CAJ | 학술논문

目的比较飞秒激光FS200制瓣辅助的LASIK(FS-LASIK)和角膜板层刀制瓣的前弹力层下激光角膜磨镶术(SBK)的临床效果及角膜像差变化.方法前瞻性病例对照研究.34例(68眼)应用FS200飞秒激光制瓣(FS组)患者和45例(90眼)M2微型角膜板层刀制瓣(SBK组)患者纳入研究.术前及术后1、3个月分别检查记录2组患者的裸眼视力、屈光度、矫正视力,并采用Pentacam-HR眼前节分析系统,对术眼进行眼前节扫描获得三维图像,通过内置分析软件获取瞳孔直径为6 mm的角膜总高阶像差(HOA)、球差(C40)、水平彗差(C31)、垂直彗差(C3-1)和水平三叶草(C33)、斜向三叶草(C3-3)数据,采用方差分析及t检验进行统计分析.结果 FS组角膜HOA、C40、C3-1手术前后比较差异均有统计学意义(F=8.511、12.356、11.843,P＜0.01);SBK组角膜HOA、C40、C3-1、C31差异也存在统计学意义(F=46.601、38.627、10.874、11.727,P＜0.01).术后1个月时SBK组HOA的增高幅度明显高于FS组,差异有统计学意义(t=3.063,P＜0.05),术后3个月仍有同样趋势(t=2.998,P＜0.05).术后1个月时2组患者角膜球差均有增高,组间差异无统计学意义(t=-1.990,P＞0.05),而3个月时FS组有所恢复,组间差异有统计学意义(t=-2.666,P＜0.05).2组三叶草像差(C33、C33)均较术前增加,术后1、3个月斜向三叶草(C3-3)与术前比较差异有统计学意义,但组间比较差异无统计学意义.结论 FS-LASIK和SBK均可造成角膜总高阶像差、球差、垂直彗差的增加,但FS-LASIK角膜总高阶像差和球差的增幅比SBK小,在提高视觉质量方面飞秒可发挥更大的作用.
목적 비교비초격광FS200제판보조적LASIK(FS-LASIK)화각막판층도제판적전탄력층하격광각막마양술(SBK)적림상효과급각막상차변화.방법 전첨성병례대조연구.34례(68안)응용FS200비초격광제판(FS조)환자화45례(90안)M2미형각막판층도제판(SBK조)환자납입연구.술전급술후1、3개월분별검사기록2조환자적라안시력、굴광도、교정시력,병채용Pentacam-HR안전절분석계통,대술안진행안전절소묘획득삼유도상,통과내치분석연건획취동공직경위6 mm적각막총고계상차(HOA)、구차(C40)、수평혜차(C31)、수직혜차(C3-1)화수평삼협초(C33)、사향삼협초(C3-3)수거,채용방차분석급t검험진행통계분석.결과 FS조각막HOA、C40、C3-1수술전후비교차이균유통계학의의(F=8.511、12.356、11.843,P＜0.01);SBK조각막HOA、C40、C3-1、C31차이야존재통계학의의(F=46.601、38.627、10.874、11.727,P＜0.01).술후1개월시SBK조HOA적증고폭도명현고우FS조,차이유통계학의의(t=3.063,P＜0.05),술후3개월잉유동양추세(t=2.998,P＜0.05).술후1개월시2조환자각막구차균유증고,조간차이무통계학의의(t=-1.990,P＞0.05),이3개월시FS조유소회복,조간차이유통계학의의(t=-2.666,P＜0.05).2조삼협초상차(C33、C33)균교술전증가,술후1、3개월사향삼협초(C3-3)여술전비교차이유통계학의의,단조간비교차이무통계학의의.결론 FS-LASIK화SBK균가조성각막총고계상차、구차、수직혜차적증가,단FS-LASIK각막총고계상차화구차적증폭비SBK소,재제고시각질량방면비초가발휘경대적작용.
Objective To compare changes in wavefront aberrations on the cornea after femtosecond laser LASIK (FS-LASIK) and sub-Bowman's keratomileusis (SBK),especially for total higher order aberrations (HOA),corneal spherical aberrations (C40),corneal horizontal coma (C31),corneal vertical coma (C3-1),corneal horizontal trefoil (C33) and corneal oblique trefoil (C3-3).Methods A prospective study was designed for 2 groups based on the procedure used.The groups were composed of 68 eyes of 34 patients who had undergone FS-LASIK and 90 eyes of 45 patients who had been treated with SBK.A Pentacam was used under dark room conditions to measure corneal aberrations before surgery and 1 and 3 months after surgery.Data were analyzed using ANOVA,an independent samples t test and Pearson correlation.Results The preoperative and postoperative differences for the total corneal HOA,corneal C40,and corneal C31in the FS-LASIK group were significant (F=8.511,12.356,11.843,P＜0.01).The corresponding differences and in addition corneal C31 were also significant for the SBK group (F=46.601,38.627,10.874,11.727,P＜0.01).One month after surgery,HOAs were higher in the SBK group than in the FS group (t=-3.063,P＜0.05),and the same tendency was found 3 months after surgery (t=2.998,P＜0.05).The differences for C40 at 1 month were not significant between the two groups (t=-1.990,P＞0.05) but the differences were statistically significant at 3 months (t=-2.666,P＜0.05).One and 3 months after surgery,the trefoil aberrations (C33,C3-3) of the cornea in the two groups were higher than before surgery; only the difference for C3-3 was significant.However,the difference in the trefoil aberrations of the cornea between the two groups was not statistically significant.Conclusion Both FS-LASIK and SBK can increase corneal HOA,corneal spherical aberrations and vertical coma,but the degree of increase after FS-LASIK is smaller than that after SBK.FS-LASIK improves visual quality more than SBK.