Objective To compare and analyze the higher-order aberrations (HOA),contrast sensitivity (CS) and CS under the glare after FEMTO LDV femtosecond laser flap and mechanical microkeratome Hansatome flap in laser in situ keratomileusis (LASIK).Methods This was a prospective clinical controlled study.Ninety-two eyes of 46 patients were treated with FEMTO LDV as the observation group,and 104 eyes of 52 patients were treated with Hansatome as the control group.Wavefront-guided LASIK (Zyoptix) was performed on each of these eyes after the flap preparation.HOA,CS and CS under the glare were evaluated before surgery and 1 week,1 month,3 months after treatment.Data were analyzed using chi-square test,ANOVA,independent t test.Results At 1 week after the surgery,59/92(64.1％) patients in the observation group had uncorrected visual acuity (UCVA) levels reaching or surpassing the preoperative best corrected visual acuity (BCVA),while in the control group,this rate was 76/104(73.1％).At 1 month after the surgery,the rate of UCVA≥preoperative BCVA was 82/92 (89.1％) in observation group and 96/104 (92.3％) in control group.At 3 months after the surgery,the rate of UCVA≥preoperative BCVA was 86/92(93.5％) in observation group and 96/104(92.3％) in control group.The two groups were not significantly different after the surgery (x2=1.423,1.112,0.183,P＞0.05).The refraction was +0.49±0.24 D in the observation group and +0.35±0.32 D in the control group at 1 week after surgery,while at 3 months,it was +0.10±0.18 D in the observation group and-0.14±0.22 D in the control group.The differences between the 2 groups were insignificant (t=0.566,1.178,P＞0.05).Higher-order aberration.At 1 week and 3 months,the HOA and coma in the observation group were all lower than in the control group (t1w=-2.422,-2.295,t3m=-1.957,-1.926,P＜0.05).There were no difference in spherical aberration and trefoil between the 2 groups (t1 w=-1.395,-0.779,t3m=-1.205,-0.922,P＞0.05).The 2 groups photopic CS was not significantly different after the surgery.The observation group mesopic CS decreased to the lowest level at 1 week postoperation,and returned to preoperative level at 1 month after operation.At 1 month and 3 months,the CS were higher than preoperation at 3.0,18.0 c/d (F=3.602,3.216,P＜0.05).At 1 week after surgery,the mesopie CS of the observation group was better than the control group at 6.0 c/d (t=2.326,P＜0.05).The 2 groups mesopic CS was not significantly different at 1 month and 3 months after operation.At 1 week after surgery,the photopic CS under the glare stimulus of the observation group was significantly higher than the control group at 3.0,12.0 c/d (t=2.173,2.327,P＜0.05).At 3 months,the medium to low spatial frequencies (1.5,3.0,6.0 c/d) the mesopic CS of observation group was higher than the control group (t=2.428,2.416,2.507,P＜0.05).Conclusion Patients undergoing femtosecond laser-assisted LASIK have better quality of vision after surgery than hansatome patients.%目的 对比分析FEMTO LDV飞秒激光与Hansatome机械角膜刀制瓣辅助准分子激光原位角膜磨镶术(LASIK)后高阶像差和对比敏感度(CS).方法 前瞻性临床对照研究.接受飞秒激光制瓣46例(92眼)作为观察组,同期用Hansatome微型角膜刀制瓣52例(104眼)作为对照组,制瓣后均行波前像差引导的准分子激光切削术.对术后高阶像差、CS及眩光CS进行比较.采用卡方检验、方差分析、独立样本t检验进行数据分析.结果 视力:术后1周,观察组裸眼视力(UCVA)达到或高于术前最佳矫正视力(BCVA)59眼(64.1％),对照组76眼(73.1％)；术后1个月2组分别为82眼(89.1％)、96眼(92.3％),术后3个月时分别为86眼(93.5％)和96眼(92.3％).各时间点2组比较差异均无统计学意义(x2=1.423、1.112、0.183,P＞0.05).屈光度:术后1周观察组为(+0.49±0.24)D,对照组为(+0.35±0.32)D；术后3个月观察组为(+0.10±0.18)D,对照组为(-0.14±0.22)D;2组差异均无统计学意义(t=0.566、1.178,P＞0.05).高阶像差:术后1周及3个月时全眼球总高阶像差及彗差的均方根值观察组低于对照组(t1周=-2.422、-2.295,t3个月=-1.957、-1.926,P＜0.05),球差及三叶草2组间差异均无统计学意义.CS:明视下2组术后各时间点差异无统计学意义.暗视下观察组CS值术后1周时最低,但对比术前差异无统计学意义(P＞0.05),1个月时CS值已达到术前水平,尤其1个月和3个月时3.0和18.0 c/d处CS值高于术前(F=3.602、3.216,P＜0.05).术后1周时6.0 c/d处观察组高于对照组(t=2.326,P＜0.05),术后1、3个月时2组间差异无统计学意义.眩光CS:明视下术后1周时3.0、12.0 c/d处观察组显著高于对照组(t=2.173、2.327,P＜0.05),术后1、3个月时2组间差异无统计学意义.暗视下眩光CS值术后1周时在空间频率为3.0、6.0 c/d处观察组高于对照组(t=2.124、2.691,P＜0.05)；术后3个月时,在中低空间频率为1.5、3.0、6.0 c/d处观察组高于对照组(t=2.428、2.416、2.507,P＜0.05).结论 飞秒激光辅助LASIK手术后CS结果优于机械角膜刀制瓣LASIK.
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