| 〔摘要〕目的 探讨Q-值调整的个体化切削LASIK手术治疗近视疗效。 方法 应用美国雷赛Astramax三维角膜地形图仪、Astrapro 个体化切削设计程序和Astrascan准分子激光系统，对33例（66眼）近视患者进行Q-值调整的个体化治疗。30例（59眼）近视患者作为对照组行雷赛准分子激光系统标准切削方式的LASIK手术。随访6个月，评价手术的安全性、有效性、可预测性和稳定性以及视觉质量。 结果 术后6个月Q-值调整切削结果（1）安全性：最佳矫正视力上升1行以上（包括上升1行）为31.5%，无一眼下降2行；（2）有效性：裸眼视力均数为5.05 ±0.07，5.0以上为91%，5.1以上为50%；术后Q值为0.107±0.23而标准切削术后Q值为0.42±0.21，两者有显著性差异；（3）可预测性：术后平均等效球镜为-0.07±0.44D, 在目标值±0.50D 以内为80.3%，±0.25D 以内为57.6%； （4） 稳定性：术后1、3和6个月的平均等效球镜为0.096591D、0.003788D和-0.07197D，变化小于0.25D； （5）视觉质量：术后6月眩光及对比敏感度检查（CSV1000－HGT）发现：在明视状态下，两组对比敏感度较术前均有下降但没有统计学意义；在暗视状态下，Q值调整组无统计学差异而标准切削组在6、12及18周/度的频段上对比敏感度有下降并有显著性差异；在低眩光状态下，Q值调整组无统计学差异而标准切削组在3及6周/度的频段上对比敏感度有下降并有显著性差异；在高眩光状态下，两组对比敏感度较术前均有下降但没有统计学意义。结论 6个月的随访结果显示，Q值引导的个体化切削具有较高的安全性、有效性、可预测性和稳定性；比标准化切削更有助于维持角膜生理性的非球面性，并在特定的视觉环境下比后者具有更好的视觉质量。 [关键词]，激光原位角膜磨镶术；Q-值；近视; 角膜非球面性 Clinical outcomes of Q-value adjusted customized treatment for myopia using laser in situ keratomilieusis 【Abstract】 Objective： To evaluate the clinical outcomes of Q-value adjusted customized laser in situ keratomileusis (LASIK) using the Lasersight platform for the treatment of myopia. Methods： Sixty-three patients were enrolled in a controlled study in which thirty-three patients were treated with the Q-value customized ablation (Q value adjusted study group, Qg) and thirty patients were treated with standard ablation (control group,Sg). Both groups were performed with lasersight Astrascan xl excimer laser system. Q-value customized ablation was prepared with Astramax topographer and Astrapro ablation planning software. The efficacy, predictability, safety, stability and visual quality were evaluated for a period of 6 months following surgery. Results： For the Q-value adjusted ablation eyes at 6 months (1)Safety: 31.5% of the group improved 1 line for the best spectacle-corrected visual acuity (BSCVA), and no eye lost more than 2 lines of BSCVA. (2) Efficacy: UCVA was 5.05 ±0.07, 5.0 or better in 91% and 5.1 or better in 50%; postoperative Q value was 0.107±0.23, which is significantly less oblate comparing to the standard group (0.42±0.21). (3) Predictability: Mean preoperative spherical equivalent (SE) was -0.07±0.44D; 80.3% of eyes were within +/-0.5 D of intended correction and 57.6% of eyes were within +/-0.25 D of intended correction. (4) Stability: SE was 0.096591D, 0.003788D and -0.07197D at 1, 3, 6 months respectively, and the change was less than 0.25D. (5) Visual quality: CSV1000－HGT tests showed: under photopic condition, contrast sensitivity (CS) of both groups decreased without statistically difference; under scotopic condition, CS was not statistically different in Qg, but decreased significantly at following spatial frequencies (3, 6, and 18 cycles per degree) in Sg; under low glare condition, CS was not statistically different in Qg, but decreased significantly at following spatial frequencies (3, 6 cycles per degree) in Sg; under high glare condition, CS of both groups decreased without statistically difference. Conclusions： Q-value adjusted customized ablation LASIK surgery shows very good safety, effecacy , stability and predictability for 6 months follow up. It also provides clinical benefits that appear to exceed those of standard treatment in terms of maintaining corneal asphericity and visual quality under a certain lighting conditions. [Key words] excimer laser; Q-values; Myopia, cornea asphericity |
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