角膜地形图引导的LASIK与非球面LASIK治疗有散光近视眼的对比研究
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摘要
[目的]比较角膜地形图引导的个性化准分子激光原位角膜磨镶术(TOSCA-LASIK)与传统非球面准分子激光原位角膜磨镶术(ASA-LASIK)治疗有散光近视眼的临床疗效。
[方法]将符合入选条件的有散光近视眼(散光>-0.75D)随机分组,使用Carl Zeiss公司的MEL80准分子激光机系统,分别选择TOSCA和ASA切削模式施行LASIK手术。随访3月,观察术后裸眼视力、最佳矫正视力、主觉验光度数、高阶像差、对比敏感度及角膜地形图的变化并进行对比,同时应用Alpins法进行散光矫正分析。数据由SPSS16.0统计软件进行分析处理,P<0.05时存在统计学意义。
[结果]本研究入选38例69眼,均获随访。TOSCA组20例36眼,ASA组18例33眼。TOSCA组1月和3月时裸眼视力不低于1.0者分别占86.1%和94.4%,ASA组占78.8%和82.7%。应用Alpins法进行散光矫正分析：角膜地形图水平,TOSCA组的绝对平均角度误差显著小于ASA组(p=0.014)；在验光水平和角膜地形图水平,两组的算术平均幅度误差均存在显著性差异(P=O,P=0.012),同时,在角膜地形图水平,TOSCA组的幅度误差(0.05±0.42D)较ASA组(-0.37±0.76D)更接近于0(P=0.05)；平整指数,矫正指数在TOSCA组也较ASA组大且在角膜地形图水平,TOSCA组均更接近于1.0(P<0.05)；两组的球镜矫正指数在屈光水平无显著性差异,在角膜地形图水平,TOSCA组显著大于ASA组(P=0.005)。术后1月,TOSCA组的总高阶像差为0.488±0.189,ASA组为0.600±0.146,两者具有显著性差异(P=0.007)；术后3月,两组总高阶像差、总彗差、球差均无显著性差异。两组病例术后3月无眩光对比敏感度较术前降低,TOSCA组显著性差异出现在4.2 cpd(P=0.030),ASA组出现在4.2,6.6,10.6 cpd(p=0.001,p=0.002,p=0.034)；眩光对比敏感度手术前后无显著性差异；两组间各空间频率对比敏感度变化百分比无显著性差异。
[结论]角膜地形图引导的个性化准分子激光原位角膜磨镶术治疗有散光近视眼安全有效,预测性佳,与传统的非球面切削模式相比,矫正散光更完全,有更大的概率获得较好裸眼视力。
Objective:To compare the clinical outcomes of topography supported custom ablation LASIK (TOSCA-LASIK) and optimized LASIK (ASA-LASIK) in myopic eyes with astigmatism.
Methods:Divide the enrolled myopic eyes with astigmatism(greater than-0.75D) into two groups randomly, performed respectively by topography supported custom ablation LASIK (TOSCA group) and optimized LASIK (ASA group) on the MEL80 excimer laser system (Carl Zeiss Meditec, Germany). Uncorrected vision acuity (UCVA), best-spectacle corrected visual acuity(BSCVA), manifest refraction, higher order aberrations (HOAs), contrast sensitivity and topography were measured and recorded preoperatively and at one month and three months postoperatively for each eye. The Alpins method was introduced to analyze the astigmatism correction. Statistical analysis was performed using SPSS 16.0 for Windows, a P value< 0.05 was considered significant.
Results:LASIK was performed on 69 eyes of 38 patients and all of them were followed for 3 months. TOSCA was performed on 36 eyes while ASA was performed on 33. UCVA of 1.0 or better was achieved in 86.1%,94.4%of eyes in the TOSCA group and 78.8%,82.7%of eyes in the ASA group respectively at 1-and 3-month. Analysis of astigmatism correction with Alpins method:The AE by keratometry was significantly smaller in the TOSCA group compared to the ASA group in absolute means (p=0.014); The mean arithmetic ME demonstrate that the ASA group tends to undercorrect the astigmatism by 0.19 and 0.37D respectively by refraction and keratometry, while the TOSCA group overcorrect by 0.14 and 0.05D (P=0.000, P=0.012); The FI, CI and S.CI of the ASA group are all significantly smaller than those in the TOSCA group both by refraction and keratometry. The mean total high-order aberrations in the ASA group (0.600±0.146) was significantly higher than it in the TOSCA group (0.488±0.189) (P=0.007), at 3-month postoperatively, all mean HOA values between both groups were similar. Mean contrast sensitivity without glare was reduced slightly 3-month after the surgery in both groups at all target sizes and the significant differences appeared at 4.2 cpd (p=0.030) of the ASA group and 4.2,6.6,10.6 cpd (p=0.001, p=0.002, p=0.034) of the TOSCA group. The mean change in the without-and with-glare contrast sensitivity 3-month postoperatively showed no significant difference between both groups.
Conclusions:Topography supported custom ablation LASIK (TOSCA-LASIK) in this study was safe, effective and predictable for the treatment of myopic eyes with astigmatism. Compared to the conventional optimized LASIK (ASA-LASIK), it reduced residual astigmatism and was more likely to have good visual acuity.
[方法]将符合入选条件的有散光近视眼(散光>-0.75D)随机分组,使用Carl Zeiss公司的MEL80准分子激光机系统,分别选择TOSCA和ASA切削模式施行LASIK手术。随访3月,观察术后裸眼视力、最佳矫正视力、主觉验光度数、高阶像差、对比敏感度及角膜地形图的变化并进行对比,同时应用Alpins法进行散光矫正分析。数据由SPSS16.0统计软件进行分析处理,P<0.05时存在统计学意义。
[结果]本研究入选38例69眼,均获随访。TOSCA组20例36眼,ASA组18例33眼。TOSCA组1月和3月时裸眼视力不低于1.0者分别占86.1%和94.4%,ASA组占78.8%和82.7%。应用Alpins法进行散光矫正分析：角膜地形图水平,TOSCA组的绝对平均角度误差显著小于ASA组(p=0.014)；在验光水平和角膜地形图水平,两组的算术平均幅度误差均存在显著性差异(P=O,P=0.012),同时,在角膜地形图水平,TOSCA组的幅度误差(0.05±0.42D)较ASA组(-0.37±0.76D)更接近于0(P=0.05)；平整指数,矫正指数在TOSCA组也较ASA组大且在角膜地形图水平,TOSCA组均更接近于1.0(P<0.05)；两组的球镜矫正指数在屈光水平无显著性差异,在角膜地形图水平,TOSCA组显著大于ASA组(P=0.005)。术后1月,TOSCA组的总高阶像差为0.488±0.189,ASA组为0.600±0.146,两者具有显著性差异(P=0.007)；术后3月,两组总高阶像差、总彗差、球差均无显著性差异。两组病例术后3月无眩光对比敏感度较术前降低,TOSCA组显著性差异出现在4.2 cpd(P=0.030),ASA组出现在4.2,6.6,10.6 cpd(p=0.001,p=0.002,p=0.034)；眩光对比敏感度手术前后无显著性差异；两组间各空间频率对比敏感度变化百分比无显著性差异。
[结论]角膜地形图引导的个性化准分子激光原位角膜磨镶术治疗有散光近视眼安全有效,预测性佳,与传统的非球面切削模式相比,矫正散光更完全,有更大的概率获得较好裸眼视力。
Objective:To compare the clinical outcomes of topography supported custom ablation LASIK (TOSCA-LASIK) and optimized LASIK (ASA-LASIK) in myopic eyes with astigmatism.
Methods:Divide the enrolled myopic eyes with astigmatism(greater than-0.75D) into two groups randomly, performed respectively by topography supported custom ablation LASIK (TOSCA group) and optimized LASIK (ASA group) on the MEL80 excimer laser system (Carl Zeiss Meditec, Germany). Uncorrected vision acuity (UCVA), best-spectacle corrected visual acuity(BSCVA), manifest refraction, higher order aberrations (HOAs), contrast sensitivity and topography were measured and recorded preoperatively and at one month and three months postoperatively for each eye. The Alpins method was introduced to analyze the astigmatism correction. Statistical analysis was performed using SPSS 16.0 for Windows, a P value< 0.05 was considered significant.
Results:LASIK was performed on 69 eyes of 38 patients and all of them were followed for 3 months. TOSCA was performed on 36 eyes while ASA was performed on 33. UCVA of 1.0 or better was achieved in 86.1%,94.4%of eyes in the TOSCA group and 78.8%,82.7%of eyes in the ASA group respectively at 1-and 3-month. Analysis of astigmatism correction with Alpins method:The AE by keratometry was significantly smaller in the TOSCA group compared to the ASA group in absolute means (p=0.014); The mean arithmetic ME demonstrate that the ASA group tends to undercorrect the astigmatism by 0.19 and 0.37D respectively by refraction and keratometry, while the TOSCA group overcorrect by 0.14 and 0.05D (P=0.000, P=0.012); The FI, CI and S.CI of the ASA group are all significantly smaller than those in the TOSCA group both by refraction and keratometry. The mean total high-order aberrations in the ASA group (0.600±0.146) was significantly higher than it in the TOSCA group (0.488±0.189) (P=0.007), at 3-month postoperatively, all mean HOA values between both groups were similar. Mean contrast sensitivity without glare was reduced slightly 3-month after the surgery in both groups at all target sizes and the significant differences appeared at 4.2 cpd (p=0.030) of the ASA group and 4.2,6.6,10.6 cpd (p=0.001, p=0.002, p=0.034) of the TOSCA group. The mean change in the without-and with-glare contrast sensitivity 3-month postoperatively showed no significant difference between both groups.
Conclusions:Topography supported custom ablation LASIK (TOSCA-LASIK) in this study was safe, effective and predictable for the treatment of myopic eyes with astigmatism. Compared to the conventional optimized LASIK (ASA-LASIK), it reduced residual astigmatism and was more likely to have good visual acuity.
引文
[1]Learning, D.V., Practice styles and preferences of ASCRS members-2003 survey. J Cataract Refract Surg,2004.30(4):p.892-900.
[2]Solomon, K.D., et al., LASIK world literature review:quality of life and patient satisfaction. Ophthalmology,2009.116(4):p.691-701.
[3]Wu, H.K., Astigmatism and LASIK. Curr Opin Ophthalmol,2002.13(4):p.250-5.
[4]Netto, M.V., W. Dupps, Jr., and S.E. Wilson, Wavefront-guided ablation:evidence for efficacy compared to traditional ablation. Am J Ophthalmol,2006.141(2):p. 360-368.
[5]Fujikado, T., et al., Age-related changes in ocular and corneal aberrations. Am J Ophthalmol,2004.138(1):p.143-6.
[6]Charman, W.N., Wavefront technology:past, present and future. Cont Lens Anterior Eye,2005.28(2):p.75-92.
[7]Yoshida, Y., et al., Topography-guided custom ablation for irregular corneal astigmatism using the NIDEK NAVEX Laser System. J Refract Surg,2008.24(1): p.24-32.
[8]Alio, J.L., et al., Topography-guided laser in situ keratomileusis (TOPOLINK) to correct irregular astigmatism after previous refractive surgery. J Refract Surg,2003. 19(5):p.516-27.
[9]Toda, I., et al., Topography-guided ablation for treatment of patients with irregular astigmatism. J Refract Surg,2007.23(2):p.118-25.
[10]Reinstein, D.Z., T.J. Archer, and M. Gobbe, Combined corneal topography and corneal wavefront data in the treatment of corneal irregularity and refractive error in LASIK or PRK using the Carl Zeiss Meditec MEL 80 and CRS-Master. J Refract Surg,2009.25(6):p.503-15.
[11]Dougherty, P.J., et al., Topographically guided laser in situ keratomileusis for myopia using a customized aspherical treatment zone. J Cataract Refract Surg, 2008.34(11):p.1862-71.
[12]Farooqui, M.A. and A.R. Al-Muammar, Topography-guided CATz versus conventional LASIK for myopia with the NIDEK EC-5000:A bilateral eye study. J Refract Surg,2006.22(8):p.741-5.
[13]Kermani,O., et al., Topographic-and wavefront-guided customized ablations with the NIDEK-EC5000CXII in LASIK for myopia. J Refract Surg,2006.22(8):p. 754-63.
[14]Waring, G., et al., Topographically guided LASIK for myopia using the Nidek CXII customized aspheric treatment zone (CATz). Trans Am Ophthalmol Soc, 2007.105:p.240-6; discussion 247-8.
[15]Artal, P., et al., Compensation of corneal aberrations by the internal optics in the human eye. J Vis,2001.1(1):p.1-8.
[16]Kelly, J.E., T. Mihashi, and H.C. Howland, Compensation of corneal horizontal/vertical astigmatism, lateral coma, and spherical aberration by internal optics of the eye. J Vis,2004.4(4):p.262-71.
[17]Gan, D., et al., Outcomes of epi-LASIK for the correction of high myopia and myopic astigmatism after more than 1 year. Ophthalmologica,2009.223(2):p. 102-10.
[18]Goes, F.J., LASIK for myopia with the Zeiss meditec MEL 80. J Refract Surg, 2005.21(6):p.691-7.
[19]Puell, M.C., et al., Contrast sensitivity and disability glare in patients with dry eye. Acta Ophthalmol Scand,2006.84(4):p.527-31.
[20]Alpins, N.A., New method of targeting vectors to treat astigmatism. J Cataract Refract Surg,1997.23(1):p.65-75.
[21]Alpins, N., Astigmatism analysis by the Alpins method. J Cataract Refract Surg, 2001.27(1):p.31-49.
[22]Hori-Komai, Y., et al., Detection of cyclotorsional rotation during excimer laser ablation in LASIK. J Refract Surg,2007.23(9):p.911-5.
[23]Ghosh, S., et al., Evaluation of iris recognition system for wavefront-guided laser in situ keratomileusis for myopic astigmatism. J Cataract Refract Surg,2008.34(2):p. 215-21.
[24]Wu, F., Y. Yang, and P.J. Dougherty, Contralateral comparison of wavefront-guided LASIK surgery with iris recognition versus without iris recognition using the MEL80 Excimer laser system. Clin Exp Optom,2009.92(3):p.320-7.
[1]Vongthongsri A, Phusitphoykai N, Tungsiriput T. Laser in situ keratomileusis for high myopia using a small zone and large aspheric transition zone. J Refract Surg, 2004,20(5 suppl):669-673.
[2]Samir A. Melki, Dimitri T. Azar. LASIK complications:etiology, management, and prevention. J Surv Ophthalmol.2001,46(2):95-116.
[3]苏静,张丰菊,张昆.LASIK单区切削与多区切削治疗高度近视的临床疗效分析.中国实用眼科杂志,2005：23(10)：1068-1071.
[4]Yamane N, Miyata K, Samejima T, Ocular higher-order aberrations and contrast sensitivity after conventional laser in situ keratomileusis. Invest ophthalmol Vis Sci, 2004,45(11):3986-3990.
[5]Llorente L, Barbero S, Cano D. Myopic versus hyperopic eyes:axial length, corneal shape and optical aberrations.J vis,2004;4(4):288-298.
[6]J.T. Holladay, D.R. Dudeja and J. Chang, Functional vision and corneal changes after laser in situ keratomileusisdetermined by contrast sensitivity, glare testing, and corneal topography, J Cataract Refract Surg,1999,25(5):663-669.
[7]Koller T, Iseli HP, Hafezi F,etc. Q-factor customized ablation profile for the correction of myopic astigmatism. J Cataract Refract Surg,2006,32(4):584-589.
[8]MacRae SM. Supernormal vision, hypervision, and customized corneal ablation. J Cataract Refract Surg,2000,26:154-157.
[9]Seitz B, Langenbucher A, Kus MM, et al. Experimental correction of irregular corneal astigmatism using topography-based flying-spot-mode excimer laser photoablation. Am J Ophthalmol,1998; 125:252.
[10]10 Arbelaez MC. Super vision:dream or reality. J Refract Surg,2001,17(2 suppl): S211.
[11]Klein SA. Optimal corneal ablation for eyes with arbitrary Hartmann-Shack aberrations. J Opt Soc Am A,1998:2580-2588.
[12]12 Hersh PS, Fry K, Blaker JW, et al. Spherical aberration after laser in situ keratomileusis and photorefractive keratectomy. J Cataract Refract Surg,2003, 29:2096-2104.
[13]Manns F,Ho A, Parel JM, et al. Ablation profiles for wavefront-guided correction of myopia and primary sptherical aberration. J cataract Refract Surg,2002, 28:766-774.
[14]Kanjani N, Jacob S, Agarwal A,et al. Wavefront-and topography-guided ablation in myopic eyes using Zyoptix. J Cataract Refract Surg,2004,30:398-402.
[15]Bababeygy SR, Zoumalan CI, Manche EE. Visual outcomes of wavefront-guided laser in situ keratomileusis in eyes with moderate or high myopia and compound myopic astigmatism. J cataract Refract Surg,2008,34(1):21-27.
[16]Zhang J, Zhou YH, Wang NL, et al. Comparison of visual performance between conventional LASIK and wavefront-guided LASIK with iris-registration. CHINESE MEDICAL JOURNAL,2008,121(2):137-142.
[17]Strenk SA, Strenk LM, Koretz.JF. The mechanism of presbyopia. Prog Retin Eye Res,2005,24:379-393.
[18]Schachar RA, Black TD,Kash RL, et all. The mechanism of accommodation and presbyopia in the primate. Ann Ophthalmol,1995,27:58-67.
[19]Weatsmith RA. Use of a monocular contact lens. Am J Ophthalmol.1958,46(1): 78-81.
[20]BelerCG. A review of the literature pertaining to monocision contact lens fitting of presbyopic patients:clinical considerations. Int Contact Lens Clin.1977,4(3):49-56.
[21]Reilly CD,Lee WB,Alvarenga L,et all. Surgical monovision and monovision reversal in LASIK. Cornea,2006,25(2):136-138.
[22]Erickson P, McGill EC. Role of visual acuity, stereoacuity and ocular dominance in monovision patient success. Optom Vis Sci.1992,69:761-764.
[23]Alain P. Telandro, John Steile III. Presbyopia: perspective on the reality of pseudoaccommodation with LASIK. Ophthalmol Clin North Am.,2006,19(1):45-69.
[24]Cantu R, Marco AR, Tepichin E, et al. Advanced surface ablation for presbyopia using the Nidek EC-500 laser. J Refract Surg,2004,20:711-713.
[2]Solomon, K.D., et al., LASIK world literature review:quality of life and patient satisfaction. Ophthalmology,2009.116(4):p.691-701.
[3]Wu, H.K., Astigmatism and LASIK. Curr Opin Ophthalmol,2002.13(4):p.250-5.
[4]Netto, M.V., W. Dupps, Jr., and S.E. Wilson, Wavefront-guided ablation:evidence for efficacy compared to traditional ablation. Am J Ophthalmol,2006.141(2):p. 360-368.
[5]Fujikado, T., et al., Age-related changes in ocular and corneal aberrations. Am J Ophthalmol,2004.138(1):p.143-6.
[6]Charman, W.N., Wavefront technology:past, present and future. Cont Lens Anterior Eye,2005.28(2):p.75-92.
[7]Yoshida, Y., et al., Topography-guided custom ablation for irregular corneal astigmatism using the NIDEK NAVEX Laser System. J Refract Surg,2008.24(1): p.24-32.
[8]Alio, J.L., et al., Topography-guided laser in situ keratomileusis (TOPOLINK) to correct irregular astigmatism after previous refractive surgery. J Refract Surg,2003. 19(5):p.516-27.
[9]Toda, I., et al., Topography-guided ablation for treatment of patients with irregular astigmatism. J Refract Surg,2007.23(2):p.118-25.
[10]Reinstein, D.Z., T.J. Archer, and M. Gobbe, Combined corneal topography and corneal wavefront data in the treatment of corneal irregularity and refractive error in LASIK or PRK using the Carl Zeiss Meditec MEL 80 and CRS-Master. J Refract Surg,2009.25(6):p.503-15.
[11]Dougherty, P.J., et al., Topographically guided laser in situ keratomileusis for myopia using a customized aspherical treatment zone. J Cataract Refract Surg, 2008.34(11):p.1862-71.
[12]Farooqui, M.A. and A.R. Al-Muammar, Topography-guided CATz versus conventional LASIK for myopia with the NIDEK EC-5000:A bilateral eye study. J Refract Surg,2006.22(8):p.741-5.
[13]Kermani,O., et al., Topographic-and wavefront-guided customized ablations with the NIDEK-EC5000CXII in LASIK for myopia. J Refract Surg,2006.22(8):p. 754-63.
[14]Waring, G., et al., Topographically guided LASIK for myopia using the Nidek CXII customized aspheric treatment zone (CATz). Trans Am Ophthalmol Soc, 2007.105:p.240-6; discussion 247-8.
[15]Artal, P., et al., Compensation of corneal aberrations by the internal optics in the human eye. J Vis,2001.1(1):p.1-8.
[16]Kelly, J.E., T. Mihashi, and H.C. Howland, Compensation of corneal horizontal/vertical astigmatism, lateral coma, and spherical aberration by internal optics of the eye. J Vis,2004.4(4):p.262-71.
[17]Gan, D., et al., Outcomes of epi-LASIK for the correction of high myopia and myopic astigmatism after more than 1 year. Ophthalmologica,2009.223(2):p. 102-10.
[18]Goes, F.J., LASIK for myopia with the Zeiss meditec MEL 80. J Refract Surg, 2005.21(6):p.691-7.
[19]Puell, M.C., et al., Contrast sensitivity and disability glare in patients with dry eye. Acta Ophthalmol Scand,2006.84(4):p.527-31.
[20]Alpins, N.A., New method of targeting vectors to treat astigmatism. J Cataract Refract Surg,1997.23(1):p.65-75.
[21]Alpins, N., Astigmatism analysis by the Alpins method. J Cataract Refract Surg, 2001.27(1):p.31-49.
[22]Hori-Komai, Y., et al., Detection of cyclotorsional rotation during excimer laser ablation in LASIK. J Refract Surg,2007.23(9):p.911-5.
[23]Ghosh, S., et al., Evaluation of iris recognition system for wavefront-guided laser in situ keratomileusis for myopic astigmatism. J Cataract Refract Surg,2008.34(2):p. 215-21.
[24]Wu, F., Y. Yang, and P.J. Dougherty, Contralateral comparison of wavefront-guided LASIK surgery with iris recognition versus without iris recognition using the MEL80 Excimer laser system. Clin Exp Optom,2009.92(3):p.320-7.
[1]Vongthongsri A, Phusitphoykai N, Tungsiriput T. Laser in situ keratomileusis for high myopia using a small zone and large aspheric transition zone. J Refract Surg, 2004,20(5 suppl):669-673.
[2]Samir A. Melki, Dimitri T. Azar. LASIK complications:etiology, management, and prevention. J Surv Ophthalmol.2001,46(2):95-116.
[3]苏静,张丰菊,张昆.LASIK单区切削与多区切削治疗高度近视的临床疗效分析.中国实用眼科杂志,2005：23(10)：1068-1071.
[4]Yamane N, Miyata K, Samejima T, Ocular higher-order aberrations and contrast sensitivity after conventional laser in situ keratomileusis. Invest ophthalmol Vis Sci, 2004,45(11):3986-3990.
[5]Llorente L, Barbero S, Cano D. Myopic versus hyperopic eyes:axial length, corneal shape and optical aberrations.J vis,2004;4(4):288-298.
[6]J.T. Holladay, D.R. Dudeja and J. Chang, Functional vision and corneal changes after laser in situ keratomileusisdetermined by contrast sensitivity, glare testing, and corneal topography, J Cataract Refract Surg,1999,25(5):663-669.
[7]Koller T, Iseli HP, Hafezi F,etc. Q-factor customized ablation profile for the correction of myopic astigmatism. J Cataract Refract Surg,2006,32(4):584-589.
[8]MacRae SM. Supernormal vision, hypervision, and customized corneal ablation. J Cataract Refract Surg,2000,26:154-157.
[9]Seitz B, Langenbucher A, Kus MM, et al. Experimental correction of irregular corneal astigmatism using topography-based flying-spot-mode excimer laser photoablation. Am J Ophthalmol,1998; 125:252.
[10]10 Arbelaez MC. Super vision:dream or reality. J Refract Surg,2001,17(2 suppl): S211.
[11]Klein SA. Optimal corneal ablation for eyes with arbitrary Hartmann-Shack aberrations. J Opt Soc Am A,1998:2580-2588.
[12]12 Hersh PS, Fry K, Blaker JW, et al. Spherical aberration after laser in situ keratomileusis and photorefractive keratectomy. J Cataract Refract Surg,2003, 29:2096-2104.
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