CAJ | 학술논문

目的评价有晶状体眼虹膜固定型人工晶状体(PIOL)植入术和准分子激光原位角膜磨镶术(LASIK)对高度近视眼视觉质量的影响,探讨高度近视优化的手术方案.方法前瞻性非随机对照研究.选取于北京同仁医院行LASIK(LASIK组)和Verisyse PIOL(Verisyse组)手术的高度近视患者各30例(30眼),2组术前等效球镜度分别为(-15.41±4.68)D和(-16.94±5.42)D,应用主观波前像差仪(WFA-1000B)分别于术前、术后6个月行波前像差检查,并进行主观评价问卷调查,2组数据之间进行t检验或x2检验分析.结果术后6个月2组间裸眼视力和最佳矫正视力均较术前明显提高,裸眼视力≥术前最佳矫正视力者Verisyse组占70％(21/30),LASIK组占43％(13/30),两者之间差异具有统计学意义(x2=4.34,P＜0.05).2组3～7阶各高阶像差及总高阶像差均较术前增加,以LASIK组更为显著,Verisyse术后3阶像差为主导像差,其中水平彗差增加明显,与术前比较差异有统计学意义(t=2.12,P＜0.05);LASIK术后3阶和4阶像差为主导像差,其中球差和彗差增加明显,差异有统计学意义(t=-6.55、-7.37,P＜0.05);2组之间比较,LASIK组各高阶像差明显高于Verisyse组,差异具有统计学意义.患者术后满意度LASIK组为60％,Verisyse组为83％,差异具有统计学意义(x2=4.02,P＜0.05).结论虽然PIOL与LASIK矫正高度近视短期随访具有相似的安全性和有效性,但是从视觉质量角度来看,PIOL术后具有更好的裸眼视力,引起的高阶像差明显低于LASIK,且不存在屈光回退,满意度较高,可作为高度近视优先考虑的手术方案.
목적 평개유정상체안홍막고정형인공정상체(PIOL)식입술화준분자격광원위각막마양술(LASIK)대고도근시안시각질량적영향,탐토고도근시우화적수술방안.방법 전첨성비수궤대조연구.선취우북경동인의원행LASIK(LASIK조)화Verisyse PIOL(Verisyse조)수술적고도근시환자각30례(30안),2조술전등효구경도분별위(-15.41±4.68)D화(-16.94±5.42)D,응용주관파전상차의(WFA-1000B)분별우술전、술후6개월행파전상차검사,병진행주관평개문권조사,2조수거지간진행t검험혹x2검험분석.결과 술후6개월2조간라안시력화최가교정시력균교술전명현제고,라안시력≥술전최가교정시력자Verisyse조점70％(21/30),LASIK조점43％(13/30),량자지간차이구유통계학의의(x2=4.34,P＜0.05).2조3～7계각고계상차급총고계상차균교술전증가,이LASIK조경위현저,Verisyse술후3계상차위주도상차,기중수평혜차증가명현,여술전비교차이유통계학의의(t=2.12,P＜0.05);LASIK술후3계화4계상차위주도상차,기중구차화혜차증가명현,차이유통계학의의(t=-6.55、-7.37,P＜0.05);2조지간비교,LASIK조각고계상차명현고우Verisyse조,차이구유통계학의의.환자술후만의도LASIK조위60％,Verisyse조위83％,차이구유통계학의의(x2=4.02,P＜0.05).결론 수연PIOL여LASIK교정고도근시단기수방구유상사적안전성화유효성,단시종시각질량각도래간,PIOL술후구유경호적라안시력,인기적고계상차명현저우LASIK,차불존재굴광회퇴,만의도교고,가작위고도근시우선고필적수술방안.
Objective To evaluate the quality of vision after implantation of a Verisyse phakic intraocular lens (PIOL) and laser in situ keratomileusis (LASIK) for correcting high myopia,and to evaluate a rational surgical approach for high myopia.Methods This was a prospective non-randomized control trial.Thirty eyes (30 patients) underwent LASIK and 30 eyes (30 patients) were implanted with Verisyse IOLs.Preoperative spherical equivalents were-15.41 ±4.68 D and-16.94±5.42 D,respectively.Wavefront aberrations were measured using a subjective aberrometer (WFA1000B)preoperatively and 6 months postoperatively.Higher-order aberrations (HOAs) were recorded and compared.Patient satisfaction (photic phenomena,overall satisfaction) was assessed by a subjective questionnaire.The data from the two groups was statistically analyzed by a t or x2 test.Results Six months after surgery,uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) had improved.Postoperative UCVA was equal to or better than preoperative BCVA in 70％(21/30) in the Verisyse group and 43.3％(13/30) in the LASIK group.The difference between the groups was statistically significant (x2=4.34,P＜0.05).3rd to 7th order and total HOAs increased in both groups after surgery,especially in the LASIK group.In the Verisyse group,3rd order aberrations were the predominant postoperative HOA and horizontal coma increased significantly (t=2.12,P＜0.05); in the LASIK group,3rd and 4th order aberrations were the predominant postoperative HOA,and coma and spherical aberrations increased significantly (t=-6.55,-7.37,P＜0.05).Each order and total HOAs in the LASIK group were higher than that in the Verisyse group,and the difference was statistically significant.Patient satisfaction was 60％ in the LASIK group and 83.3％ in the Verisyse group (x2=4.02,P＜0.05).Conclusion PIOL and LASIK surgery were found to be comparatively safe and effective for high myopia.But when quality of vision is taken into account,UCVA was better with PIOL implantation and it resulted in a smaller increase in HOAs and higher patient satisfaction compared to LASIK.Therefore,PIOL implants may be considered as the first choice for high myopia.