像差与景深的相互作用对波前像差引导的准分子激光角膜切削术后效果的影响。

Impact of crossplay between ocular aberrations and depth of focus in topo-guided laser-assisted keratomileusis outcomes.

机构信息

Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India.

Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India.

出版信息

Indian J Ophthalmol. 2023 Feb;71(2):467-475. doi: 10.4103/ijo.IJO_191_22.

DOI:10.4103/ijo.IJO_191_22

PMID:36727342

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10228944/

Abstract

PURPOSE

To develop a nomogram in cases with mismatch between subjective and Topolyzer cylinder, and based on the magnitude of the mismatch, customize a treatment plan to attain good visual outcomes post-laser-assisted in situ keratomileusis (LASIK) surgery.

METHODS

The patients were evaluated preoperatively using corneal tomography with Pentacam. Five optimal corneal topography scans were obtained from the Topolyzer Vario were used for planning the LASIK treatment. For the nomogram purpose, the patients were divided into three categories based on the difference between the subjective cylinder and Topolyzer (corneal) cylinder. The first group (group 1) consisted of eyes of patients, where the difference was less than or equal to 0.4 D. The second group (group 2) consisted of eyes, where the difference was more than 0.4 D and the subjective cylinder was lesser than the Topolyzer cylinder. The third group (group 3) included eyes where the difference was more than 0.4 D but the subjective cylinder was greater than the Topolyzer cylinder. LASIK was performed with the WaveLight FS 200 femtosecond laser and WaveLight EX500 excimer laser. Assessment of astigmatism correction for the three groups was done using Aplins vector analysis. For comparison of proportions, Chi-square test was used. A P value less than 0.05 was considered statistically significant.

RESULTS

The UDVA was statistically significantly different when compared between groups 1 and 2 (P = 0.02). However, the corrected distance visual acuity (CDVA) was similar among all the three groups (P = 0.1). Group 3 showed an increase of residual cylinder by -0.25 D, which was significant at intermediate and near reading distances (P < 0.05). Group 3 showed significantly higher target-induced astigmatism (TIA) compared to groups 1 and 2 (P = 0.01). The mean surgically induced astigmatism (SIA) was the least in group 2, which was statistically significant (P < 0.01).

CONCLUSION

The outcomes for distance vision using our nomogram postoperatively were excellent, but further refinement for improving the near vision outcomes is required.

摘要

目的

针对主觉验光和 Topolyzer 柱镜度数不匹配的情况，建立列线图，并根据不匹配的程度，制定个体化的治疗方案，以实现激光辅助原位角膜磨镶术（LASIK）术后良好的视觉效果。

方法

患者术前采用 Pentacam 角膜断层扫描仪进行评估。从 Topolyzer Vario 中获取 5 个最佳角膜地形图扫描，用于 LASIK 治疗计划。为了建立列线图，根据主觉柱镜和 Topolyzer（角膜）柱镜之间的差异，将患者分为 3 组。第 1 组（组 1）由柱镜差值≤0.4 D 的患者组成。第 2 组（组 2）由柱镜差值＞0.4 D 且主觉柱镜小于 Topolyzer 柱镜的患者组成。第 3 组（组 3）包括柱镜差值＞0.4 D 但主觉柱镜大于 Topolyzer 柱镜的患者。使用 WaveLight FS 200 飞秒激光和 WaveLight EX500 准分子激光进行 LASIK。采用 Aplins 向量分析评估 3 组的散光矫正效果。采用卡方检验比较比例，P 值＜0.05 认为具有统计学意义。

结果

组 1 和组 2 之间的未矫正远视力（UDVA）存在统计学差异（P=0.02）。然而，3 组的矫正距离视力（CDVA）相似（P=0.1）。组 3 在中距和近距阅读时，残留柱镜增加了-0.25 D，差异有统计学意义（P＜0.05）。与组 1 和组 2 相比，组 3 的目标诱导散光（TIA）显著更高（P=0.01）。组 2 的手术诱导散光（SIA）最少，差异有统计学意义（P＜0.01）。