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
2011年
1期
17-22
,共6页
樊容%邸玉兰%邱岩%翟国光%屈哲%李耀宇
樊容%邸玉蘭%邱巖%翟國光%屈哲%李耀宇
번용%저옥란%구암%적국광%굴철%리요우
偏心切削%高阶像差%彗差%角膜磨镶术,激光原位
偏心切削%高階像差%彗差%角膜磨鑲術,激光原位
편심절삭%고계상차%혜차%각막마양술,격광원위
Decentred ablation%Higher-order aberrations%Coma aberration%Keratomileusis,laser in situ
目的 分析因传统准分子激光原位角膜磨镶术(LASIK)和波前像差引导的LASIK(波前引导LASIK)偏心切削引发视觉质量下降的病例中,其高阶像差分布特征和偏心切削程度的评价.方法 回顾性病例对照研究.初次LASIK术后(包括传统LASIK和波前引导LASIK)出现重影和星芒等视觉症状的患者40例(48眼),术后复诊3个月以上[复诊期限:波前引导组平均为9个月(4至26个月),传统组平均为24个月(5个月至6年)],屈光度稳定在±1.00 D以内者,除外过矫、欠矫和眼表及眼内疾患导致的视力下降,行WaveScan(3.62版)波前像差仪检查.本研究选取了这部分患者中初次LASIK术后主导像差为彗差(垂直彗差或水平彗差)的26例(28眼),分析检测所得高阶像差结果,并测定术中偏心的切削中心相对瞳孔中心在水平方向(X轴)、垂直方向(Y轴)和矢量的偏移.将波前像差引导LASIK组的术前与术后结果采用配对t检验或者配对秩和检验进行比较;波前像差引导LASIK组术后与传统LASIK组术后结果采用独立样本t检验或者独立样本秩和检验进行比较.结果 波前引导组的总高阶像差均方根值(RMS)由(0.425±0.192)μm增加至术后的(1.262±0.590)μm,增加了1.96倍.总彗差RMS值由(0.190±0.114)μm增加至术后的(0.686±0.315)μm,增加了 2.61倍.水平彗差RMS值由(0.118±0.061)μm增加至术后的(0.257±0.237)μm,增加了1.17倍;垂直彗差RMS值由(0.130±0.122)μm增加至术后的(0.587±0.329)μm,增加了3.51倍.初次LASIK术后的水平彗差明显小于垂直彗差(Z=-2.803,P=0.004).传统组的总高阶像差、总慧差与波前引导组比较,差异无统计学意义,但总慧差占总高阶像差的比例,两组差异有统计学意义(t=-1.548,P=0.007).偏心切削量水平方向(X轴)位移右眼为(0.65±0.38)mm,左眼为(0.90±0.35)mm;垂直方向(Y轴)位移右眼为(0.80±0.30)mm,左眼为(0.53±0.34)mm;矢量位移右眼为(1.11±0.25)mm,左眼为(1.13±0.22)mm.全部28眼矢量位移均＞0.5 mm,71%的患眼切削中心偏移瞳孔中心的距离＞1.0 mm,矢量位移程度是LASIK术后无视觉症状人群的2.02倍.右眼在垂直方向(Y轴)的位移大于左眼(t=2.157,P=0.040)结论由于偏心切削引发的LASIK术后视觉质量下降病例中,高阶像差和总彗差明显增加,垂直彗差增加大于水平彗差;其偏心切削的程度属于中度和重度偏移.因此,偏心切削是LASIK术后视觉质量下降的主要原因之一.
目的 分析因傳統準分子激光原位角膜磨鑲術(LASIK)和波前像差引導的LASIK(波前引導LASIK)偏心切削引髮視覺質量下降的病例中,其高階像差分佈特徵和偏心切削程度的評價.方法 迴顧性病例對照研究.初次LASIK術後(包括傳統LASIK和波前引導LASIK)齣現重影和星芒等視覺癥狀的患者40例(48眼),術後複診3箇月以上[複診期限:波前引導組平均為9箇月(4至26箇月),傳統組平均為24箇月(5箇月至6年)],屈光度穩定在±1.00 D以內者,除外過矯、欠矯和眼錶及眼內疾患導緻的視力下降,行WaveScan(3.62版)波前像差儀檢查.本研究選取瞭這部分患者中初次LASIK術後主導像差為彗差(垂直彗差或水平彗差)的26例(28眼),分析檢測所得高階像差結果,併測定術中偏心的切削中心相對瞳孔中心在水平方嚮(X軸)、垂直方嚮(Y軸)和矢量的偏移.將波前像差引導LASIK組的術前與術後結果採用配對t檢驗或者配對秩和檢驗進行比較;波前像差引導LASIK組術後與傳統LASIK組術後結果採用獨立樣本t檢驗或者獨立樣本秩和檢驗進行比較.結果 波前引導組的總高階像差均方根值(RMS)由(0.425±0.192)μm增加至術後的(1.262±0.590)μm,增加瞭1.96倍.總彗差RMS值由(0.190±0.114)μm增加至術後的(0.686±0.315)μm,增加瞭 2.61倍.水平彗差RMS值由(0.118±0.061)μm增加至術後的(0.257±0.237)μm,增加瞭1.17倍;垂直彗差RMS值由(0.130±0.122)μm增加至術後的(0.587±0.329)μm,增加瞭3.51倍.初次LASIK術後的水平彗差明顯小于垂直彗差(Z=-2.803,P=0.004).傳統組的總高階像差、總慧差與波前引導組比較,差異無統計學意義,但總慧差佔總高階像差的比例,兩組差異有統計學意義(t=-1.548,P=0.007).偏心切削量水平方嚮(X軸)位移右眼為(0.65±0.38)mm,左眼為(0.90±0.35)mm;垂直方嚮(Y軸)位移右眼為(0.80±0.30)mm,左眼為(0.53±0.34)mm;矢量位移右眼為(1.11±0.25)mm,左眼為(1.13±0.22)mm.全部28眼矢量位移均＞0.5 mm,71%的患眼切削中心偏移瞳孔中心的距離＞1.0 mm,矢量位移程度是LASIK術後無視覺癥狀人群的2.02倍.右眼在垂直方嚮(Y軸)的位移大于左眼(t=2.157,P=0.040)結論由于偏心切削引髮的LASIK術後視覺質量下降病例中,高階像差和總彗差明顯增加,垂直彗差增加大于水平彗差;其偏心切削的程度屬于中度和重度偏移.因此,偏心切削是LASIK術後視覺質量下降的主要原因之一.
목적 분석인전통준분자격광원위각막마양술(LASIK)화파전상차인도적LASIK(파전인도LASIK)편심절삭인발시각질량하강적병례중,기고계상차분포특정화편심절삭정도적평개.방법 회고성병례대조연구.초차LASIK술후(포괄전통LASIK화파전인도LASIK)출현중영화성망등시각증상적환자40례(48안),술후복진3개월이상[복진기한:파전인도조평균위9개월(4지26개월),전통조평균위24개월(5개월지6년)],굴광도은정재±1.00 D이내자,제외과교、흠교화안표급안내질환도치적시력하강,행WaveScan(3.62판)파전상차의검사.본연구선취료저부분환자중초차LASIK술후주도상차위혜차(수직혜차혹수평혜차)적26례(28안),분석검측소득고계상차결과,병측정술중편심적절삭중심상대동공중심재수평방향(X축)、수직방향(Y축)화시량적편이.장파전상차인도LASIK조적술전여술후결과채용배대t검험혹자배대질화검험진행비교;파전상차인도LASIK조술후여전통LASIK조술후결과채용독립양본t검험혹자독립양본질화검험진행비교.결과 파전인도조적총고계상차균방근치(RMS)유(0.425±0.192)μm증가지술후적(1.262±0.590)μm,증가료1.96배.총혜차RMS치유(0.190±0.114)μm증가지술후적(0.686±0.315)μm,증가료 2.61배.수평혜차RMS치유(0.118±0.061)μm증가지술후적(0.257±0.237)μm,증가료1.17배;수직혜차RMS치유(0.130±0.122)μm증가지술후적(0.587±0.329)μm,증가료3.51배.초차LASIK술후적수평혜차명현소우수직혜차(Z=-2.803,P=0.004).전통조적총고계상차、총혜차여파전인도조비교,차이무통계학의의,단총혜차점총고계상차적비례,량조차이유통계학의의(t=-1.548,P=0.007).편심절삭량수평방향(X축)위이우안위(0.65±0.38)mm,좌안위(0.90±0.35)mm;수직방향(Y축)위이우안위(0.80±0.30)mm,좌안위(0.53±0.34)mm;시량위이우안위(1.11±0.25)mm,좌안위(1.13±0.22)mm.전부28안시량위이균＞0.5 mm,71%적환안절삭중심편이동공중심적거리＞1.0 mm,시량위이정도시LASIK술후무시각증상인군적2.02배.우안재수직방향(Y축)적위이대우좌안(t=2.157,P=0.040)결론유우편심절삭인발적LASIK술후시각질량하강병례중,고계상차화총혜차명현증가,수직혜차증가대우수평혜차;기편심절삭적정도속우중도화중도편이.인차,편심절삭시LASIK술후시각질량하강적주요원인지일.
Objective To study cases with visual complaints caused by ablation induced decentration after traditional laser in situ keratomileusis (LASIK) and wavefront-guided LASIK. To evalulate the distribution of higher-order aberrations and the degree of decentered ablation. Methods This was a retrospective case control study. Forty-eight eyes of 40 patients with double vision,starburst and other visual symptoms were checked with WaveScan (3.62 version) after LASIK. All postoperative cases were followed for more than 3 months. Their refractive errors were within ±1.0 D and stable except for overcorrection, under correction, and other eye diseases. The period of observation was (9.3±5.7)months (range: 4-26 months) for the wavefront-guided LASIK group, and (24.1±22.7)months (range: 5-72 months) for the traditional LASIK group. For this study, 28 eyes of 26 patients were selected whose dominant aberrations were vertical or horizontal comas due to decentered ablation after LASIK surgery. Higher-order aberrations in post-LASIK eyes were analyzed.The variations between the ablation center with the pupil center were measured and plotted on the horizontal (X-axis) and vertical (Y-axis) and the vector shift was drawn. The preoperative and postoperative results of the wavefront-guided LASIK group were compared (using a paired samples t test or Wilcoxon signed rank test). The postoperative results for the wavefront-guided LASIK group and tranditional LASIK group were also compared (using an independent samples t test or a Mann-Whitney test). Results The higher-order aberration root mean squares (RMS) value for the postoperative wavefront-guided eyes was (1.262±0.590)μm, which was 1.96 times greater than the average for preoperative eyes. The total coma RMS value of the postoperative wavefront-guided eyes was (0.686±0.315)μm, which was 2.61 times greater than the average for preoperative eyes. There was a 3.51 time increase in vertical coma and a 1.17 time increase in horizontal coma after LASIK.The horizontal coma after LASIK was significantly less than the vertical coma (Z=-2.803, P=0.004).The difference of total higher order aberrations and total coma between traditional LASIK and wavefront-guided LASIK was without any significance, however, the proportion of total coma in total higher order aberrations between the two groups was statistically significant (t=-1.548, P=0.007).Decentered ablation measurement: the mean ablation induced decentration was (0.65±0.38)mm for the right eye and (0.90±0.35)mm for the left eye horizontally (X-axis). The mean for the right eye was (0.80±0.30) and (0.53±0.34)mm for the left eye vertically (Y-axis). The mean ablation induced decentration vector was (1.11±0.25)mm for the right eye and (1.13±0.22)mm for the left eye. For all 28 eyes, the vector shift was ＞0.5 mm, and for 71% of the eyes, ablation centers differed from pupil centers ＞1.0 mm. The vector decentration for LASIK ablated eyes was 2.02 times higher than the population but with no visual symptoms. Right eyes had a more significant pupil shift than left eyes in the vertical direction (t=2.157, P=0.040). Conclusion Total higher-order aberrations and coma aberrations increased significantly in cases with visual symptoms caused by ablation induced decentration after LASIK surgery, with vertical coma increasing more than horizontal coma. The degree of decentration was moderate to severe in these patients. Therefore, decentration is one of the main factors that lead to distorted images after LASIK.
