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波前像差引导SBK与常规SBK矫正近视比较研究

Comparative study of Wavefront-guided Sub-Bowman-Keratomileusis versus conventional Sub-Bowman-Keratomileusis for correcting myopia

摘要:

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.

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abstracts:

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.

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作者: 刘伟民 [1] 黄建忠 [1] 肖信 [1] 罗武强 [1]
栏目名称: 临床研究
DOI: 10.3760/cma.j.issn.1006-4443.2014.03.013
发布时间: 2014-04-22
基金项目:
广西医疗卫生科研课题
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