CAJ | 학술논문

目的：比较飞秒激光和角膜板层刀制瓣准分子激光原位角膜磨镶术（ laser in situ keratomileusis ， LASIK）的视觉质量。方法：回顾性系列病例研究。选取2011-06/09我院完成的LASIK手术病例150例300眼，根据制瓣方式分为飞秒激光组和板层刀组各75例150眼，所有手术均采用EC5000 CX-Ⅱ（日本Nidek公司）行基质切削，且都由同一手术医师完成。比较两组患者术前及术后1 wk；1，3 mo的裸眼视力（ uncorrected visual acuity ，UCVA）、屈光度、术后最佳矫正视力（ best corrected visual acuity ，BCVA）、波前像差及明视和暗视状态下的对比敏感度。结果：术后1wk；1，3mo两组患者的UCVA和屈光度（等效球镜）比较差异均无统计学意义。在术后1 mo时，飞秒组C7的绝对值、RMSh， RMS3和RMS6值均低于板层刀组（ P＜0．05）；术后3 mo 时飞秒组 C7的绝对值、C14和RMS6的值均显著低于板层刀组（ P＜0．05）。明视和暗视对比敏感度在术后1 wk时，飞秒组和板层刀组均较术前降低，差异均有统计学意义（P＜0．05）。术后1mo时，明视和暗视对比敏感度较术后1 wk有所提高，至术后3 mo略高于术前水平，差异无统计学意义（P＞0．05）。结论：飞秒激光制作角膜瓣的LASIK 手术在治疗近视和散光方面具有安全性、有效性的特点。飞秒激光在提高UCVA的同时，还能减少高阶像差的产生，并且不会导致术后对比敏感度的下降，能够提高了患者的视觉质量。其术后效果优于角膜板层刀制作角膜瓣的LASIK手术。
목적：비교비초격광화각막판층도제판준분자격광원위각막마양술（ laser in situ keratomileusis ， LASIK）적시각질량。방법：회고성계렬병례연구。선취2011-06/09아원완성적LASIK수술병례150례300안，근거제판방식분위비초격광조화판층도조각75례150안，소유수술균채용EC5000 CX-Ⅱ（일본Nidek공사）행기질절삭，차도유동일수술의사완성。비교량조환자술전급술후1 wk；1，3 mo적라안시력（ uncorrected visual acuity ，UCVA）、굴광도、술후최가교정시력（ best corrected visual acuity ，BCVA）、파전상차급명시화암시상태하적대비민감도。결과：술후1wk；1，3mo량조환자적UCVA화굴광도（등효구경）비교차이균무통계학의의。재술후1 mo시，비초조C7적절대치、RMSh， RMS3화RMS6치균저우판층도조（ P＜0．05）；술후3 mo 시비초조 C7적절대치、C14화RMS6적치균현저저우판층도조（ P＜0．05）。명시화암시대비민감도재술후1 wk시，비초조화판층도조균교술전강저，차이균유통계학의의（P＜0．05）。술후1mo시，명시화암시대비민감도교술후1 wk유소제고，지술후3 mo략고우술전수평，차이무통계학의의（P＞0．05）。결론：비초격광제작각막판적LASIK 수술재치료근시화산광방면구유안전성、유효성적특점。비초격광재제고UCVA적동시，환능감소고계상차적산생，병차불회도치술후대비민감도적하강，능구제고료환자적시각질량。기술후효과우우각막판층도제작각막판적LASIK수술。
AIM:To compare the visual quality of LASIK flap made by femtosecond laser with that by microkeratome. METHODS: Retrospective case series research was undertaken.In 2011, there were 150 cases ( 300 eyes ) underwent LASIK surgery from June to September.The patients were divided into 2 groups: flap made by femtosecond laser was group 1; flap made by microkeratome was group 2, wi th 75 cases (150 eyes) for each group.All surgeries performed stroma ablation with EC5000CX-Ⅱ ( NIDEK CO., LTD) by the same surgeon. Uncorrected visual acuity ( UCVA ) , diopter before operation and one week, one month, three months after the operation were compared between two groups, as well as corresponding data of the best corrected visual acuity, wavefront aberrations, the scotopic and photopic contrast sensitivity. RESULTS:The refractive diopter and uncorrected visual acuity between 2 groups had no significant difference at 1 week,1 month and 3 months after operation.Absolute value of C7, RMS3, RMS6 and RMSh of femtosecond laser group were lower compared with microkeratome group at 1 month after operation (P<0.05).C7 and C14 of femtosecond laser group were also lower at 3 months after operation (P<0.05).At 1 week after operation, the photopic and mesopic contrast sensitivity function in two groups decreased for all spatial frequencies, there were statistical differences compared with which before operation (P<0.05).The scotopic and photopic contrast sensitivity of the first postoperative month was increased compared with that of the first postoperative week.Till the third postoperative month, the contrast sensitivity function in two groups restored to preoperative level.The difference showed no statistic significance. CONCLUSION: LASIK flap made by femtosecond laser can safely and effectively correct myopia and astigmatism.Femtosecond can improve UCVA and visual quality, decrease high order aberration without reducing postoperative contrast sensitivity. Its postoperative outcome is much better than that of LASIK flap made by microkeratome.