摘要目的 探讨波阵面像差引导的准分子激光原位角膜磨镶术(WG-LASIK)治疗近视散光眼的疗效,以及保留和去除负相垂直彗差Z(3,-1)术后视功能的变化.方法 随机对照研究.对自愿接受LASIK的近视散光患者常规进行术前检查及波阵面像差检查,从中选取Z(3,-1)低于-0.15μm设为A组,高于+0.15μm者设为B组,共42例(78只眼)入选.依照随机排列表法将两组各自分别再分为试验组和对照组,所有患眼的总高阶像差均方根值(RMSh)＞0.25μm,并且排除Z(3,-3),Z(3,1)、Z(3,3)、Z(4,0)大的病例.试验A组11例(19只眼),对照A组13例(26只眼);试验B组4例(8只眼),对照B组14例(25只眼).试验组行WG-LASIK,对照组则行常规的LASIK.分别评价各组术前及术后3～6个月的视觉质量.结果 无论Z(3,-1)为正值或负值,术后早期各组屈光度数均呈轻微过矫状态,之后发生轻微回退,且屈光度均达到预期理想效果.试验A组各高阶像差增长幅度大于对照A组,如试验A组和对照A组术后1个月Z(3,-3)均比术前增加,且试验A组增幅较大,术后3和6个月试验A组像差继续增加,而对照A组则减少(试验A组增加0.2706,对照A组增加0.1450).试验A组和对照A组术后各个时间Z(3,1)、Z(3,3)、Z(4,0)均增加,其中Z(4,O)试验A组增加0.1196,对照A组增加0.0728,术后6个月与术后3个月相比变化轻微.试验B组各高阶像差增长幅度小于对照B组,如术后Z(3,-3)较术前增加,但对照B组增幅较大(术后1个月与术前相比,对照B组增加0.1243,试验B组增加0.0346).对照A组术后对比敏感度优于试验A组,如试验A组术后1个月无眩光对比敏感度数值比术前增加了77.0000,术后3和6个月逐渐恢复;对照A组术后数值比术前减少了74.2308.试验B组术后对比敏感度优于对照B组,如术后1个月与术前相比,试验组无眩光对比敏感度和眩光对比敏感度分别减少83.2500和86.0000,对照组则分别减少40.9565和36.5218.术后6个月时,试验A组和对照A组对术后视觉质量满意者有分别为10(83.3%)和14只眼(93.3%),差异无统计学意义(X2=0.675,P＞0.05).试验B组和对照B组对术后视觉质量满意者分别为8(100.0%)和13只眼(86.7%),差异无统计学意义(X2=1.168,P＞0.05).结论 波阵面像差引导的LASIK治疗近视散光眼建议保留负向垂直彗差,消除正向垂直彗差,有利于合理节省角膜组织,避免不必要的角膜损失,有目的 地提高视觉质量.(中华眼科杂志,2008,44:217-222)

abstractsObjective To investigate the efficacy and safety of wavefront guided(WG)LASIK for the mvopia and astigrnatism.Methods This study is a randomized control trial.42 cases(78 eyes) were collected in the studv through the routine examinations and wavefront analysis,which were divided into two groups(A and B).The value of Z(3,-1)being less than-0.15μm was evaluated as Group A(24 cases,45 eyes):The value of Z(3,-1)being more than+0.15 μm was as Group B(18cases,33eyes).Both A and B were also divided into two subgroups(test and control).WG-LASIK was performed in tested groups,and classic LASIK was performed in control group. Visual quality,wavefront examination,and CSF were analyzed after surgery 3-6 months compared with that of preoperation. Results In the earlier period of postoperation time,diopters of the two groups were both slightly overcorrected, and then began to decrease slightly later and the diopters of both tested and control groups were corrected perfectly.RMSh of tested group increased higher than that of control group when Z(3,-1)was negative and the CSF in control group was better than that in test group after WG-LASIK in Group A.RMSh of tested group increased lower than that of control group when Z(3,-1)was positive and the CSF in tested group was better than that in control group after WG-LASIK in Group B.Conclusions These results suggest that retaining negative vertical coma and removing positive vertical coma were beneficial to the visual function after the WG-LASIK,which could save the corneal tissue reasonably in order to improve visual quMity effectively.(Chin J Ophthalmol,2008,44:217-222)