Q值引导非球面切削治疗近视的临床效果观察与评价
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摘要
目的:观察Q值(Q-Factor)引导的非球面切削(Aspherical Algorithm)模式下的准分子激光原位角膜磨镶术(LASIK)治疗近视(或合并近视散光)的临床效果,从安全性、有效性、稳定性等各方面对这一新兴的治疗方式做一综合和客观评价,并尝试探讨如何进一步优化改进等问题。
方法:选取近视(或合并轻到中度近视散光)患者共63人,122眼(其中4人接受单眼治疗、其余双眼治疗),按其切削模式不同分为两组:实验组接受Q值引导的非球面切削治疗(Zyoptix Aspheric),共31人,60眼;对照组接受普通模式下的LASIK手术治疗(Planoscan),共32人,62眼。记录患者的年龄等一般信息及暗处瞳孔直径、手术治疗光区直径等数据。随访患者,于术前及术后一个月、三个月检查并记录其裸眼视力,屈光度(球镜、柱镜、轴向及等值球镜大小)、最佳矫正视力、K、Q值,对比敏感度检查结果、高阶像差RMS值及其中球差大小。比较组内各项数值在术前和术后一个月、三个月时的变化及两组间的差异并进行统计分析。
结果:实验组术前的屈光度、暗处瞳孔直径均大于对照组,选用的手术光区直径小于对照组,差别有统计学意义(P<0.05)。两组同样得到了令人满意的术后视力和屈光度。实验组患者术后主观视觉质量更好,对比敏感度检查结果优于对照组,差别有统计学意义(P<0.05)。Q值在术后3个月较术前的变化量?Q在两组之间有统计学差异(P<0.05),实验组小于对照组。术后3个月时高阶像差和球差数值和两者较术前的变化量在两组间的差别无统计学意义(P<0.05)。
结论:Q值引导的非球面切削模式下的LASIK在对近视的治疗中表现出了良好的安全性和有效性,在所随访期间内稳定性好。其术后的主观视觉质量和客观检查结果、手术前后的Q值的变化量小于传统切削模式的治疗结果。进一步的评价需要扩大样本和延长随访时间。如何更好的改进算法及设定目标Q值等需要进一步探讨。
Purpose: To investigate and evaluate the clinical results of Q-factor guided Aspherical LASIK in the treatment of myopia (or with myopic astigmatism) by comparison with traditional planoscan LASIK in the aspects of safety,stability and effectiveness.
Methods: A retrospective study with self-control and comparison between 2 groups was carried out where 63 patients with myopia (or myopia with myopic astigmatism),122 eyes(4 received single-eye treatment while others bilateral) were divided into 2 groups: study group,31 patients , 60 eyes underwent LASIK with the Q-factor guided Zyoptix Aspheric algorithm; control group,32 patients,62 eyes with traditional planoscan LASIK. In both of the 2 groups patients were examined and treated under the regular clinical LASIK standards and guidance by one surgeon with the same set of Technolas 217z Excimer Laser. The basic information of the patients as well as the diameter of mesopic pupil and optic zone were recorded. Patients were examined at the point of pre-operation、post-operation 1 month and 3 months with their following results noted: UCVA(uncorrected visual acuity),refractive status(spherical、cylinder and axis ),MRSE(mean refractive spherical equivalent),BCVA(best corrected visual acuity),K-value, Q-factor, contrast sensitivity and aberrations. Preoperative and postoperative parameters and their changes in each group and between the 2 groups were compared as well as linear correlations between the parameters were studied.
Resuts: There is significant difference between the 2 groups as for the pre-operation MRSE, mesopic pupil and optic zone diameter(P<0.05).The post-operation VA and MRSE show no significant differences between the 2 groups(P>0.05).Patients in the study group feels more satisfied with there visual quality, which is also approved by the advantage in the CSF examination outcome(sP<0.05),with less change in Q-factor noted with significant difference(P<0.05).No significant difference is found between the 2 groups as for the value of post-operational HoRMS and spherical RMS as well as their changes during the period.
Conclusion: At 3 months the Zyoptix Aspherical Algorithm shows reliable safety and stable effectiveness in the treatment of myopia and myopic astigmatism. Compared with Planoscan Algorithm there is less change in Q-factor. Longer investigation and observation is needed for a long-term assessment.
方法:选取近视(或合并轻到中度近视散光)患者共63人,122眼(其中4人接受单眼治疗、其余双眼治疗),按其切削模式不同分为两组:实验组接受Q值引导的非球面切削治疗(Zyoptix Aspheric),共31人,60眼;对照组接受普通模式下的LASIK手术治疗(Planoscan),共32人,62眼。记录患者的年龄等一般信息及暗处瞳孔直径、手术治疗光区直径等数据。随访患者,于术前及术后一个月、三个月检查并记录其裸眼视力,屈光度(球镜、柱镜、轴向及等值球镜大小)、最佳矫正视力、K、Q值,对比敏感度检查结果、高阶像差RMS值及其中球差大小。比较组内各项数值在术前和术后一个月、三个月时的变化及两组间的差异并进行统计分析。
结果:实验组术前的屈光度、暗处瞳孔直径均大于对照组,选用的手术光区直径小于对照组,差别有统计学意义(P<0.05)。两组同样得到了令人满意的术后视力和屈光度。实验组患者术后主观视觉质量更好,对比敏感度检查结果优于对照组,差别有统计学意义(P<0.05)。Q值在术后3个月较术前的变化量?Q在两组之间有统计学差异(P<0.05),实验组小于对照组。术后3个月时高阶像差和球差数值和两者较术前的变化量在两组间的差别无统计学意义(P<0.05)。
结论:Q值引导的非球面切削模式下的LASIK在对近视的治疗中表现出了良好的安全性和有效性,在所随访期间内稳定性好。其术后的主观视觉质量和客观检查结果、手术前后的Q值的变化量小于传统切削模式的治疗结果。进一步的评价需要扩大样本和延长随访时间。如何更好的改进算法及设定目标Q值等需要进一步探讨。
Purpose: To investigate and evaluate the clinical results of Q-factor guided Aspherical LASIK in the treatment of myopia (or with myopic astigmatism) by comparison with traditional planoscan LASIK in the aspects of safety,stability and effectiveness.
Methods: A retrospective study with self-control and comparison between 2 groups was carried out where 63 patients with myopia (or myopia with myopic astigmatism),122 eyes(4 received single-eye treatment while others bilateral) were divided into 2 groups: study group,31 patients , 60 eyes underwent LASIK with the Q-factor guided Zyoptix Aspheric algorithm; control group,32 patients,62 eyes with traditional planoscan LASIK. In both of the 2 groups patients were examined and treated under the regular clinical LASIK standards and guidance by one surgeon with the same set of Technolas 217z Excimer Laser. The basic information of the patients as well as the diameter of mesopic pupil and optic zone were recorded. Patients were examined at the point of pre-operation、post-operation 1 month and 3 months with their following results noted: UCVA(uncorrected visual acuity),refractive status(spherical、cylinder and axis ),MRSE(mean refractive spherical equivalent),BCVA(best corrected visual acuity),K-value, Q-factor, contrast sensitivity and aberrations. Preoperative and postoperative parameters and their changes in each group and between the 2 groups were compared as well as linear correlations between the parameters were studied.
Resuts: There is significant difference between the 2 groups as for the pre-operation MRSE, mesopic pupil and optic zone diameter(P<0.05).The post-operation VA and MRSE show no significant differences between the 2 groups(P>0.05).Patients in the study group feels more satisfied with there visual quality, which is also approved by the advantage in the CSF examination outcome(sP<0.05),with less change in Q-factor noted with significant difference(P<0.05).No significant difference is found between the 2 groups as for the value of post-operational HoRMS and spherical RMS as well as their changes during the period.
Conclusion: At 3 months the Zyoptix Aspherical Algorithm shows reliable safety and stable effectiveness in the treatment of myopia and myopic astigmatism. Compared with Planoscan Algorithm there is less change in Q-factor. Longer investigation and observation is needed for a long-term assessment.
引文
1. Nancy I. Fan-Paul, MD, Night vision disturbances after corneal refractive surgery. Survey of ophthalmology 2002 november-december 47(6) :505-510
2. Oshica T et al. Comparison of corneal wavefront aberrations after photorefractive keratectomy and laser in situ keratomileusis . Am J Ophthalmol, 1999.127: 1-7.
3. Jack T. Holladay, MD, MSEE, Joseph A. Janes, OD. Topographic changes in corneal asphericity and effective optical zone after laser in situ keratomileusis. J Cataract Refract Surg 2002; 28:942-947 ? 2002 ASCRS and ESCRS
4. Bosch&Lomb.Aspherical-release.2006
5. Gatinel D, Haouat M, Hoang-Xuan T. A review of mathematical descriptors of corneal asphericityJ Fr Ophtalmol. 2002 Jan;25(l):81-90.
6. Tobias Koller, MD, Hans Peter Iseli, MD.Q-factor customized ablation profile for the correction of myopic astigmatism J Cataract Refract Surg 2006; 32:584-589 2006 ASCRS and ESCRS
7. Bosch&Lomb.Zyoptix Aspherical multi-center study-in press
8. Tuan KM, Chernyak D.Corneal asphericity and visual function afterwavefront-guided LASIK.VISX, Incorporated.
9．沈政伟，周和政，尹禾，吴金桃，李丽．Q值引导个体化LASIK治疗近视临床疗效
评价．国际眼科杂志，2005；12(5)，1194-1198．
10. .Mantry S, Yeung I, Shah S. Aspheric ablation with the Nidek EC-5000 CX II with OPD-Scan objective analysis J Refract Surg. 2004 Sep-Oct;20(5 Suppl):S666-8
11. Vinciguerra P, Camesasca FI, Urso R. Reduction of spherical aberration with the nidek NAVEX customized ablation system.J Refract Surg. 2003 Mar-Apr; 19(2 Suppl):S 195-201
12. Kermani,Farooqui MA, Al-Muammar AR.Topography-guided CATz versus conventional LASIK for myopia with the NIDEK EC-5000: A bilateral eye study. Refract Surg. 2006 Oct;22(8):741-5.
13.Du CX, Yang YB, Shen Y, Wang Y, Dougherty PJ. Bilateral comparison of conventional versus topographic-guided customized ablation for myopic LASIK with theNIDEK EC-5000. J Refract Surg. 2006 Sep;22(7):642-6.
14. Kermani,O, Schmiedt K, Oberheide U, Gerten G. Topographic- and wavefront-guided customized ablations with the NIDEK-EC5000CXII in LASIK for myopia.J Refract Surg.2006Oct;22(8):754-63.
15. Clinique Michel Pop, Montreal, Quebec, Canada. Clinical outcomes of CATz versus OPDCAT.Pop M, Bains HS. J Refract Surg.2006Oct;22(8):700-12
1. Nancy I. Fan-Paul, MD, Night vision disturbances after corneal refractive surgery. Survey of ophthalmology 2002 november-december 47(6) :505-510
2. Seiler T. Kaernmerer M,Mierdel P,et al .Ocular optical aberrations after photorefractive keratectomy for myopia and myopic astigmatism. Arch Ophthalmol .2000.118:17-21
3. Oshica T et al. Comparison of corneal wavefront aberrations after photorefractive keratectomy and laser in situ keratomileusis . Am J Ophthalmol, 1999.127: 1-7.
4.王铮，杨斌，张醇。Zyoptix波前引导的准分子激光原位角膜磨镶术治疗近视眼的临床疗效分析中华眼科杂志，2004；40(1)：9-13
5．高宁 胡隆基等。准分子激光原位角膜磨镶术与准分子激光角膜上皮瓣下磨镶术对眼波阵面像差影响的对比。中华眼科杂志2005．11 42(11)：966-971
6. Pallikaris IG.,Kymionis GD,Panagopeulou SI,et al.Induced optical aberrationsfollowing formation of a laser in situ keratomileusis flap. J Cataract Refract Surg,2002.28(10): 1737-1741.
7.Moreiio-Barfiuso et al .Ocular aberrations before and after myopic corneal refractivesurgery :induced changes measured with laser ray tracing.Invest Ophthalmol Vis Sci,2001,42(6): 1396-1403.
8. Oshika T. Quantitative assessment of quality of vision. Nippon Ganka Gakkai Zasshi. 2004Dec;108(12):770-807
9. Vongthongsri A,Phusitphoykai N,Naripthapan P,et al.Comparison of wavefront-guided customized ablation vs conventional ablation in laser in situ keratomileusis. J Refract Surg, 2002, 18(3):487-491
10. Mrochen M,Kanmerer M,Seiler .Cinical results of wavefront-guided laser in situ keratomileusis 3 months after surgery. J Catarct Refreer Surg, 2001:201-207.
11．吕帆，瞿佳等．眼球光学 第二讲．眼视光学杂志2001 3(2)：121-123
12. Gatinel D, Haouat M, Hoang-Xuan T. A review of mathematical descriptors of corneal asphericityJ Fr Ophtalmol. 2002 Jan;25(l):81-90.
13. Bosch&Lomb.Zyoptix Aspherical multi-center study-in press
14. Tuan KM, Chernyak D.Corneal asphericity and visual function afterwavefront-guided LAS1K.VISX, Incorporated.
15. Jack T. Holladay, MD, MSEE, Joseph A. Janes, OD. Topographic changes in corneal asphericity and effective optical zone after laser in situ keratomileusis. J Cataract Refract Surg 2002; 28:942-947 ? 2002 ASCRS and ESCRS
16. Bosch&Lomb.Aspherical-release.2006
17. Tobias Koller, MD, Hans Peter Iseli, MD.Q-factor customized ablation profile for the correction of myopic astigmatism J Cataract Refract Surg 2006; 32:584-5892006 ASCRS and ESCRS
18．沈政伟，周和政，尹禾，吴金桃，李丽．Q值引导个体化LASIK治疗近视临床疗 效评价．国际眼科杂志，2005；12(5)，1194-1198．
19. .Mantry S, Yeung I, Shah S. Aspheric ablation with the Nidek EC-5000 CX II with OPD-Scan objective analysis J Refract Surg. 2004 Sep-Oct;20(5 Suppl):S666-8
20. Vinciguerra P, Camesasca FI, Urso R. Reduction of spherical aberration with the nidek NAVEX customized ablation system.J Refract Surg. 2003 Mar-Apr; 19(2 Suppl):S 195-201
21. Kermani,Farooqui MA, Al-Muammar AR.Topography-guided CATz versus conventional LAS1K for myopia with the NIDEK. EC-5000: A bilateral eye study. Refract Surg. 2006 Oct;22(8):741 -5.
22.Du CX, Yang YB, Shen Y, Wang Y, Dougherty PJ. Bilateral comparison of conventional versus topographic-guided customized ablation for myopic LASIK with the NIDEK EC-5000. J Refract Surg. 2006 Sep;22(7):642-6.
23. Kermani,O, Schmiedt K, Oberheide U, Gerten G. Topographic- and wavefront-guided customized ablations with the NIDEK-EC5000CXII in LASIK for myopia.J Refract Surg.2006Oct;22(8):754-63.
24. Clinique Michel Pop, Montreal, Quebec, Canada. Clinical outcomes of CATz versus OPDCAT.Pop M, Bains HS. J Refract Surg.2006Oct;22(8):700-12.
2. Oshica T et al. Comparison of corneal wavefront aberrations after photorefractive keratectomy and laser in situ keratomileusis . Am J Ophthalmol, 1999.127: 1-7.
3. Jack T. Holladay, MD, MSEE, Joseph A. Janes, OD. Topographic changes in corneal asphericity and effective optical zone after laser in situ keratomileusis. J Cataract Refract Surg 2002; 28:942-947 ? 2002 ASCRS and ESCRS
4. Bosch&Lomb.Aspherical-release.2006
5. Gatinel D, Haouat M, Hoang-Xuan T. A review of mathematical descriptors of corneal asphericityJ Fr Ophtalmol. 2002 Jan;25(l):81-90.
6. Tobias Koller, MD, Hans Peter Iseli, MD.Q-factor customized ablation profile for the correction of myopic astigmatism J Cataract Refract Surg 2006; 32:584-589 2006 ASCRS and ESCRS
7. Bosch&Lomb.Zyoptix Aspherical multi-center study-in press
8. Tuan KM, Chernyak D.Corneal asphericity and visual function afterwavefront-guided LASIK.VISX, Incorporated.
9．沈政伟，周和政，尹禾，吴金桃，李丽．Q值引导个体化LASIK治疗近视临床疗效
评价．国际眼科杂志，2005；12(5)，1194-1198．
10. .Mantry S, Yeung I, Shah S. Aspheric ablation with the Nidek EC-5000 CX II with OPD-Scan objective analysis J Refract Surg. 2004 Sep-Oct;20(5 Suppl):S666-8
11. Vinciguerra P, Camesasca FI, Urso R. Reduction of spherical aberration with the nidek NAVEX customized ablation system.J Refract Surg. 2003 Mar-Apr; 19(2 Suppl):S 195-201
12. Kermani,Farooqui MA, Al-Muammar AR.Topography-guided CATz versus conventional LASIK for myopia with the NIDEK EC-5000: A bilateral eye study. Refract Surg. 2006 Oct;22(8):741-5.
13.Du CX, Yang YB, Shen Y, Wang Y, Dougherty PJ. Bilateral comparison of conventional versus topographic-guided customized ablation for myopic LASIK with theNIDEK EC-5000. J Refract Surg. 2006 Sep;22(7):642-6.
14. Kermani,O, Schmiedt K, Oberheide U, Gerten G. Topographic- and wavefront-guided customized ablations with the NIDEK-EC5000CXII in LASIK for myopia.J Refract Surg.2006Oct;22(8):754-63.
15. Clinique Michel Pop, Montreal, Quebec, Canada. Clinical outcomes of CATz versus OPDCAT.Pop M, Bains HS. J Refract Surg.2006Oct;22(8):700-12
1. Nancy I. Fan-Paul, MD, Night vision disturbances after corneal refractive surgery. Survey of ophthalmology 2002 november-december 47(6) :505-510
2. Seiler T. Kaernmerer M,Mierdel P,et al .Ocular optical aberrations after photorefractive keratectomy for myopia and myopic astigmatism. Arch Ophthalmol .2000.118:17-21
3. Oshica T et al. Comparison of corneal wavefront aberrations after photorefractive keratectomy and laser in situ keratomileusis . Am J Ophthalmol, 1999.127: 1-7.
4.王铮，杨斌，张醇。Zyoptix波前引导的准分子激光原位角膜磨镶术治疗近视眼的临床疗效分析中华眼科杂志，2004；40(1)：9-13
5．高宁 胡隆基等。准分子激光原位角膜磨镶术与准分子激光角膜上皮瓣下磨镶术对眼波阵面像差影响的对比。中华眼科杂志2005．11 42(11)：966-971
6. Pallikaris IG.,Kymionis GD,Panagopeulou SI,et al.Induced optical aberrationsfollowing formation of a laser in situ keratomileusis flap. J Cataract Refract Surg,2002.28(10): 1737-1741.
7.Moreiio-Barfiuso et al .Ocular aberrations before and after myopic corneal refractivesurgery :induced changes measured with laser ray tracing.Invest Ophthalmol Vis Sci,2001,42(6): 1396-1403.
8. Oshika T. Quantitative assessment of quality of vision. Nippon Ganka Gakkai Zasshi. 2004Dec;108(12):770-807
9. Vongthongsri A,Phusitphoykai N,Naripthapan P,et al.Comparison of wavefront-guided customized ablation vs conventional ablation in laser in situ keratomileusis. J Refract Surg, 2002, 18(3):487-491
10. Mrochen M,Kanmerer M,Seiler .Cinical results of wavefront-guided laser in situ keratomileusis 3 months after surgery. J Catarct Refreer Surg, 2001:201-207.
11．吕帆，瞿佳等．眼球光学 第二讲．眼视光学杂志2001 3(2)：121-123
12. Gatinel D, Haouat M, Hoang-Xuan T. A review of mathematical descriptors of corneal asphericityJ Fr Ophtalmol. 2002 Jan;25(l):81-90.
13. Bosch&Lomb.Zyoptix Aspherical multi-center study-in press
14. Tuan KM, Chernyak D.Corneal asphericity and visual function afterwavefront-guided LAS1K.VISX, Incorporated.
15. Jack T. Holladay, MD, MSEE, Joseph A. Janes, OD. Topographic changes in corneal asphericity and effective optical zone after laser in situ keratomileusis. J Cataract Refract Surg 2002; 28:942-947 ? 2002 ASCRS and ESCRS
16. Bosch&Lomb.Aspherical-release.2006
17. Tobias Koller, MD, Hans Peter Iseli, MD.Q-factor customized ablation profile for the correction of myopic astigmatism J Cataract Refract Surg 2006; 32:584-5892006 ASCRS and ESCRS
18．沈政伟，周和政，尹禾，吴金桃，李丽．Q值引导个体化LASIK治疗近视临床疗 效评价．国际眼科杂志，2005；12(5)，1194-1198．
19. .Mantry S, Yeung I, Shah S. Aspheric ablation with the Nidek EC-5000 CX II with OPD-Scan objective analysis J Refract Surg. 2004 Sep-Oct;20(5 Suppl):S666-8
20. Vinciguerra P, Camesasca FI, Urso R. Reduction of spherical aberration with the nidek NAVEX customized ablation system.J Refract Surg. 2003 Mar-Apr; 19(2 Suppl):S 195-201
21. Kermani,Farooqui MA, Al-Muammar AR.Topography-guided CATz versus conventional LAS1K for myopia with the NIDEK. EC-5000: A bilateral eye study. Refract Surg. 2006 Oct;22(8):741 -5.
22.Du CX, Yang YB, Shen Y, Wang Y, Dougherty PJ. Bilateral comparison of conventional versus topographic-guided customized ablation for myopic LASIK with the NIDEK EC-5000. J Refract Surg. 2006 Sep;22(7):642-6.
23. Kermani,O, Schmiedt K, Oberheide U, Gerten G. Topographic- and wavefront-guided customized ablations with the NIDEK-EC5000CXII in LASIK for myopia.J Refract Surg.2006Oct;22(8):754-63.
24. Clinique Michel Pop, Montreal, Quebec, Canada. Clinical outcomes of CATz versus OPDCAT.Pop M, Bains HS. J Refract Surg.2006Oct;22(8):700-12.