CAJ | 학술논문

目的比较波前像差引导前弹力层下激光角膜磨镶术(SBK)与常规SBK矫正近视及近视散光的有效性、安全性、预测性、稳定性及术后视觉质量.方法前瞻性随机对照研究.对2009年12月至2010年12月在广西视光中心就诊122例近视的患者,采用随机数字表法分为波前引导SBK(WG-SBK组)和常规SBK(SBK组),WG-SBK组行波前像差引导的SBK手术,SBK组行常规SBK手术,术后1d、1周、1个月、3个月和6个月定期随访,检测视力、屈光度、高阶像差和对比敏感度.结果术后6个月,WG-SBK组术后裸眼视力≥1.0的比例为98.07％,与SBK组的98.57％持平(P=0.764).两组均未出现最佳矫正视力下降达2行者,术后矫正视力提高≥1行者WG-SBK组占84.61％,高于SBK组的65.71％差异有统计学意义(P＜0.01).WG-SBK组和SBK组术后等效球镜在±0.50 D内的比例分别为69.23％和57.86％ (P =0.069),在±1.00 D内的比例分别为92.31％和86.43％(P =0.148).WG-SBK组与SBK组的术后残余散光度分别为(-0.30±0.32)D和(-0.34±0.33)D(P=0.344).两组等效球镜在术前、术后1d和1周比较差异无统计学意义(P＞0.05),但在术后1个月、3个月和6个月时点上比较差异有统计学意义(P＜0.05).术后6个月WG-SBK组和SBK组的总高阶像差、慧差、三叶草差和球差RMS较术前的变化量分别为(0.25±0.26)、(0.05±0.15)、(0.05±0.12)(0.14±0.24) μm和(0.39±0.34)、(0.10±0.27、(0.03±0.10)、(0.29±0.26) μm差异有统计学意义(P＜0.01,P=0.089、0.157).WG-SBK组和SBK组的3 c/d,6 c/d,12 c/d和18 c/d频率的对比敏感度变化量分别为0.17±0.36、-0.04±0.35、0.18±0.29、0.29±0.31和-0.22±0.44、-0.01±0.51,-0.05±0.40,-0.02±0.46差异有统计学意义(P＜0.01).结论波前像差引导SBK和常规SBK矫正近视均能获得满意的术后视力和屈光度,但波前像差引导的个性化切削能更有效地减少高阶像差的增加,提高术后高、低空间频率的对比敏感度,使患者获得更舒适的视觉体验. 目的比較波前像差引導前彈力層下激光角膜磨鑲術(SBK)與常規SBK矯正近視及近視散光的有效性、安全性、預測性、穩定性及術後視覺質量.方法前瞻性隨機對照研究.對2009年12月至2010年12月在廣西視光中心就診122例近視的患者,採用隨機數字錶法分為波前引導SBK(WG-SBK組)和常規SBK(SBK組),WG-SBK組行波前像差引導的SBK手術,SBK組行常規SBK手術,術後1d、1週、1箇月、3箇月和6箇月定期隨訪,檢測視力、屈光度、高階像差和對比敏感度.結果術後6箇月,WG-SBK組術後裸眼視力≥1.0的比例為98.07％,與SBK組的98.57％持平(P=0.764).兩組均未齣現最佳矯正視力下降達2行者,術後矯正視力提高≥1行者WG-SBK組佔84.61％,高于SBK組的65.71％差異有統計學意義(P＜0.01).WG-SBK組和SBK組術後等效毬鏡在±0.50 D內的比例分彆為69.23％和57.86％ (P =0.069),在±1.00 D內的比例分彆為92.31％和86.43％(P =0.148).WG-SBK組與SBK組的術後殘餘散光度分彆為(-0.30±0.32)D和(-0.34±0.33)D(P=0.344).兩組等效毬鏡在術前、術後1d和1週比較差異無統計學意義(P＞0.05),但在術後1箇月、3箇月和6箇月時點上比較差異有統計學意義(P＜0.05).術後6箇月WG-SBK組和SBK組的總高階像差、慧差、三葉草差和毬差RMS較術前的變化量分彆為(0.25±0.26)、(0.05±0.15)、(0.05±0.12)(0.14±0.24) μm和(0.39±0.34)、(0.10±0.27、(0.03±0.10)、(0.29±0.26) μm差異有統計學意義(P＜0.01,P=0.089、0.157).WG-SBK組和SBK組的3 c/d,6 c/d,12 c/d和18 c/d頻率的對比敏感度變化量分彆為0.17±0.36、-0.04±0.35、0.18±0.29、0.29±0.31和-0.22±0.44、-0.01±0.51,-0.05±0.40,-0.02±0.46差異有統計學意義(P＜0.01).結論波前像差引導SBK和常規SBK矯正近視均能穫得滿意的術後視力和屈光度,但波前像差引導的箇性化切削能更有效地減少高階像差的增加,提高術後高、低空間頻率的對比敏感度,使患者穫得更舒適的視覺體驗.
목적 비교파전상차인도전탄력층하격광각막마양술(SBK)여상규SBK교정근시급근시산광적유효성、안전성、예측성、은정성급술후시각질량.방법 전첨성수궤대조연구.대2009년12월지2010년12월재엄서시광중심취진122례근시적환자,채용수궤수자표법분위파전인도SBK(WG-SBK조)화상규SBK(SBK조),WG-SBK조행파전상차인도적SBK수술,SBK조행상규SBK수술,술후1d、1주、1개월、3개월화6개월정기수방,검측시력、굴광도、고계상차화대비민감도.결과 술후6개월,WG-SBK조술후라안시력≥1.0적비례위98.07％,여SBK조적98.57％지평(P=0.764).량조균미출현최가교정시력하강체2행자,술후교정시력제고≥1행자WG-SBK조점84.61％,고우SBK조적65.71％차이유통계학의의(P＜0.01).WG-SBK조화SBK조술후등효구경재±0.50 D내적비례분별위69.23％화57.86％ (P =0.069),재±1.00 D내적비례분별위92.31％화86.43％(P =0.148).WG-SBK조여SBK조적술후잔여산광도분별위(-0.30±0.32)D화(-0.34±0.33)D(P=0.344).량조등효구경재술전、술후1d화1주비교차이무통계학의의(P＞0.05),단재술후1개월、3개월화6개월시점상비교차이유통계학의의(P＜0.05).술후6개월WG-SBK조화SBK조적총고계상차、혜차、삼협초차화구차RMS교술전적변화량분별위(0.25±0.26)、(0.05±0.15)、(0.05±0.12)(0.14±0.24) μm화(0.39±0.34)、(0.10±0.27、(0.03±0.10)、(0.29±0.26) μm차이유통계학의의(P＜0.01,P=0.089、0.157).WG-SBK조화SBK조적3 c/d,6 c/d,12 c/d화18 c/d빈솔적대비민감도변화량분별위0.17±0.36、-0.04±0.35、0.18±0.29、0.29±0.31화-0.22±0.44、-0.01±0.51,-0.05±0.40,-0.02±0.46차이유통계학의의(P＜0.01).결론 파전상차인도SBK화상규SBK교정근시균능획득만의적술후시력화굴광도,단파전상차인도적개성화절삭능경유효지감소고계상차적증가,제고술후고、저공간빈솔적대비민감도,사환자획득경서괄적시각체험.
Objective To compare outcomes in visual acuity,refraction,higher-order aberrations (HOAs),and contrast sensitivity function (CSF) in myopic patients undergoing wavefront-guided sub-bowman-keratomileusis (WG-SBK) or sub-bowman-keratomileusis (SBK).Methods In this prospective,randomized,comparative study,244 eyes (122 patients) of myopia or myopic astigmatism were recruited randomized from the myopic surgery candidates and were random allocated into WG-SBK group and SBK group using random digits table.Wavefront-guided custom ablation was performed on the patients from WG-SBK group and standard ablation was performed on the patients from SBK group.Visual acuity,refraction,HOAs and CSF were measured preoperatively at 1 day,1 week,1 month,3 months and 6 months postoperatively.The results were compared between the two groups.Results After 6 months,98.07％ of Wavefront-guided ablation eyes and 98.57％ of standard ablation had uncorrected visual acuity of 1.0 or better (P =0.764).None treated eyes in either group lost more than two lines of best corrected visual acuity (BCVA).The percentage of eyes gained 1 line or more improved in BCVA was 84.61％ and 65.71％ in the WG-SBK and SBK groups (P ＜0.01),respectively.WG-SBK group 69.23％ eyes and SBK group of 57.86％ eyes spherical equivalent within ±0.50 D (P =0.069),WG-SBK group of 92.31％ eyes and SBK group of 86.43％ eyes spherical equivalent within ±1.00 D (P =0.148).Mean residual astigmatism in WG-SBK group and SBK group were-0.30±0.32 DC and-0.34±0.33 DC,respectively (P =0.344).There were no statistically significant in mean residual spherical equivalent between WG-SBK group and SBK group at preoperative,postoperative 1 day and 1 week,respectively (P ＞0.05).However,there were statistically significant in mean residual spherical equivalent between WG-SBK group and SBK group at postoperative 1 month,3 months and 6 months.Mean postoperative absolute changes of six months in HOAs,coma,trefoil and spherical aberration root-mean-square (RMS) in the WG-SBK group and SBK group were 0.25±0.26μm,0.05±0.15μm,0.05±0.12μm,0.14±0.24μm and 0.39±0.34μ m,0.10±0.27μm,0.03±0.10μm,0.29±0.26μm,respectively (P ＜0.01,P =0.089,P =0.157,P ＜0.01).Mean postoperative changes in 3 c/d,6 c/d,12 c/d and 18 c/d CSF in the WG-SBK group and SBK group were 0.17±0.36,-0.04±0.35,0.18±0.29,0.29±0.31 and-0.22±0.44,-0.01±0.51,-0.05± 0.40,-0.02±0.46,respectively (P ＜0.01,P =0.6062,P ＜0.01,P ＜0.01).Conclusions Both wavefront-guided ablation and standard ablation in sub-bowman-keratomileusis for myopia can gain satisfactory postoperative visual acuity and refraction,however,wavefront-guided SBK is efficient to decrease the new induce higher-order aberrations and improve low and high spatial frequency contrast sensitivity of postoperative compared with standard SBK.