中华眼视光学与视觉科学杂志
中華眼視光學與視覺科學雜誌
중화안시광학여시각과학잡지
CHINESE JOURNAL OF OPTOMETRY OPHTHALMOLOGY AND VISUAL SCIENCE
2010年
1期
5-10
,共6页
李莹%李俏%龙琴%罗岩%艾凤荣
李瑩%李俏%龍琴%囉巖%艾鳳榮
리형%리초%룡금%라암%애봉영
近视%角膜磨镶术,激光原位%角膜磨镶术,上皮下,激光%角膜磨镶术,激光原位,微型角膜刀%波前像差%视觉质量
近視%角膜磨鑲術,激光原位%角膜磨鑲術,上皮下,激光%角膜磨鑲術,激光原位,微型角膜刀%波前像差%視覺質量
근시%각막마양술,격광원위%각막마양술,상피하,격광%각막마양술,격광원위,미형각막도%파전상차%시각질량
Myopia%Keratomileusis,laser in situ%Keratomileusis,subepithelial,laserassisted%Keratomileusis,laser in situ,epipolis%Wavefront aberration%Quality of vision
目的 比较角膜表层与基质层屈光手术后高阶像差等客观指标以及主观视觉主诉,并分析术后主观视觉感受与视觉质量检查的相关性.方法 选择61例行准分子激光治疗的患者(116眼)进行分析,接受准分子激光原位角膜磨镶术(LASIK)患者45例(84眼),接受新型表层手术(ASA)16例(32眼).LASIK组术前等效球镜度(SE)范围为-1.25～-8.75 D,平均为(-5.85±1.77)D;ASA手术组术前SE范围为-2.00～-9.25 D,平均为(-5.38±1.83)D.术前及术后第1、第3、第6个月检查裸眼视力(UC-VA)、最佳矫正视力(BCVA)、球镜及柱镜度数、SE以及波前像差(WA)等.术后第1、第3、第6个月,由同一名医师询问患者术后总体评价、术后与术前最佳矫正视力时的视觉质最及视觉症状.采用独立样本t检验、配对样本t检验、Pearson相关性分析及一元线性回归分析等对所得数据进行统计学分析.结果 术后第1个月时,ASA组C7绝对值、RMSh、RMS3、RMS6均显著小于LASIK组(0.17 vs0.32,0.39 vs 0.50,0.29 vs 0.38,0.07 vs 0.09,P均<0.05),但RMSh的差异更为显著(0.39 vs 0.50,P<0.01);术后第3个月、第6个月时差异项减少.术后早期,LASIK组白天及夜间开车容易程度、白天远视力、夜间视力、夜间眩光、总体视力的评分显著高于ASA组,两组评分差异有统计学意义(P<0.05);术后第6个月,两组评分差异无统计学意义.同术前戴镜相比,白天远视力是患者认为优于术前的最显著项目,眩光和夜视质量下降是患者手术后早期的主诉.术后早期SE和球镜度变化值越大,夜间开车容易程度、夜间眩光、夜间视力评分越差.夜视症状随时间延长明显好转.术后早期总高阶像差、彗差和球差增大程度越大,患者夜间眩光越显著.结论 术后早期,ASA组患者视觉质量评分稍差于LASIK组,但第6个月时差异不显著.两者手术效果相当.术后早期,SE、球镜度、高阶像差的变化值越大,夜间视觉质量越差,夜间眩光越显著.
目的 比較角膜錶層與基質層屈光手術後高階像差等客觀指標以及主觀視覺主訴,併分析術後主觀視覺感受與視覺質量檢查的相關性.方法 選擇61例行準分子激光治療的患者(116眼)進行分析,接受準分子激光原位角膜磨鑲術(LASIK)患者45例(84眼),接受新型錶層手術(ASA)16例(32眼).LASIK組術前等效毬鏡度(SE)範圍為-1.25～-8.75 D,平均為(-5.85±1.77)D;ASA手術組術前SE範圍為-2.00～-9.25 D,平均為(-5.38±1.83)D.術前及術後第1、第3、第6箇月檢查裸眼視力(UC-VA)、最佳矯正視力(BCVA)、毬鏡及柱鏡度數、SE以及波前像差(WA)等.術後第1、第3、第6箇月,由同一名醫師詢問患者術後總體評價、術後與術前最佳矯正視力時的視覺質最及視覺癥狀.採用獨立樣本t檢驗、配對樣本t檢驗、Pearson相關性分析及一元線性迴歸分析等對所得數據進行統計學分析.結果 術後第1箇月時,ASA組C7絕對值、RMSh、RMS3、RMS6均顯著小于LASIK組(0.17 vs0.32,0.39 vs 0.50,0.29 vs 0.38,0.07 vs 0.09,P均<0.05),但RMSh的差異更為顯著(0.39 vs 0.50,P<0.01);術後第3箇月、第6箇月時差異項減少.術後早期,LASIK組白天及夜間開車容易程度、白天遠視力、夜間視力、夜間眩光、總體視力的評分顯著高于ASA組,兩組評分差異有統計學意義(P<0.05);術後第6箇月,兩組評分差異無統計學意義.同術前戴鏡相比,白天遠視力是患者認為優于術前的最顯著項目,眩光和夜視質量下降是患者手術後早期的主訴.術後早期SE和毬鏡度變化值越大,夜間開車容易程度、夜間眩光、夜間視力評分越差.夜視癥狀隨時間延長明顯好轉.術後早期總高階像差、彗差和毬差增大程度越大,患者夜間眩光越顯著.結論 術後早期,ASA組患者視覺質量評分稍差于LASIK組,但第6箇月時差異不顯著.兩者手術效果相噹.術後早期,SE、毬鏡度、高階像差的變化值越大,夜間視覺質量越差,夜間眩光越顯著.
목적 비교각막표층여기질층굴광수술후고계상차등객관지표이급주관시각주소,병분석술후주관시각감수여시각질량검사적상관성.방법 선택61례행준분자격광치료적환자(116안)진행분석,접수준분자격광원위각막마양술(LASIK)환자45례(84안),접수신형표층수술(ASA)16례(32안).LASIK조술전등효구경도(SE)범위위-1.25～-8.75 D,평균위(-5.85±1.77)D;ASA수술조술전SE범위위-2.00～-9.25 D,평균위(-5.38±1.83)D.술전급술후제1、제3、제6개월검사라안시력(UC-VA)、최가교정시력(BCVA)、구경급주경도수、SE이급파전상차(WA)등.술후제1、제3、제6개월,유동일명의사순문환자술후총체평개、술후여술전최가교정시력시적시각질최급시각증상.채용독립양본t검험、배대양본t검험、Pearson상관성분석급일원선성회귀분석등대소득수거진행통계학분석.결과 술후제1개월시,ASA조C7절대치、RMSh、RMS3、RMS6균현저소우LASIK조(0.17 vs0.32,0.39 vs 0.50,0.29 vs 0.38,0.07 vs 0.09,P균<0.05),단RMSh적차이경위현저(0.39 vs 0.50,P<0.01);술후제3개월、제6개월시차이항감소.술후조기,LASIK조백천급야간개차용역정도、백천원시력、야간시력、야간현광、총체시력적평분현저고우ASA조,량조평분차이유통계학의의(P<0.05);술후제6개월,량조평분차이무통계학의의.동술전대경상비,백천원시력시환자인위우우술전적최현저항목,현광화야시질량하강시환자수술후조기적주소.술후조기SE화구경도변화치월대,야간개차용역정도、야간현광、야간시력평분월차.야시증상수시간연장명현호전.술후조기총고계상차、혜차화구차증대정도월대,환자야간현광월현저.결론 술후조기,ASA조환자시각질량평분초차우LASIK조,단제6개월시차이불현저.량자수술효과상당.술후조기,SE、구경도、고계상차적변화치월대,야간시각질량월차,야간현광월현저.
Objective To compare higher order aberrations (HOA) and visual quality after corneal surface and stromal ablation surgeries;to evaluate the relationship between subjective visual perception and objective examination results of visual quality. Methods This prospective study in- cluded 116 eyes of 61 patients who underwent refractive surgery;84 eyes of 45 patients underwent laser in situ keratomileusis (LASIK) and 32 eyes of 16 patients underwent advanced surface ablation (ASA). The spherical equivalent (SE) of the LASIK group ranged from -1.25 to -8.75 D, average was (-5.85±1.77)D;the SE of the ASA group was -2.00 to -9.25 D, average was (-5.38±1.83)D. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BCVA), spherical and cylindrical values, SE, and wavefront aberrations of patients were recorded before ablation and 1, 3, and 6 months after ablation. A general evaluation and a comparison of pre- and postoperative visual quality and symptoms were done by the same clinician 1, 3, and 6 months after ablation surgery. Results C7, RMS3, RMS6, and RMSh of the ASA group were significantly smaller than that of the LASIK group 1 month after surgery (0.17 vs 0.32, 0.39 vs 0.50, 0.29 vs 0.38, 0.07 vs 0.09, P<0.05). Differences between the groups were smaller 3 and 6 months after surgery. Early postopera- tive scales of driving (diurnal, 2.92 vs 3.44, P<0.01;nocturnal, 2.92 vs 3.19, P<0.05), diurnal distant sight vision (3.40 vs 4.05, P<0.01), nocturnal vision (3.11 vs 3.60, P<0.01), glare (2.70 vs 2.87, P< 0.01) and general vision (3.40 vs 3.95, P<0.01) were lower in ASA group than in LASIK group, while symptoms for the two groups had no significant differences. The scales between the groups 6 months after surgery had no significant differences. Compared with best spectacle corrected vision preopera- tively, diurnal vision improved in most patients, but most patients complained about glare and noc- turnal vision. Early postoperative changes in SE and spherical values negatively correlated with noc- tamai driving, glare, and nocturnal vision vales. Nocturnal symptoms improved during the follow-up period. Symptoms of glare positively correlated with postoperative coma, spherical aberration, and HOA. Conclusion The HOA of the ASA group was smaller than that of the LASIK group. Early postoperative visual quality scales for the ASA group were lower than that of the LASIK group, but the difference disappeared 6 months post-surgery. Larger early postoperative changes in SE, spherical values, and HOA correlated with worse nocturnal visual quality and glare.
