目的：研究开角型青光眼患者非穿透性深层巩膜切除术后高阶像差的变化。

方法：研究包括20例患者20眼， 其中10例为原发性开角型青光眼， 10例为继发性开角型青光眼。患者术前接受非穿透性深层巩膜切除术，并辅以Tenon囊下注射(0.02% of MMC)。术前及术后1、3mo用i-Trace分析仪测定角膜总高阶像差。每次随访时评估眼压(IOP)、最佳矫正视力(BCVA)和眼泡形态。手术的成功率分为完全成功、相对成功和失败。

结果：术前IOP为24.05±3.07 mmHg，平均用药2.85±0.67次，随访3mo后，IOP为12.30±3.32 mmHg，平均用药0.70±0.98次。随访期间IOP均明显下降(P<0.001)。术后随访1mo，总高阶像差(HOT)均方根(RMS)和总球型像差值明显升高，3mo后下降。术后各时间段三叶肌和全眼昏迷样像差变化无统计学意义。术后1mo HOT RMS及球形角膜均明显增加，3mo随访后明显减少。术后角膜三叶肌变化与术前相比无统计学意义。患者年龄和IOP对HOT和角膜HOT的变化无显著影响。

结论：深度巩膜切除术后1mo内角膜和眼部高阶像差增加，3mo后下降，与术前相比无统计学意义。在3mo随访时，患者的BCVA和等效球镜(SE)与术前相比无统计学差异。

METHODS: Twenty eyes from 20 patients were enrolled in the study. There were 10 eyes with primary open angle glaucoma(POAG)and 10 eyes with secondary open angle(SOAG; pseudoexfoliation). Patients underwent non-penetrating deep sclerectomy surgery augmented with sub-Tenon injections(0.2 mL of MMC 0.02%)before surgery. All patients were evaluated in terms of corneal total higher-order aberrations via i-Trace analyzer before surgery and 1mo and 3mo after surgery. The intraocular pressure(IOP), best corrected visual acuity(BCVA), and bleb morphology were evaluated at each visit. The success rate of surgery was categorized as complete, relative, or failure.

RESULTS: The IOP before surgery was 24.05±3.07 mmHg with a mean of 2.85±0.67 medication, which reached to 12.30±3.32 mmHg with 0.70±0.98 medication at the 3mo follow-up. The reduction in IOP was significant at all periods of the follow-up(P<0.001). The values of total higher-order total(HOT)root mean square(RMS)and total ocular spherical-like aberrations significantly increased at 1mo follow-up after surgery and decreased over the course of 3mo. Trefoil and total ocular coma-like aberration changes were not statistically significant at all periods after surgery. The HOT RMS, coma-like and spherical-like corneal increased significantly 1mo after surgery and decreased at the 3mo follow-up. Corneal trefoil changes were not statistically significant after surgery compared to preoperative state. Patients age and IOP did not have a significant effect on changes in HOT and corneal HOT aberrations.

CONCLUSION: Corneal and ocular higher-order aberrations increased within 1mo after deep sclerectomy surgery and then decreased over a 3mo period, which showed no statistically significant change compared to preoperative state. The BCVA and spherical equivalent(SE)of the patients shown no statistically significant differences compared to the preoperative state at the 3mo follow-up.