目的:探讨非球面因子Q引导准分子激光角膜上皮瓣下磨镶术(laser epithelial keratomileusis,LASEK)治疗近视散光的长期疗效。方法:接受LASEK的近视散光患者138例随机分为2组,接受Q值引导LASEK患者72例72眼为试验组,接受常规LASEK患者66例66眼为对照组。术前2组各项指标均相似,差异无统计学意义。均取右眼进行分析,对两组疗效进行比较。术前及术后检测裸眼远近视力、最佳矫正视力、屈光度、眼压、角膜地形图、K值、Q值、波阵面像差、对比敏感度、超声角膜厚度和haze等。随诊时间为术前、术后0.25,1,2,3,4,6和12mo。结果:术后12mo,试验组的裸眼视力为1.12±0.16,对照组为1.07±0.14,两者差异无统计学意义(t=1.280,P=0.205);试验组的最佳矫正视力为1.16±0.19,对照组为1.12±0.17,两者差异无统计学意义(t=0.885,P=0.380);试验组Q值平均为0.478±0.203,对照组为0.798±0.238,两者差异有统计学意义(t=-5.006,P=0.000);试验组整体高阶像差为0.406±0.103μm,对照组为0.613±0.105μm,两者差异有统计学意义(t=-6.276,P=0.000);试验组球差平均为-0.186±0.108μm,对照组为-0.320±0.159μm,两者差异有统计学意义(t=3.579,P=0.001);两组的高阶像差及球差值均低于术后6mo时;试验组haze平均为0.125±0.275级,对照组为0.375±0.535级,两者差异无统计学意义(t=-1.859,P=0.071);试验组对比敏感度术后3mo恢复至术前水平,对照组术后6mo恢复至术前水平,术后12mo时试验组对比敏感度优于术前水平,除明亮无眩光外,两者差异均有统计学意义,以昏暗状态下为著。结论:非球面因子Q值引导LASEK安全、稳定、有效;减少手术诱导的高阶像差及球差,更好地保持了角膜的非球面性,更多地节约了角膜组织,更快更好地恢复对比敏感度haze更轻,视觉质量更好。

·AIM:To explore the long-term efficacy of myopic astigmatism treated by Q-factor guided laser epithelial keratomileusis(LASEK).·METHODS:Seventy-two cases(72 eyes)who were treated with Q-guided LASEK were trial group.66 cases(66 eyes)who were treated with conventional LASEK were control group.Naked distant and near visual acuity(VA),best-corrected VA,refractive diopters,intraocular pressure,topography,K value,Q value,wave-front aberration,contrast sensitivity,corneal thickness and haze of pre-and post-operation were detected.The patients were followed up for more than 12 months.·RESULTS:At 12 months post-operative,the naked VA of trial group was 1.12±0.16 while 1.07±0.14 for control group.The best-corrected VA of trial group was 1.16±0.19 while 1.12±0.17 for control group.Q value of trial group was 0.478±0.203 while 0.798±0.238 for control group.The difference was significant.Higher-order aberrations of trial group was 0.406±0.103μm while 0.613±0.105μm for control group.The difference was significant.Spherical aberration of trial group was-0.186±0.108μm,while-0.320±0.159μm for control group.The difference was significant.There was 0.125±0.275 haze in trial group while 0.375±0.535 in control group.Contrast sensitivity of trial group recovered to pre-operative level at 3 months post-operatively while control group delayed to recover until 6 months post-operatively.In trial group,contrast sensitivity of 12 months post-operative was better than pre-operative.The difference of two groups was more prominent in dark glare status.·CONCLUSION:Q-factor guided LASEK is safe and effective with good stability.Compared with conventional LASEK,Q-factor guided LASEK can reduce higher-order aberrations and spherical aberration induced by surgery.The results become better as longer follow-up time.The contrast sensitivity recovers sooner and with less haze postoperatively.Better visual quality can be achieved in Q-factor guided LASEK.·

R779.63