摘要
目的探讨应用虹膜识别技术进行波阵面像差引导的准分子激光原位角膜磨镶术（LASIK）治疗近视或近视散光眼术后视力结果以及像差和对比敏感度变化。方法前瞻性系列病例研究，对158只近视或近视性散光眼（85例）分为两组，一组应用虹膜识别技术进行波阵面像差引导的LASIK治疗（虹膜识别组），另一组不应用虹膜识别技术通过角膜缘作标记点进行波阵面像差引导的LASIK治疗（无虹膜识别组）。对两组术后视力、残余屈光度、高阶像差均方根值和对比敏感度进行对比分析。计量资料采用完全随机设计两样本均数比较，计数资料采用X2检验。结果两组术后10d、1个月和3个月之间的平均裸眼视力（t=0．039，0．058，0．898；P=0．844，0．810，0．343）、最佳矫正视力（t=0．320，0．440，1．515；P=0．572，0．507，0．218）以及残留的屈光度[等值球镜（t=0．027，0．215，0．238；P=0．869，0．643，0．626）、球镜（t=0．145，0．117，0．038；P=0．704，0．732，0．845）和柱镜（t=1．676，1．936，0．334；P=0．195，0．164，0．563）]差异均无统计学意义。术后3个月虹膜识别组的安全性指数为1．06，无虹膜识别组为1．03；虹膜识别组的有效性指数为1．01，无虹膜识别组为1．00；虹膜识别组93．83％眼和无虹膜识别组90．91％眼等值球镜在±0．50D内（x2=0．479，P=0．489），虹膜识别组98．77％眼和无虹膜识别组97．40％眼的等值球镜在±1．00D内（Fisher精确检验，P=0．613），两组安全性、有效性和可预测性之间均无差异。无虹膜识别组术后1个月和术后3个月3阶像差的均方根值比虹膜识别组大（t=3．414，-2．870；P=0．027，0．045），表现在彗差上；两组总体高阶像差（t=0．386，1．132；P=0．719，0．321）、4阶像差（t=0．808，2．720；P=0．464，0．063）和5阶像差（t=0．148，-1．717；P=0．890，0．161）之间无差异。术后3个月两组所有频段对比敏感度已达到术前水平，虹膜识别组在暗视下3．0c／d（t=3．209，P=0．002）和6．0c／d（t=2．997，P=0．004）频段对比敏感度高于无虹膜识别组，眩光对比敏感度明视下在3．0c／d（t=3．423，P=0．001）和6．0c／d（t=6．986，P=0．000）频段与暗视下在1．5c／d（t=9．839，P=0．000）和3．0c／d（t=7．367，P=0．000）虹膜识别组高于无虹膜识别组，其余各频段之间无差异。结论虽然应用虹膜识别技术与不应用虹膜识别技术进行波阵面像差引导的LASIK，术后同样能够获得较好视力；但是应用虹膜识别技术可以减少术后彗差，提高对比敏感度。
Objective To explore the postoperative visual acuity results of wavefront-guided LASIK with iris recognition for myopia or myopic astigmatism and the changes of higher-order aberrations and contrast sensitivity function（CSF）. Methods Series of prospective case studies, 158 eyes （85 cases） of myopia or myopic astigmatism were divided into two groups： one group underwent wavefront-guided LASIK with iris recognition （ iris recognition group ） ; another group underwent wavefront-guided LASIK treatment without iris recognition through the limbus mating point （ non-iris recognition group）. To comparative analyzethe postoperative visual acuity, residual refraction, the RMS of higher-order aberrations and CSF of two groups. Results There was no statistical significance difference between two groups of the average uncorrected visual acuity（t = 0. 039,0. 058,0. 898; P = 0. 844,0. 810,0. 343 ）, best corrected visual acuity （ t = 0. 320,0. 440,1. 515 ; P = 0. 572, 0. 507,0. 218 ）, and residual refraction [ spherical equivalent （ t = 0. 027,0. 215,0.238; P =0. 869,0. 643,0. 626） ,spherical （t =0. 145,0. 117,0. 038; P =0. 704,0. 732, 0. 845） and cylinder （ t = 1. 676,1. 936,0. 334 ; P = O. 195,0. 164,0. 563） ] at postoperative 10 days, 1 month and 3 month. The security index of iris recognition group at postoperative 3 month was 1.06 and non- iris recognition group was 1.03 ; the efficacy index of iris recognition group is 1.01 and non-iris recognition group was 1.00. Postoperative 3 month iris recognition group 93.83% eyes and non-iris recognition group of 90. 91% eyes spherical equivalent within ± 0. 50 D （ x2 = 0. 479, P = 0. 489 ）, iris recognition group of 98.77% eyes and non-iris recognition group of 97.40% eyes spherical equivalent within ± 1.00 D（ Fisher test,P=0. 613）. There was no significance difference between the two groups of security, efficacy and predictability. Non-iris recognition group postoperative 1 month and postoperative 3 months 3-order order aberrations root mean square value （RMS） higher than the iris recognition group increased（t = 3. 414, - 2. 870 ; P = 0. 027,0. 045 ）, in particular of coma ; the general higher-order aberrations （ t = 0. 386,1.132 ; P =0. 719,0. 321 ） ,4-order aberrations（t =0. 808,2. 720;P = 0. 464,0. 063） ,and 5-order aberrations（ t = 0. 148, -1. 717 ;P =0. 890,0. 161 ） show no statistically significant difference. Three months after surgery, two groups have recovered at all spatial frequencies of CSF,iris recognition group at 3.0 c/d （ t = 3. 209,P = 0. 002）and 6. 0 c/d （t = 2. 997, P = 0. 004 ） spatial frequencies of CSF under mesopic condition was better than non-iris recognition group, glare contrast sensitivity function （GCSF） for 3.0 c/d （ t = 3.423, P = 0. 001 ） and 6. 0 c/d（ t = 6. 986, P = 0. 000 ） spatial frequencies under mesopic condition and 1.5 c/d （ t = 9. 839, P =0. 000） and 3.0 c/d （ t = 7. 367, P = 0. 000 ） spatial frequencies under photopic condition in iris recognition group were better than non-iris recognition group, there were no siginificant difference between two groups at the other spatial frequencies. Conclusions Wavefront-guided LASIK with or without iris recognition both acquired better postoperative visual acuity, but in comparion with without iris recognition, wavefront-guided LASIK with iris recognition is efficient to reduce coma and enhance contrast sensitivity of postoperative.
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2011年第10期927-933,共7页
Chinese Journal of Ophthalmology
关键词
角膜磨镶术
激光原位
虹膜
近视
散光
Keratomileusis,laser in situ
Iris
Myopia
Astigmatism
