Q值引导的飞秒激光与机械板层刀制瓣的SBK术后视觉质量比较

摘要

Objective To investigate the improvement in visual quality in high myopia patients after sub-Bowman＇s keratomileusis (SBK) using femtosecond laser or a mechanically guided system using Q values.Methods In this prospective study,110 cases (220 eyes) of high myopia patients were treated and screened in our department from June 2013 to January 2015.They were divided into an OUP group and a Femto group randomly.Fifty-five high myopia patients (110 eyes) in the Femto group were treated with SBK using femtosecond laser to create corneal flaps guided by the Q value,and the same number of high myopia patients in the OUP group were treated with SBK using femtosecond laser alone to create corneal flaps.Visual acuity,corneal flap thickness,residual refractive error,total higher-order aberrations,spherical aberration,horizontal coma,vertical coma,and contrast sensitivity were evaluated during the follow-up.t-tests and repeated measures analysis of variance were used for data analysis in the first day,the first week,the first month,the third month,and the sixth month after SBK.Results There were no statistically significant differences between the two groups for visual acuity,residual refractive error,vertical coma,or contrast sensitivity (P＞0.05),but results for patients in the Femto group were better than results in the OUP group for corneal flap thickness and default (t＝24.45,P＜0.01).In addition,the added values of total higher-order aberrations,spherical aberration and horizontal coma in patients in the Femto group were better than those in the OUP group (t＝12.87,7.12,7.26,P＜0.01).Conclusion Aberrations from femtosecond laser flap SBK surgery for high myopia are milder and the procedure can provide relatively better visual quality.%目的 比较Q值引导的机械板层刀制瓣的前弹力层下角膜磨镶术(OUP-SBK)和飞秒激光制瓣的SBK(Femto-SBK)2种手术方式矫治高度近视患者后的视觉质量.方法 前瞻性队列研究.筛选丽水市中心医院近视激光中心2013年6月至2015年1月间收治的高度近视患者110例(220眼),根据制瓣方式分为Femto组55例(110眼),OUP组55例(110眼),分别行Q值引导的飞秒激光与机械板层刀制瓣的SBK术矫治高度近视.测量2种术式中制作的角膜瓣厚度及术后1d、1周、1个月、3个月、6个月的视力、残余屈光度、总高阶像差、球差、水平彗差、垂直彗差、对比敏感度等指标.数据采用t检验及重复测量资料的方差分析进行比较.结果 术后1、3、6个月,2组间患者的裸眼视力、屈光度、垂直彗差增幅、对比敏感度差异无统计学意义(P＞0.05).术中Femto组制作的角膜瓣厚度与预设差值小于OUP组(t＝24.45,P＜0.01),且总高阶像差、球差、水平彗差增幅均小于OUP组(t＝12.87、7.12、7.26,P＜0.01).结论 与机械板层刀制瓣的SBK相比,飞秒激光制瓣的SBK术治疗高度近视时引出的像差更小,可能可以提供相对更好的视觉质量.