【摘要】 目的探讨非球面因子Q值调整的个体化准分子激光角膜上皮瓣下磨镶术(laser epithelial keratomileusis,LASEK)治疗近视散光的疗效及其对视觉质量的影响。方法收集自愿接受LASEK治疗的近视散光患者32例(64眼),分别于术前及术后1个月、3个月、6个月检查裸眼视力、最佳矫正视力、等效球镜,超声角膜测厚,Orbscan-Ⅱ角膜地形图检查K值、Q值。结果术后1个月最佳矫正视力平均为1.16,术后6个月为1.18。安全性指数(术后最佳矫正视力/术前最佳矫正视力)为1.15,有效性指数(术后裸眼视力/术前最佳矫正视力)为1.12。术后早期等效球镜呈过矫状态,术后3个月开始回退为(0.35±0.27)D,术后6个月为(0.25±0.16)D。术前及术后1个月、3个月、6个月,Q值分别为-0.18±0.11、0.43±0.19、0.17±0.08、-0.16±0.07。术后1个月、3个月Q值与术前比较,差异均有统计学意义(t=2.738,P<0.01;t=2.257,P<0.05),术后6个月Q值与术前比较,差异无统计学意义(t=1.25,P>0.05)。术后6个月角膜形态基本接近术前角膜非球面形态。术后患者视觉质量提高,尤其夜间视力好,无光晕、眩光等。结论 Q值调整的LASEK安全、有效,具有良好的稳定性。较少的角膜切削可以减轻术后角膜创面愈合反应程度、减少haze的发生、更好地保持角膜的非球面性,提高患者术后视觉质量。更多还原

【Abstract】 Objective To explore the efficacy of Q value guided individualized laser epithelial keratomileusis(LASEK)for myopic astigmatism,and its effects on visual quality.Methods A total of 32 myopic astigmatism patients(64 eyes)were selected to take LASEK.Naked vision,best corrected visual acuity,spherical equivalent and intraocular pressure were examined,corneal thickness was measured with ultrasound corneal pachymeter,K value and Q value were measured with Orbscan-Ⅱ topography at pre-operation,postoperative 1 month,3 months and 6 months.Results The best corrected visual acuity were 1.16 at postoperative 1 month,and 1.18 at postoperative 6 months.The reliable index(postoperative best corrected visual acuity/preoperative best corrected visual acuity)was 1.15,the efficacy index(postoperative naked vision/preoperative best corrected visual acuity)was 1.12.Spherical equivalent was over-corrected at preoperative early time,back to(0.35±0.27)D at postoperative 3 months and(0.25±0.16)D at postoperative 6 months.Q values were-0.18±0.11,0.43±0.19,0.17±0.08 and-0.16±0.07 at pre-operation,postoperative 1 month,3 months and 6 months.Compared with that at pre-operation,Q value had statistical differences at postoperative 1 month and 3 months(t=2.738,P<0.01;t=2.257,P<0.05),but no difference was found at postoperative 6 months(t=1.25,P>0.05).Corneal morphology recovered to preoperative aspherial morphology at postoperative 6 months.Visual quality improved,especially for night vision,and there was no halation or glare postoperatively.Conclusions Q value guided LASEK is safe,effective and with good stability.Less corneal ablation can lessen postoperative healing reaction of corneal wound surface,reduce the incidence of haze,keep aspherial morphology of cornea and improve postoperative visual quality.更多还原