飞秒激光和显微板层刀行LASIK手术后视觉质量比较

Comparison of visual quality between LASIK flap made by femtosecond laser and by microkeratome

摘要:

目的：比较飞秒激光和角膜板层刀制瓣准分子激光原位角膜磨镶术(laser in situ keratomileusis， LASIK)的视觉质量。

方法：回顾性系列病例研究。选取2011-06/09我院完成的LASIK手术病例150例300 眼，根据制瓣方式分为飞秒激光组和板层刀组各75例150眼，所有手术均采用EC5000CX-Ⅱ( 日本Nidek公司)行基质切削，且都由同一手术医师完成。比较两组患者术前及术后1wk； 1，3mo的裸眼视力(uncorrected visual acuity，UCVA)、屈光度、术后最佳矫正视力(best corrected visual acuity，BCVA)、波前像差及明视和暗视状态下的对比敏感度。

结果：术后1wk； 1，3mo两组患者的UCVA和屈光度(等效球镜)比较差异均无统计学意义。在术后1mo时， 飞秒组C7的绝对值、RMSh，RMS3和RMS6值均低于板层刀组(P<0.05)； 术后3mo时飞秒组C7的绝对值、C14和RMS6的值均显著低于板层刀组(P<0.05)。明视和暗视对比敏感度在术后1wk时， 飞秒组和板层刀组均较术前降低，差异均有统计学意义(P<0.05)。术后1mo时，明视和暗视对比敏感度较术后1wk有所提高，至术后3mo略高于术前水平，差异无统计学意义(P>0.05)。

结论：飞秒激光制作角膜瓣的LASIK 手术在治疗近视和散光方面具有安全性、有效性的特点。飞秒激光在提高UCVA的同时，还能减少高阶像差的产生，并且不会导致术后对比敏感度的下降，能够提高了患者的视觉质量。其术后效果优于角膜板层刀制作角膜瓣的LASIK手术。

Abstract:

AIM: To compare the visual quality of LASIK flap made by femtosecond laser with that by microkeratome.

METHODS: Retrospective case series research was undertaken. In 2011, there were 150 cases(300 eyes)underwent LASIK surgery from June to September. The patients were divided into 2 groups: flap made by femtosecond laser was group 1; flap made by microkeratome was group 2, with 75 cases(150 eyes)for each group. All surgeries performed stroma ablation with EC5000CX-Ⅱ(NIDEK CO., LTD)by the same surgeon. Uncorrected visual acuity(UCVA), diopter before operation and one week, one month, three months after the operation were compared between two groups, as well as corresponding data of the best corrected visual acuity, wavefront aberrations, the scotopic and photopic contrast sensitivity.

RESULTS: The refractive diopter and uncorrected visual acuity between 2 groups had no significant difference at 1 week,1 month and 3 months after operation. Absolute value of C7, RMS3, RMS6 and RMSh of femtosecond laser group were lower compared with microkeratome group at 1 month after operation(P<0.05). C7 and C14 of femtosecond laser group were also lower at 3 months after operation(P<0.05). At 1 week after operation, the photopic and mesopic contrast sensitivity function in two groups decreased for all spatial frequencies, there were statistical differences compared with which before operation(P<0.05). The scotopic and photopic contrast sensitivity of the first postoperative month was increased compared with that of the first postoperative week. Till the third postoperative month, the contrast sensitivity function in two groups restored to preoperative level. The difference showed no statistic significance.

CONCLUSION: LASIK flap made by femtosecond laser can safely and effectively correct myopia and astigmatism. Femtosecond can improve UCVA and visual quality, decrease high order aberration without reducing postoperative contrast sensitivity. Its postoperative outcome is much better than that of LASIK flap made by microkeratome.