CAJ | 학술논문

目的：研究在治疗正性Q值的近视散光患者中非球面因子Q 引导的准分子激光角膜上皮瓣下磨镶术( laser epithelial keratomleusis , LASEK)的安全性及有效性。 　　方法：选择要求LASEK手术的检测Q值为正的近视和散光患者158眼随机分为两组,接受Q值引导LASEK患者86眼作为观察组,接受常规LASEK的患者72眼为常规组。检测手术前后患者的裸眼视力( UCVA)、最佳矫正视力( BCVA)、屈光度、眼压、角膜地形图、角膜曲率值K值(keratometry)、非球面因子Q值(aspherical factor Q)、高阶像差( HOA)、超声角膜测厚、对比敏感度( CS)并且观察术后角膜上皮下混浊( haze )出现情况。术前所检测的各项指标两组差异无统计学意义。术后14d；1,3,6,12mo随访。 　　结果：术后12 mo时两组的UCVA及BCVA无统计学差异,但安全性指数观察组为1.10,常规组为1.07；有效性指数观察组为1.06,常规组为0.99；观察组总HOA为0.45±0.17μm,常规组为0.72±0.25μm,统计学差异显著( t=-8.193,P=0.000)；观察组 Q值平均为0.41±0.17,常规组为0.77±0.22,存在统计学差异( t=11.377, P=0.028)；术后3 mo观察组CS基本可以达到术前状态,而常规组术后6 mo恢复至术前水平。 　　结论：在治疗正性Q值患者的近视及散光方面Q值引导的LASEK较常规LASEK更好地保持了角膜的非球面性且安全有效,视觉质量更好。
목적：연구재치료정성Q치적근시산광환자중비구면인자Q 인도적준분자격광각막상피판하마양술( laser epithelial keratomleusis , LASEK)적안전성급유효성。 　　방법：선택요구LASEK수술적검측Q치위정적근시화산광환자158안수궤분위량조,접수Q치인도LASEK환자86안작위관찰조,접수상규LASEK적환자72안위상규조。검측수술전후환자적라안시력( UCVA)、최가교정시력( BCVA)、굴광도、안압、각막지형도、각막곡솔치K치(keratometry)、비구면인자Q치(aspherical factor Q)、고계상차( HOA)、초성각막측후、대비민감도( CS)병차관찰술후각막상피하혼탁( haze )출현정황。술전소검측적각항지표량조차이무통계학의의。술후14d；1,3,6,12mo수방。 　　결과：술후12 mo시량조적UCVA급BCVA무통계학차이,단안전성지수관찰조위1.10,상규조위1.07；유효성지수관찰조위1.06,상규조위0.99；관찰조총HOA위0.45±0.17μm,상규조위0.72±0.25μm,통계학차이현저( t=-8.193,P=0.000)；관찰조 Q치평균위0.41±0.17,상규조위0.77±0.22,존재통계학차이( t=11.377, P=0.028)；술후3 mo관찰조CS기본가이체도술전상태,이상규조술후6 mo회복지술전수평。 　　결론：재치료정성Q치환자적근시급산광방면Q치인도적LASEK교상규LASEK경호지보지료각막적비구면성차안전유효,시각질량경호。
AIM: To explore the long-term efficacy of Q-factor guided laser epithelial keratomleusis ( LASEK ) for myopia and astigmatism with positive Q-factor. METHODS: There were 158 eyes which were myopia and astigmatism with positive Q- factor taken in two groups randomly: 86 eyes accepted Q - factor guided LASEK as observation group and 72 eyes accepted routine LASEK as control group. The difference between the two groups about all data was similar. The uncorrected visual acuity ( UCVA ) and the best corrected visual acuity ( BCVA ) as well as diopter, ocular tension, corneal topography, Keratometry value K, aspherical factor Q, Higher-order aberrations ( HOA ) , corneal thickness by ultrasound and, contrast sensitivity ( CS ) , Haze were examined and compared before and after surgery. All the cased were followed up for 14d, 1, 3, 6, 12mo. And there were no statistical difference among the data before surgery. RESULTS: After 12mo there were no statistical difference between the two groups about UCVA and BCVA. But the safety index of observation group was 1.10, that of control group was 1. 07. The validity index of observation group was 1. 06, that of control group was 0.99. The HOA of observation group was 0. 45±0. 17μm, and that of control group was 0. 72±0.25μm, there was statistically significant difference (t=-8. 193,P=0. 000). Q factor of observation group was 0. 41±0. 17, that of control group was 0. 77±0. 22, there was significant difference (t=11. 377,P = 0. 028). The contrast sensitivity of 3mo post surgery of patients in the observation group returned to the level of before surgery. But in the control group the contrast sensitivity of the patients did not returned until 6mo. CONCLUSION:Q-factor guided LASEK for myopia and astigmatism with positive Q-factor is stable, safe and effective. The operation allow for reducing the high order aberrations, maintaining the most asphericity of cornea, saving more in corneal tissue, which cause faster recovery of contrast sensitivity, less haze and better visual quality.