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目的探讨波前引导准分子激光原位角膜磨镶术(LASIK)对视;力、对比敏感度和高阶像差的影响。方法采用随机盲前瞻性对照研究,将50名(100眼)拟行LASIK的青壮年近视患者随机分为波前引导组和传统组,分别检查术前、术后10d、1mon、3mon和6mon明暗光下裸眼视力(UCVA)和最佳矫正视力(BSCVA)、明暗光下及眩光下的对比敏感度和高阶像差进行比较。结果术后不同时间明暗光下的UCVA、BSCVA、安全指数、有效指数和对比敏感度两组间均无显著差异。术后6mon时引导组和传统组明光下UCVA、BSCVA均值分别为1.16、1.17和1.15、1.17,安全指数、有效指数分别为1.06、1.05和1.05、1.03。术后残留屈光度引导组明显高于传统组,以术后1mon最著。术后两组高阶像差RMS值(RMSh)均较术前增加,平均增加约1位;术后10d～3monRMSh及RMS4值、术后10d～6monC12系数值引导组明显低于传统组(p<0.05);术后6mon时RMSh值增加倍率分别为0.94和1.34倍。在术前未戴角膜接触镜的患者中,术后RMSh和各高阶像差RMS值(RMS3～6)增加倍率引导组明显低于传统组(p<0.05);在术前RMSh值高于0.20μm以上者中,术后RMSh值增加倍率引导组明显比传统组低,尤其以RMS4值最明显。结论波前引导LASIK在术后视力、对比敏感度方面并不优于传统LASIK。但在高阶像差矫正方面有优势,尤其是术前高阶像差偏高者。波前引导LASIK的屈光度矫正的准确性尚需进一步提高,这也许是影响视觉质量的重要因素之一。
Objective To investigate the effect of wavefront guided excimer laser in situ keratomileusis (LASIK) on the power, contrast sensitivity and higher order aberrations. Methods A total of 50 young (100 eyes) LASIK patients with myopia were randomly divided into two groups according to a randomized, prospective, controlled study: wavefront-guided group and traditional group. Preoperative, postoperative 10d, 1mon, 3mon and 6mon light and dark UCVA and BSCVA under light, contrast sensitivity and higher-order aberrations under light and dark and under glare. Results There were no significant differences in UCVA, BSCVA, safety index, effective index and contrast sensitivity between light and dark at different time points after operation. The average value of UCVA and BSCVA in guiding group and conventional group at 6mon after operation was 1.16, 1.17 and 1.15, 1.17 respectively. The safety index and effective index were 1.06, 1.05 and 1.05, 1.03 respectively. Postoperative residual diopter guidance group was significantly higher than the traditional group, the most postoperative 1mon. The RMSh values of both groups increased more than preoperatively, with an average increase of about 1 point. After 10 days to 3mon RMS and RMS4 values, the scores of postoperative 10d ~ 6monC12 values in the guide group were significantly lower than those in the conventional group <0.05). After 6months, RMSh value increased by 0.94 and 1.34 times respectively. In the patients without corneal contact lens before surgery, RMSh and RMS of high-order aberration (RMS3 ~ 6) in postoperative magnification group were significantly lower than those in the traditional group (p <0.05) 0.20μm or more, RMSh value increased after surgery group was significantly lower than the traditional group, especially RMS4 value of the most obvious. Conclusion wavefront guided LASIK in postoperative visual acuity, contrast sensitivity is not superior to the traditional LASIK. However, there are advantages in higher-order aberration correction, especially those with higher preoperative aberrations. The accuracy of wavefront guided LASIK refraction correction needs to be further improved, which may be one of the important factors that affect the visual quality.