目的：观察波前像差引导LASIK与波前像差优化LASIK对全眼高阶像差在0.3μm以下近视散光眼的疗效差异。

方法：前瞻性病例系列研究。收集在我院就诊拟行LASIK手术的近视散光患者30例60眼。每位患者随机选取一眼接受波前像差引导的LASIK，对侧眼接受波前像差优化的LASIK。术后6mo观察患者的视力、屈光度、全眼高阶像差及暗光下对比敏感度。采用配对样本t检验和χ²检验进行统计学分析。

结果：术后6mo，波前像差引导组与波前像差优化组分别有93%及90%的术眼裸眼视力≥5.0，两组术后等效球镜值在±0.50D范围内的比例分别为87%及83%，差异无统计学意义(P>0.05)。两组术后均未出现最佳矫正视力丢失2行或以上的情形。两组术后总高阶像差、球差、彗差均较术前增大(P<0.01)，但增幅在两组间无统计学差异(P>0.05)。两组术后6mo暗光下对比敏感度在各个空间频率均恢复至术前水平，差异无统计学意义(P>0.05)。

结论：对术前全眼高阶像差小于0.3μm的近视散光眼，波前像差引导LASIK与波前像差优化LASIK对术后视力、屈光度、全眼高阶像差及对比敏感度的影响无明显差异。

AIM:To compare the clinical outcomes of wavefront-guided and wavefront-optimized laser in situ keratomileusis(LASIK)to correct myopia and myopic astigmatism in patients with a preoperative total ocular higher-order aberrations(HOAs)lower than 0.3μm.

METHODS:In this prospective study, 60 eyes of 30 patients with myopia with or without astigmatism in our department were included. One eye of each patient was randomized to undergo wavefront-guided LASIK, and the fellow eye received wavefront-optimized LASIK. Postoperative outcome measures at 6mo included visual acuity, refraction, ocular HOAs, and contrast sensitivity under mesopic condition. Paired t-test and χ² test were used to analyze the data.

RESULTS:Six months postoperatively, 93% of eyes in the wavefront-guided group and 90% in the wavefront-optimized group had uncorrected visual acuity of 5.0 or better; 87% and 83%, respectively, had a postoperative spherical equivalent refraction of ±0.50D diopter. The differences were not statistically significant(P>0.05). No eye in either group lost 2 lines or more BCVA. Total HOAs, spherical aberration and coma increased in both groups postoperatively(P<0.01), with no statistical differences in HOA changes between groups(P>0.05). Contrast sensitivity under mesopic conditions in both groups recovered to preoperative levels at all spatial frequencies at 6mo postoperative(P>0.05).

CONCLUSION:For eyes with preoperative HOAs lower than 0.3μm, wavefront-guided LASIK and wavefront-optimized LASIK can provide similar results in terms of visual acuity, refraction, HOAs, and contrast sensitivity.

河北省卫计委基金资助项目(No.20150136)