, predictability and stability of compensated laser cutting with presbyopic spherical aberration.
Methods From 2005 to 2008, 24 presbyopic patients (21 myopic patients, 3 hyperopic patients, 13 laser in situ keratomileusis (LASIK) and 23 laser subepithelial keratomileusis (LASIK) were included in the study. In the experimental group, 12 patients were all female, mean 47.09 years old, mean spherical equivalent (SE) was - 2.98DS. In the control group, 12 patients (5 males, 7 females, mean 48.33 years old, mean preoperative SE was - 5.20DS) were matched with preoperative age, SE, ADD value and operation time. The refractive index of the dominant eye was -0.25DS and the refractive index of the non-dominant eye was - 0.50DS. The refractive index of the dominant eye was - 0.25DS and the refractive index of the non-dominant eye was - 1.OODS in the control group. Corrected distant visual acuity (CDVA), uncorrected distant visual acuity (UDVA), uncorrected near visual acuity (UNVA), hyperopia corrected near visual acuity, binocular simultaneous visual acuity, contrast sensitivity (CS). WFA-1000 aberration meter measured the whole eye aberration and observed the spherical aberration. (spherical aberration, SA) (Z (4,0)) early and long-term changes after surgery. Pentacam measured corneal anterior surface curvature, calculated the mean of K value at radius 2 mm and 4 mm (K2mm, K4m), observed the continuous changes of K2 (corneal vertex K-K2mm), and K 4 (K2mm-K4m). The mean follow-up time was 4.5 years. SPSS13.0 statistical software. Statistical analysis of data showed that P0.05 was statistically significant.
Results UNVA was 0.20 at 3 months and 0.40 at 4.5 years after surgery, which was 2 rows lower than that at 3 months (p = 0.019). There was no significant difference in near vision (p = 0.365) between non-dominant eyes and dominant eyes (p = 0.041) after 4.5 years (p = 0.298). 4.5 years after operation, the mean value of UDVA LogMAR in both eyes of the experimental group was - 0.03 and that of the control group was 0.01. The mean value of UNVA LogMAR in both eyes of the experimental group was 0.38 and 0.30 respectively. There was no difference between the experimental group and the control group in UDVA and UNVA (p = 0.096, P = 0.054). There was no significant difference in postoperative CDVA between the experimental group and the control group (p = 1.000). There was no significant difference in spatial frequency CS between the experimental group and the control group (n = 9) at 6 months after surgery and at 4.5 years after surgery, compared with the preoperative spatial frequency of 1.6 and 0.7 visual angles. The CS value of glare was slightly increased (p = 0.025, P = 0.046; n = 12), and the CS value of glare was slightly increased (p = 0.042, n = 11) at the spatial frequency of 1.0 degrees. The average expected SE value of non-dominant eyes in the experimental group was - 0.50DS, 4.5 years after operation was - 0.53DS, which was not different from the expected SE value (p = 0.268). The ADD value of the experimental group was not different before and after operation, but that of the control group was higher than that before operation (p = 0.012). ADD in the experimental group was smaller than that in the control group (p = 0.041). The mean SA in the non-dominant eye was - 0.045 micron at 6 months after operation and - 0.190 micron before operation, and the difference was statistically significant (p = 0.022, n = 8); the mean SA in the non-dominant eye was - 0.143 micron at 4.5 years after operation, which was not significantly different from that before operation (p = 0.359, n = 11), and was positively different from that of the dominant eye (p = 0.002, n = 11). The mean value of preoperative K2 was - 0.022D in the experimental group and 0.303D in the postoperative 4.5 years. The difference was statistically significant (p = 0.005, n = 9). The mean value of preoperative K4 was 0.066D, and 0.362D in the postoperative 4.5 years. The difference was statistically significant (p = 0.010, n = 9). The delta K decreases and the K4 changes greatly.
Conclusion Old parallax compensated laser ablation is effective, safe and predictive in the short term. Its long-term effectiveness and stability need to be further explored by enlarging the sample.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R779.63
本文編號(hào)：2195601
[Abstract]:Objective to explore the effectiveness, safety, predictability and stability of compensated laser cutting with presbyopic spherical aberration.
Methods From 2005 to 2008, 24 presbyopic patients (21 myopic patients, 3 hyperopic patients, 13 laser in situ keratomileusis (LASIK) and 23 laser subepithelial keratomileusis (LASIK) were included in the study. In the experimental group, 12 patients were all female, mean 47.09 years old, mean spherical equivalent (SE) was - 2.98DS. In the control group, 12 patients (5 males, 7 females, mean 48.33 years old, mean preoperative SE was - 5.20DS) were matched with preoperative age, SE, ADD value and operation time. The refractive index of the dominant eye was -0.25DS and the refractive index of the non-dominant eye was - 0.50DS. The refractive index of the dominant eye was - 0.25DS and the refractive index of the non-dominant eye was - 1.OODS in the control group. Corrected distant visual acuity (CDVA), uncorrected distant visual acuity (UDVA), uncorrected near visual acuity (UNVA), hyperopia corrected near visual acuity, binocular simultaneous visual acuity, contrast sensitivity (CS). WFA-1000 aberration meter measured the whole eye aberration and observed the spherical aberration. (spherical aberration, SA) (Z (4,0)) early and long-term changes after surgery. Pentacam measured corneal anterior surface curvature, calculated the mean of K value at radius 2 mm and 4 mm (K2mm, K4m), observed the continuous changes of K2 (corneal vertex K-K2mm), and K 4 (K2mm-K4m). The mean follow-up time was 4.5 years. SPSS13.0 statistical software. Statistical analysis of data showed that P0.05 was statistically significant.
Results UNVA was 0.20 at 3 months and 0.40 at 4.5 years after surgery, which was 2 rows lower than that at 3 months (p = 0.019). There was no significant difference in near vision (p = 0.365) between non-dominant eyes and dominant eyes (p = 0.041) after 4.5 years (p = 0.298). 4.5 years after operation, the mean value of UDVA LogMAR in both eyes of the experimental group was - 0.03 and that of the control group was 0.01. The mean value of UNVA LogMAR in both eyes of the experimental group was 0.38 and 0.30 respectively. There was no difference between the experimental group and the control group in UDVA and UNVA (p = 0.096, P = 0.054). There was no significant difference in postoperative CDVA between the experimental group and the control group (p = 1.000). There was no significant difference in spatial frequency CS between the experimental group and the control group (n = 9) at 6 months after surgery and at 4.5 years after surgery, compared with the preoperative spatial frequency of 1.6 and 0.7 visual angles. The CS value of glare was slightly increased (p = 0.025, P = 0.046; n = 12), and the CS value of glare was slightly increased (p = 0.042, n = 11) at the spatial frequency of 1.0 degrees. The average expected SE value of non-dominant eyes in the experimental group was - 0.50DS, 4.5 years after operation was - 0.53DS, which was not different from the expected SE value (p = 0.268). The ADD value of the experimental group was not different before and after operation, but that of the control group was higher than that before operation (p = 0.012). ADD in the experimental group was smaller than that in the control group (p = 0.041). The mean SA in the non-dominant eye was - 0.045 micron at 6 months after operation and - 0.190 micron before operation, and the difference was statistically significant (p = 0.022, n = 8); the mean SA in the non-dominant eye was - 0.143 micron at 4.5 years after operation, which was not significantly different from that before operation (p = 0.359, n = 11), and was positively different from that of the dominant eye (p = 0.002, n = 11). The mean value of preoperative K2 was - 0.022D in the experimental group and 0.303D in the postoperative 4.5 years. The difference was statistically significant (p = 0.005, n = 9). The mean value of preoperative K4 was 0.066D, and 0.362D in the postoperative 4.5 years. The difference was statistically significant (p = 0.010, n = 9). The delta K decreases and the K4 changes greatly.
Conclusion Old parallax compensated laser ablation is effective, safe and predictive in the short term. Its long-term effectiveness and stability need to be further explored by enlarging the sample.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R779.63
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 魯靜;周躍華;鄭燕;;近視眼波前像差對(duì)對(duì)比敏感度的影響[J];眼科新進(jìn)展;2007年09期
，本文編號(hào)：2195601
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