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
目的:探讨中低度近视前弹力层下激光角膜磨镶术(sub-Bowmans keratomileusis,SBK)及准分子激光原位角膜磨镶术(laser in situkeratomi leusis,LASIK)术后角膜后表面高度的变化。方法:中低度近视患者108例216眼,前瞻性、随机性为其1眼行...目的:探讨中低度近视前弹力层下激光角膜磨镶术(sub-Bowmans keratomileusis,SBK)及准分子激光原位角膜磨镶术(laser in situkeratomi leusis,LASIK)术后角膜后表面高度的变化。方法:中低度近视患者108例216眼,前瞻性、随机性为其1眼行SBK手术,其对侧眼行LASIK手术,术前及术后1wk;1,3,6mo应用Pentacam三维眼前节分析系统检查,分析比较SBK和LASIK两组间各个不同时间点的角膜后表面高度。结果:术后所有患者视力均达到或超过术前矫正视力。经配对t检验,SBK组和LASIK组术前术后,术后各时间段的比较,差异均无统计学意义。各时期两组间角膜后表面高度值比较,差异亦无统计学差异。结论:SBK和LASIK手术对中低度近视患者术后角膜后表面高度无明显影响。展开更多
目的通过远期临床观察评价准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)矫治儿童高度远视性屈光参差的安全性、有效性、可预测性和稳定性,并探讨其对术后长期弱视治疗效果的影响。方法采用回顾性研究方法观察自2000年...目的通过远期临床观察评价准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)矫治儿童高度远视性屈光参差的安全性、有效性、可预测性和稳定性,并探讨其对术后长期弱视治疗效果的影响。方法采用回顾性研究方法观察自2000年9月开始接受LASIK手术矫治的61例61眼高度远视屈光参差性弱视儿童病例,年龄6~14岁。使用SVS Apex plus准分子激光系统及科医人公司鹰视世纪波及鹰视酷眼准分子激光系统,在局麻或基础麻醉下对患儿重度远视眼施行LASIK手术,矫治屈光度范围:(+3.00^+7.50)D。术后根据患儿年龄、弱视类型及弱视严重程度制定后期弱视治疗方案。22例随访时间60个月以上。结果术前患儿裸眼远视力为(0.12±0.07),裸眼近视力为(0.25±0.14),矫正远视力为(0.23±0.14),矫正近视力为(0.35±0.23)。双眼扩瞳等值球镜屈光参差度为(+6.41±1.24)D,小瞳等值球镜屈光参差度为(+5.52±1.16)D。中心同时视47.5%,中心融合16.4%,立体视3.3%,≤3%不等像14.8%。术后60个月:裸眼远视力为(0.35±0.13),裸眼近视力为(0.70±0.19),矫正远视力为(0.48±0.18),矫正近视力为(0.81±0.18),与术前比较,差异均有统计学意义(P<0.05)。双眼扩瞳等值球镜屈光参差度为(+0.61±1.43)D,小瞳等值球镜屈光参差度为(+0.59±1.37)D,与术前比较,差异均有统计学意义(P<0.05)。中心同时视91.7%,中心融合75.0%,立体视33.3%,≤3%不等像66.7%,与术前比较,差异均有统计学意义(P<0.05)。术后60个月所随访的22眼均没有发现最佳矫正远、近视力丢失。结论 LASIK手术可显著降低儿童高度远视性屈光参差,长期随访结果表明其具有较好的安全性、有效性、可预测性和稳定性,术后可显著提高弱视治愈率。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.
文摘目的:探讨中低度近视前弹力层下激光角膜磨镶术(sub-Bowmans keratomileusis,SBK)及准分子激光原位角膜磨镶术(laser in situkeratomi leusis,LASIK)术后角膜后表面高度的变化。方法:中低度近视患者108例216眼,前瞻性、随机性为其1眼行SBK手术,其对侧眼行LASIK手术,术前及术后1wk;1,3,6mo应用Pentacam三维眼前节分析系统检查,分析比较SBK和LASIK两组间各个不同时间点的角膜后表面高度。结果:术后所有患者视力均达到或超过术前矫正视力。经配对t检验,SBK组和LASIK组术前术后,术后各时间段的比较,差异均无统计学意义。各时期两组间角膜后表面高度值比较,差异亦无统计学差异。结论:SBK和LASIK手术对中低度近视患者术后角膜后表面高度无明显影响。
