随着屈光手术技术的发展,患者对术后视觉质量的关注已逐渐超越单纯的裸眼视力提升。波前像差引导的LASIK技术通过个性化切削设计和精确的波前测量,显著减少术后高阶像差(HOAs)的发生,优化了术后视觉效果,成为近年来屈光手术领域的研究...随着屈光手术技术的发展,患者对术后视觉质量的关注已逐渐超越单纯的裸眼视力提升。波前像差引导的LASIK技术通过个性化切削设计和精确的波前测量,显著减少术后高阶像差(HOAs)的发生,优化了术后视觉效果,成为近年来屈光手术领域的研究热点。然而,术后视觉质量仍可能受到高阶像差的负面影响,表现为眩光、光晕、夜间视力下降以及对比敏感度降低等问题,这些仍是影响患者满意度和术后效果的核心难题。本文系统综述了波前像差引导的LASIK手术在减少术后高阶像差和优化视觉质量方面的优势,详细探讨了术后高阶像差的变化规律及其对视觉质量的多维影响,分析了相关影响因素及技术局限性。结合现有研究成果,本文展望了波前像差技术未来在设备改进、个性化设计及术后管理等方面的发展方向,以期为进一步提升手术设计和患者满意度提供科学依据。With the advancement of refractive surgical techniques, patients’ focus on postoperative visual quality has gradually shifted from mere improvement in unaided visual acuity to a more comprehensive assessment. Wavefront-guided LASIK technology, through personalized ablation designs and precise wavefront measurements, significantly reduces the occurrence of postoperative higher-order aberrations (HOAs), thereby optimizing postoperative visual outcomes. This approach has become a research hotspot in the field of refractive surgery in recent years. However, postoperative visual quality may still be negatively affected by higher-order aberrations, manifested as glare, halos, reduced night vision, and decreased contrast sensitivity. These issues remain core challenges affecting patient satisfaction and surgical outcomes. This review systematically summarizes the advantages of wavefront-guided LASIK surgery in reducing postoperative higher-order aberrations and optimizing visual quality. It also discusses in detail the patterns of changes in higher-order aberrations and their multidimensional impact on visual quality, analyzing relevant influencing factors and technical limitations. In light of existing research, the article also anticipates future developments of wavefront aberration technology in areas such as equipment improvements, personalized design, and postoperative management, aiming to provide scientific evidence for further enhancing surgical design and patient satisfaction.展开更多
AIM:To investigate the impact of preoperative anterior corneal topographic parameters on the morphology of the postoperative effective optical zone(EOZ)in patients undergoing keratorefractive lenticule extraction(KLEx...AIM:To investigate the impact of preoperative anterior corneal topographic parameters on the morphology of the postoperative effective optical zone(EOZ)in patients undergoing keratorefractive lenticule extraction(KLEx)and wavefront-guided LASIK(WG-LASIK).METHODS:This retrospective study included 310 eyes from patients who underwent either KLEx(via small incision lenticule extraction,171 eyes)or WG-LASIK(139 eyes).Patients were stratified into subgroups based on the median values of spherical equivalent(SE)and anterior corneal topographic parameters.Postoperative EOZ parameters were measured 1mo after surgery and compared across subgroups.Correlation analysis and multivariable linear regression analysis were performed to explore the associations between preoperative anterior corneal topographic parameters and EOZ parameters.RESULTS:A total of 310 eyes were included(KLEx:171 eyes from 88 patients;WG-LASIK:139 eyes from 82 patients).The mean age was 30.65±5.67y in the KLEx cohort and 29.06±5.94y in the WG-LASIK cohort.In the KLEx cohort,SE,preoperative mean keratometry(Km),steep keratometry(K2),and anterior corneal astigmatism(K2-K1)were positively correlated with the postoperative optical zone reduction ratio(RR=EOZ/planned optical zone×100%;all P<0.01).Multivariable regression identified SE[β=0.027,95%confidence interval(CI):0.022-0.032,P<0.001],Km(β=0.009,95%CI:0.002-0.016,P=0.014),and anterior corneal astigmatism(β=0.031,95%CI:0.013-0.049,P<0.001)as significant predictors of RR(R²=0.456,P<0.001).In the WG-LASIK cohort,SE was positively correlated with RR(P<0.01);K2 and anterior corneal astigmatism were positively correlated with both RR(P<0.05)and EOZ eccentricity(P<0.01).Multivariable regression showed SE(β=0.015,95%CI:0.007-0.023,P<0.001)and anterior corneal astigmatism(β=0.029,95%CI:0.012-0.047,P=0.001)were significant predictors of RR(R²=0.121,P<0.001).CONCLUSION:Preoperative anterior corneal topographic parameters,particularly anterior corneal astigmatism,significantly affect postoperative EOZ morphology in both KLEx and WG-LASIK.Additionally,Km is a predictor of EOZ reduction specifically in KLEx.展开更多
文摘随着屈光手术技术的发展,患者对术后视觉质量的关注已逐渐超越单纯的裸眼视力提升。波前像差引导的LASIK技术通过个性化切削设计和精确的波前测量,显著减少术后高阶像差(HOAs)的发生,优化了术后视觉效果,成为近年来屈光手术领域的研究热点。然而,术后视觉质量仍可能受到高阶像差的负面影响,表现为眩光、光晕、夜间视力下降以及对比敏感度降低等问题,这些仍是影响患者满意度和术后效果的核心难题。本文系统综述了波前像差引导的LASIK手术在减少术后高阶像差和优化视觉质量方面的优势,详细探讨了术后高阶像差的变化规律及其对视觉质量的多维影响,分析了相关影响因素及技术局限性。结合现有研究成果,本文展望了波前像差技术未来在设备改进、个性化设计及术后管理等方面的发展方向,以期为进一步提升手术设计和患者满意度提供科学依据。With the advancement of refractive surgical techniques, patients’ focus on postoperative visual quality has gradually shifted from mere improvement in unaided visual acuity to a more comprehensive assessment. Wavefront-guided LASIK technology, through personalized ablation designs and precise wavefront measurements, significantly reduces the occurrence of postoperative higher-order aberrations (HOAs), thereby optimizing postoperative visual outcomes. This approach has become a research hotspot in the field of refractive surgery in recent years. However, postoperative visual quality may still be negatively affected by higher-order aberrations, manifested as glare, halos, reduced night vision, and decreased contrast sensitivity. These issues remain core challenges affecting patient satisfaction and surgical outcomes. This review systematically summarizes the advantages of wavefront-guided LASIK surgery in reducing postoperative higher-order aberrations and optimizing visual quality. It also discusses in detail the patterns of changes in higher-order aberrations and their multidimensional impact on visual quality, analyzing relevant influencing factors and technical limitations. In light of existing research, the article also anticipates future developments of wavefront aberration technology in areas such as equipment improvements, personalized design, and postoperative management, aiming to provide scientific evidence for further enhancing surgical design and patient satisfaction.
文摘AIM:To investigate the impact of preoperative anterior corneal topographic parameters on the morphology of the postoperative effective optical zone(EOZ)in patients undergoing keratorefractive lenticule extraction(KLEx)and wavefront-guided LASIK(WG-LASIK).METHODS:This retrospective study included 310 eyes from patients who underwent either KLEx(via small incision lenticule extraction,171 eyes)or WG-LASIK(139 eyes).Patients were stratified into subgroups based on the median values of spherical equivalent(SE)and anterior corneal topographic parameters.Postoperative EOZ parameters were measured 1mo after surgery and compared across subgroups.Correlation analysis and multivariable linear regression analysis were performed to explore the associations between preoperative anterior corneal topographic parameters and EOZ parameters.RESULTS:A total of 310 eyes were included(KLEx:171 eyes from 88 patients;WG-LASIK:139 eyes from 82 patients).The mean age was 30.65±5.67y in the KLEx cohort and 29.06±5.94y in the WG-LASIK cohort.In the KLEx cohort,SE,preoperative mean keratometry(Km),steep keratometry(K2),and anterior corneal astigmatism(K2-K1)were positively correlated with the postoperative optical zone reduction ratio(RR=EOZ/planned optical zone×100%;all P<0.01).Multivariable regression identified SE[β=0.027,95%confidence interval(CI):0.022-0.032,P<0.001],Km(β=0.009,95%CI:0.002-0.016,P=0.014),and anterior corneal astigmatism(β=0.031,95%CI:0.013-0.049,P<0.001)as significant predictors of RR(R²=0.456,P<0.001).In the WG-LASIK cohort,SE was positively correlated with RR(P<0.01);K2 and anterior corneal astigmatism were positively correlated with both RR(P<0.05)and EOZ eccentricity(P<0.01).Multivariable regression showed SE(β=0.015,95%CI:0.007-0.023,P<0.001)and anterior corneal astigmatism(β=0.029,95%CI:0.012-0.047,P=0.001)were significant predictors of RR(R²=0.121,P<0.001).CONCLUSION:Preoperative anterior corneal topographic parameters,particularly anterior corneal astigmatism,significantly affect postoperative EOZ morphology in both KLEx and WG-LASIK.Additionally,Km is a predictor of EOZ reduction specifically in KLEx.
