波前引导准分子激光原位角膜磨镶术与非球面准分子激光原位角膜磨镶术治疗近视的高阶像差及角膜非球面性的对比评估

Comparative evaluation of higher-order aberrations and corneal asphericity between wavefront-guided and aspheric LASIK for myopia.

作者信息

Goyal Jawahar Lal, Garg Arushi, Arora Ritu, Jain Parul, Goel Yashpal

出版信息

J Refract Surg. 2014 Nov;30(11):777-84. doi: 10.3928/1081597X-20141021-10.

DOI:10.3928/1081597X-20141021-10

PMID:25375851

Abstract

PURPOSE

To compare visual outcome, higher-order aberrations, and corneal asphericity (Q value) between wavefront-guided and aspheric LASIK for myopia and myopic astigmatism.

METHODS

Forty patients were randomly selected to receive wavefront-guided LASIK (wavefront-guided group) or aspheric LASIK (aspheric group) (40 eyes of 20 patients in each group) using the Technolas 217z excimer laser platform (Bausch & Lomb, Rochester, NY). Flaps were created using the Zyoptix XP microkeratome (Bausch & Lomb). Preoperative and postoperative evaluation included uncorrected distance visual acuity (UDVA), corneal topography, wavefront aberrometry, and contrast sensitivity. Minimum follow-up period was 6 months.

RESULTS

At 6 months postoperatively, the aspheric group had significantly better UDVA (logMAR 0.04 ± 0.04 [Snellen 20/16] [range: -0.079 to 0.000]) and lower mean residual spherical error (+0.10 ± 0.52 diopters [D] [range: -1.12 to 1.25 D]) than the wavefront-guided group (logMAR UDVA 0.00 ± 0.07 [range: -0.079 to 0.176]; MRSE -0.35 ± 0.47 D [range: -1.5 to 0.62 D]) (P = .003 and < .001, respectively). Mean change in higher-order aberration root mean square at 6 months postoperatively (6-mm pupil) was 0.16 ± 0.17 µm after aspheric LASIK and 0.27 ± 0.28 µm after wavefront-guided LASIK (P = .02). Aspheric LASIK induced minimal change in spherical aberrations postoperatively (0.03 ± 0.12 µm, P = .09), unlike wavefront-guided LASIK (0.23 ± 0.17 µm, P < .01). Change in Q value was significantly less in the aspheric group (0.53 ± 0.31) than the wavefront-guided group (0.91 ± 0.30) (P < .01). The aspheric group had significant improvement in contrast sensitivity at all spatial frequencies (P < .01), whereas the wavefront-guided group showed a slight decrease at higher spatial frequency (18 cycles per degree).

CONCLUSIONS

Aspheric LASIK induced significantly less change in higher-order aberrations and maintained corneal asphericity better than wavefront-guided LASIK. The visual outcome and contrast sensitivity was better in the aspheric group at 6 months postoperatively.

摘要

目的

比较波前引导的准分子原位角膜磨镶术（LASIK）和非球面LASIK治疗近视及近视散光后的视觉效果、高阶像差和角膜非球面性（Q值）。

方法

随机选择40例患者，使用Technolas 217z准分子激光平台（博士伦公司，纽约州罗切斯特）接受波前引导的LASIK（波前引导组）或非球面LASIK（非球面组）（每组20例患者的40只眼）。使用Zyoptix XP微型角膜刀（博士伦公司）制作角膜瓣。术前和术后评估包括裸眼远视力（UDVA）、角膜地形图、波前像差测量和对比敏感度。最短随访期为6个月。

结果

术后6个月，非球面组的UDVA明显更好（logMAR 0.04±0.04[Snellen 20/16][范围：-0.079至0.000]），平均残余球镜度误差更低（+0.10±0.52屈光度[D][范围：-1.12至1.25 D]），优于波前引导组（logMAR UDVA 0.00±0.07[范围：-0.079至0.176]；MRSE -0.35±0.47 D[范围：-1.5至0.62 D]）（P分别为0.003和<0.001）。术后6个月（6毫米瞳孔）高阶像差均方根的平均变化在非球面LASIK后为0.16±0.17µm，在波前引导的LASIK后为0.27±0.28µm（P = 0.02）。与波前引导的LASIK（0.23±0.17µm，P<0.01）不同，非球面LASIK术后诱导的球差变化最小（0.03±0.12µm，P = 0.09）。非球面组Q值的变化（0.53±0.31）明显小于波前引导组（0.91±0.30）（P<0.01）。非球面组在所有空间频率下的对比敏感度均有显著改善（P<0.01），而波前引导组在较高空间频率（每度18周）时略有下降。