目的:观察非球面切削准分子激光原位角膜磨镶术(A-LASIK)、波前像差引导的准分子激光原位角膜磨镶术(W-LASIK)及标准准分子激光原位角膜磨镶术(S-LASIK)术后患者的临床疗效,对比分析A-LASIK、W-LASIK和S-LASIK在低、中、高度屈光范围的安全性和有效性,为临床对不同屈光度近视患者提高术后视觉质量选择个体化的、合适的手术术式提供理论依据。方法:选取拟做准分子激光原位角膜磨镶术的近视眼患者136例268眼,按屈光度分为低度(<-3.00D),中度(-3.00～-6.00D)和高度(-6.00>～<-9.00D)3组,每组柱镜度数均<-2.00D,各组再随机分成3组,一组行A-LASIK,一组行W-LASIK,另外一组行S-LASIK,手术切削区直径为6.0～7.0mm;检测指标包括术后视觉满意度调查、裸眼视力、Orbscan眼前节分析系统测量角膜非球面系数(Q值)及波前像差(6mm瞳孔直径)分析;随访时段为术前、术后1mo、术后3mo及术后6mo;观察分析各组手术前后各检测指标的变化及相关性。结果:术后6mo时,术后视觉满意度调查,A-LASIK组和W-LASIK组优于S-LASIK组,差异有统计学意义(P<0.05)。在中度组,W-LASIK组视力明显好于A-LASIK组和S-LASIK组,差异有统计学意义(P<0.05),A-LASIK组角膜非球面形态保持更好Q值差异有明显统计学意义(P<0.01),W-LASIK组角膜彗差和RMS值较A-LASIK组和S-LASIK组明显下降,差异有显著统计学意义(P<0.01),A-LASIK组角膜球差较W-LASIK组和S-LASIK组明显下降,差异有显著统计学意义(P<0.01)。结论:A-LASIK、W-LASIK和S-LASIK均能有效地矫正近视和散光,手术效果安全、稳定。A-LASIK和W-LASIK术后的夜间视觉质量更好。A-LASIK适合于低、中、高度近视患者,尤其能有效维持中度近视患者的角膜非球面性,减少中、高度,尤其是中度近视患者近视患者术后球差的增加。W-LASIK能显著提高中度近视患者的术后视力,减少中、高度近视患者,尤其是中度近视患者术后角膜彗差和总高阶像差RMS值的增加。屈光不正患者选择A-LASIK或W-LASIK有助于提高术后视觉质量。

·AIM:To observe the changes of early retrospective clinical study between aspherical oblation excimer laser in situ keratomileusis(A-LASIK),the wavefront-guided laser in situ keratomileusis(W-LASIK)and the standard laser in situ keratomileusis(S-LASIK)for treatment of myopia and provide the directions to selecte individuation surgery for the different diopters of spherical refractive,and to compare and analyze the safety and efficiency of A-LASIK,W-LASIKand W-LASIK for treatment of myopia.·METHODS:Two hundreds and sixty-eight eyes of 136 cases myopia were enrolled and presented into three groups according to their diopters of spherical refractive error(low:<-3.00D;middle:-3.00>-<-6.00D;high:-6.00>-<-9.00D).The cases in each group were subdivided into three groups again according to their surgery method:A-LASIK,W-LASIK and S-LASIK.Topography which visual acuity,diopter,offer Q value,high order aberration refraction,also postoperative glare were noted.The ablation zone was from 6.0 to 7.0mm.Wavefront aberrations were analyzed for 6.0mm pupil zone.Refraction were observed before and 1,3 and 6 months after surgery.To compare and analyze the changes and relationships of index.·RESULTS:At the 6 months after surgery,A-LASIK group and W-LASIK showed the better acception than S-LASIK group,difference was statistical significant(P<0.05).In middle group,the visual acuity of W-LASIK was better than the others,and the difference was statisticaly significant(P<0.05).In midlle group,the asphericity of A-LASIK group was the more decreased obviously than W-LASIK group and S-LASIK group,the coma was increased in W-LASIK and spherical aberration was decreased obviously in A-LASIK,and the difference was statisticaly significant(P<0.01).·CONCLUSION:A-LASIK,W-LASIK and S-LASIK are effective on correcting myopia and astigmatism safely and effectivly.A-LASIK and W-LASIK show the better acuity at night.A-LASIK can degrade the spherical aberration after surgery in low group and high group,especially in middle group.W-LASIK can elevate the acuity of vision postoperativly in middle group and decrease RMS of anterior corneal coma in middle group and high group markedly.It is a good choice to raise acuity by A-LASIK and W-LASIK.·

R779.63