摘要
目的:探究不同戴镜状态近视患者行角膜屈光手术后早期视功能的变化。方法:前瞻性临床研究。随机选取2023年9月至2024年3月于济南明水眼科医院角膜屈光科行角膜屈光手术的近视患者231例(462眼),年龄17~34(22.4±4.6)岁。术前所戴的框架镜SE为(-4.76±1.54)D,散瞳后综合验光仪复光SE为(-5.01±1.68)D。根据框架镜SE与散瞳后综合验光仪复光SE差值将患者分为3组:框架镜过矫组30例(60眼),差值≤-0.50 D;框架镜足矫组117例(234眼),-0.50 D<差值<+0.50 D;框架镜欠矫组84例(168眼),差值≥+0.50 D。所有患者在角膜屈光手术前后常规行眼科检查;行调节幅度(AMP)、负相对调节(NRA)、正相对调节(PRA)、单眼调节灵敏度(MAF)、双眼调节灵敏度(BAF)、调节反应(BCC)等调节功能检查;行近水平隐斜视(NLP)、远水平隐斜视(DLP)、调节性集合/调节量比值(AC/A)、集合近点(NPC)等集合功能检测。术后随访时间(3.4±1.1)个月,末次复查与术前结果的比较分析采用单因素重复测量方差分析或Mann-whitney检验。影响术后视功能的相关因素及各参数变化之间的关系采用Spearman相关分析。结果:术后3组患者视力均明显提高,手术前后视力对比差异均有统计学意义(均P<0.05),框架镜足矫组改善最明显。术前散瞳后复光球镜度3组对比差异有统计学意义(P<0.05),框架镜欠矫组散瞳后复光屈光度明显高于框架镜过矫组,框架镜过矫组框架镜的柱镜度明显高于框架镜欠矫组,差异均有统计学意义(P<0.05)。调节功能各参数手术前后各组间参数对比差异无统计学意义,框架镜欠矫组术后MAF(OD)、AMP(OD)、AMP(OS)、NRA、BCC与术前对比差异均有统计学意义(均P<0.05);框架镜足矫组术后NRA、PRA、BCC与术前对比差异均有统计学意义(均P<0.05)。在集合功能方面,各组间参数比较差异均无统计学意义(均P>0.05),框架镜足矫组手术前后的NPC比较差异有统计学意义(P<0.05)。Spearman相关分析显示:PRA与术前框架镜的球镜度、复光球镜度、复光SE呈负相关(r=-0.17~-0.14,均P<0.05),NLP、DLP与术后球镜度呈负相关(r=-0.14、-0.13,均P<0.05),BAF、AMP(OU)、MAF(OS)、NPC与年龄呈负相关(r=-0.50~-0.13,均P<0.05)。结论:戴镜适宜患者角膜屈光手术前后的视功能较为稳定,术后调节功能改善。戴镜欠矫、过矫患者手术前后调节、集合功能下降。戴镜的准确性影响角膜屈光手术患者术后视功能恢复。
Objective:To investigate the early changes in visual function after corneal refractive surgery in myopia patients with various lens-wearing conditions.Methods:This was a prospective study.A total of 231 patients(462 eyes),aged 17-34(22.4±4.6)years old,were randomly selected from those undergoing corneal refractive surgery in the Department of Corneal refraction in Jinan Mingshui Eye Hospital from September 2023 to March 2024.The SE of patients'spectacles before surgery was-4.76±1.54 D,while the SE after dilation as measured by composite optometer was-5.01±1.68 D.The participants in this study were divided into three groups according to the difference between the SE of their spectacles and the SE obtained through complex optometry after mydriasis:the over-correction group comprising 30 cases(60 eyes)with a difference≤-0.50 D;the suitable-correction group with 117 patients(234 eyes),where the difference ranged between-0.50 D and+0.50 D(exclusive);and the under-correction group consisting of 84 cases(168 eyes)with a difference≥+0.50 D.All patients underwent routine ophthalmic examination before and after corneal refractive surgery,including assessments of accommodative function such as amplitude of accommodation(AMP),negative relative accommodation(NRA),positive relative accommodation(PRA),monocular accommodative facility(MAF),binocular accommodative facility(BAF),and binocular cross-cylinder(BCC),as well as convergence function comprising near level phoria(NLP),distance level phoria(DLP),accommodation convergence/accommodation ratio(AC/A),and near point of convergence(NPC).The postoperative follow-up time was 3.4±1.1 months.Univariate repeated measurement ANOVA and non-parametric test(Mann-whitney test)were used to analyze the results from the final follow-up in comparison to the preoperative results.Results:The visual acuity of patients in all three groups significantly improved,and the difference before and after surgery was statistically significant(all P<0.05).And the suitable-correction group exhibited the most pronounced improvement.After mydriasis,there was a statistically significant difference in the mean spherical power obtained through complex optometry between the three groups(P<0.05),and the refractive power was significantly higher in the under-correction group than in the over-correction group.The mean cylindrical power of patients'own spectacles in the over-correction group was significantly higher than that in the under-correction group,and the difference was statistically significant(P<0.05).There were no statistically significant differences in accommodative function parameters among the groups before and after surgery.However,within the under-correction group,statistically significant differences were observed in MAF(OD),AMP(bilateral eyes),NRA and BCC before and after surgery(all P<0.05).In the suitable-correction group,there were statistically significant differences in NRA,PRA,and BCC before and after surgery(all P<0.05).As for the convergence function analysis,there was no significant difference in parameter comparison among all groups(all P>0.05).There was a statistically significant in NPC between preoperative and postoperative measurements in the suitable-correction group(P<0.05).The results of Spearman correlation analysis for postoperative visual function showed that PRA was negatively correlated with the mean spherical power of the patients'spectacles,the mean spherical power and SE measured by composite optometer(r=-0.17--0.14,all P<0.05).Additionally,NLP and DLP were negatively correlated with postoperative spherical lens power(r=-0.14,-0.13,both P<0.05),while BAF,AMP(OU),MAF(OS),and NPC were negatively correlated with age(r=-0.50--0.13,all P<0.05).Conclusions:The visual function of patients with suitable state of wearing spectacles remains relatively stable before and after corneal refractive surgery,with an improvement in accommodative function postoperatively.In contrast,patients with under-correction or over-correction experience a decline in accommodative and convergent function before and after surgery.The accuracy of wearing spectacles significantly affects the recovery of visual function in patients undergoing corneal refractive surgery.
作者
张静
许亚菲
侯杰
董亚慧
雷玉琳
杨星花
Jing Zhang;Yafei Xu;Jie Hou;Yahui Dong;Yulin Lei;Xinghua Yang(Jinan Mingshui Eye Hospital,Jinan 250200,China)
出处
《中华眼视光学与视觉科学杂志(中英文)》
北大核心
2025年第6期441-447,共7页
Chinese Journal Of Optometry Ophthalmology And Visual Science
基金
2023年山东大学卫生健康委员会大数据项目(2023-YBD-2-24)。
关键词
眼镜
矫正
视功能
视觉质量
视疲劳
eye glasses
corrected
visual function
visual quality
visual fatigue
