摘要目的 观察波阵面像差引导的非球面LASIK术后高阶像差的变化.方法 前瞻性研究.选取符合条件的患者120例(240只眼)分为3个组:波阵面像差引导的非球面LASIK组(A组);波阵面像差引导的LASIK组(B组);Q值引导的非球面LASIK组(C组),对手术前后A组的高阶像差进行研究,随访时间为术后1周及1、3、6个月.对3个组患者术后高阶像差进行比较,随访时间为术后6个月.手术前后数据的比较采用独立样本t检验;3个组之间的数据比较采用单因素方差分析,组间的多重比较进行Dunnet t检验.结果 A组总高阶像差术前及术后1周、1、3、6个月分别为(0.43±0.12)、(0.39±0.12)、(0.47±0.14)、(0.40±0.12)、(0.38±0.11) μm,术后各时间点与术前比较差异均无统计学意义(t=0.874,-1.145,0.652,0.496;P＞0.05),但随着时间的延长,有变小的趋势;球差分别为(0.14±0.08)、(0.17±0.11)、(0.26±0.10)、(0.25±0.12)、(0.18±0.09) μm,术后1周和术前比较差异无统计学意义(t=-1.815,P=0.077),术后1、3、6个月时均大于术前(t=-4.410,-2.375,-1.870,P＜0.05).术后6个月,术后A组、B组、C组总高阶像差分别为(0.38±0.11)、(0.61±0.13)、(0.46±0.15) μm,球差分别为(0.18±0.09)、(0.46±0.12)、(0.19±0.13) μm,高阶像差和球差3个组之间的比较,A组和C组明显低于B组,差异均有统计学意义(P＜0.05),A组和C组差异无统计学意义(P =0.866),但A组术后较术前变化小于C组;A组、B组、C组垂直彗差分别为(0.16±0.11)、(0.17±0.13)、(0.13±0.12) μm,水平彗差分别为(0.16±0.13)、(0.23±0.15) μm、(0.14±0.10)μm,3个组患者在垂直彗差和水平彗差方面比较差异均无统计学意义(F =0.367,0.254;P＞0.05).结论 波阵面像差引导的非球面个体化LASIK与波阵面像差引导的LASIK相比能更好地减少术后高阶像差和球差的增加,且术后较术前变化小于Q值引导的非球面LASIK.

abstractsObjective To compare the higher order aberration of wavefront-guided aspherical versus wavefront-guided and Q-value guided aspheric personalized LASIK surgery in the treatment of myopia.Methods Prospective study.120 patients with myopia and/or astigmatism(240 eyes) were involved in our hospital from August 2010 to December 2010.There was a prospective study,divided into three groups:Wavefront-guided aspherical personalized LASIK in group A; Wavefront-guided LASIK in group B; Q-value guided aspheric LASIK in group C.The follow-up time was 6 months.The comparison of data before and after operation was two independent samples t test.The comparison among three groups was one-way analysis of variance,and multiple comparison between groups was Dunnet t test.Results A group:The differences between before and after surgery were not statistically significant in higher order aberration(t1 week =0.874,P1 week =0.387;t1 mouth =-1.145,P1 mouth =0.259;t3 mouth =0.652,P3 mouth =0.518; t6 mouth =0.496,P6 mouth =0.439),but as the extension of time,The values have a tendency to become smaller; the difference was notstatistically significant in spherical aberration between before and after surgery 1 week (t =-1.815,P =0.077),and was statistically significant between before and after surgery 1 month,3 months and 6 months after surgery (t1 month =-4.410,P1 mouth =0.000 ; t3 mouth =-2.375,P3 mouth =0.022 ; t6 mouth =-1.870,P6 month =0.000),the values after surgery were higher.The differences between before and after surgery were not statistically significant in coma aberration (t1 week =1.028,P1 week =0.310; t1 mouth =0.847,P1 mouth =0.402;t3 mouth =0.210,P3 mouth =0.984; t6 mouth =0.533,P6 mouth =0.597).At 6 months,the higher order aberration and spherical aberration in A group and C group were significantly lower than the B group,and the differences were statistically significant(PA&B =0.000; PC&B =0.000),the differences between A group and C group were not statistically significant in higher order aberration and spherical aberration (P =0.866),but A group is less than the C group in changes before and after surgery.The differences among three groups were not statistically significant in the vertical and horizontal coma(Frertical coma =0.367,Pvertical come =0.683;Fhorizontal coma =0.254,Phorizontal coma =0.797).Conclusion Wavefront-guided aspherical personalized LASIK compared with wavefront-guided personalized LASIK can better reduce the increases of the higher order aberration and spherical aberration,and the changes between preoperative and postoperative is less than Qvalue guided aspheric personalized LASIK.