【摘要】 目的 比较飞秒激光制瓣LASIK（飞秒LASIK）和有晶状体眼后房型人工晶状体（ICL）植入在矫正高度近视术后光学质量和客观眼内散射的差异。方法 前瞻性病例对照研究。入选近视度数为-6~-12 D患者44例，年龄18~40岁，其中24例（48眼）接受飞秒LASIK术，20例（40眼）行ICL植入术，除角膜厚度（t=4.77，P<0.05）外，2组间术前资料差异均无统计学意义。术后1个月和3个月运用视觉质量分析系统（OQASTMⅡ）分别测量客观散射指数、调制传递函数截止频率、斯特列尔比和对比度为100%、20%及9%的OQAS值。术后随访3个月，组内比较采用配对t检验，2组间比较采用独立样本t检验。结果 术后1个月ICL组相较飞秒LASIK组残余轻度散光（t=4.95，P<0.05）；2组间裸眼及矫正视力、等效球镜度差异均无统计学意义，安全性指数ICL组大于飞秒LASIK组（t=2.22，P<0.05）。术后3个月同术后1个月相比，ICL组等效球镜度数变化差异无统计学意义，而飞秒LASIK组有50%眼发生平均约（-0.72±1.23）D的屈光回退。术后1个月和3个月2组间各光学质量参数比较差异均无统计学意义，仅在术后1个月ICL组的客观散射指数大于飞秒LASIK组（t=-2.14，P<0.05）。结论 飞秒LASIK或ICL植入均能有效矫正-6 D到-12 D范围的高度近视，同飞秒LASIK相比，植入ICL更安全更稳定；尽管植入ICL早期客观眼内散射略大，但两者术后总体光学质量结果相似。
【关键词】 近视； 飞秒激光； 角膜磨镶术，激光原位； 有晶状体眼人工晶状体植入术； 光学质量； 眼内散射； 双通道技术
DOI：10.3760/cma.j.issn.1674-845X.2014.04.003
基金项目：国家自然科学基金面上项目（11074052）；上海市科学技术委员会引导项目（）
作者单位：200031 上海，眼科卫生部近视眼重点实验室
通信作者：王晓瑛，Email：xiaoyingbbb@163.com
Comparison of optical quality and intraocular scattering after femtosecond LASIK and posterior chamber phakic intraocular lenses implantation
Chen Feifei， Wang Xiaoying， Zhou Xingtao， Zhang Xi， Wang Lin. Department of Ophthalmology， Eye and ENT Hospital， Fudan University， Myopia Key Laboratory of Health Ministry， Shanghai 200031， China
Corresponding author：Wang Xiaoying，Emai：xiaoyingbbb@163.com
【Abstract】 Objective To compare optical quality and objective intraocular scattering after femtosecond laser in situ keratomileusis （FS-LASIK） and implantable collamer lenses （ICL） implantation for high myopia. Methods This observational case-control study selected 44 consecutive patients （ages range from 18 to 40 years） with myopia between -6 D to -12 D， of which 24 cases （48 eyes） accepted FS-LASIK surgery and 20 cases （40 eyes） underwent ICL implantation. In addition to the corneal thickness （t=4.77， P<0.05）， all the preoperative data were matched between the two groups. Measurements were performed one and three-month postoperatively by a double-pass optical quality analysis system （OQASTM， Visiometrics， Spain）. We assessed the objective scattering index （OSI）， modulation transfer function （MTF） cutoff frequency， Strehl ratio and OQAS values （OVs） at contrasts of 100%， 20% and 9%. Paired t test for data comparison within group and independent sample t test between groups were used for statistical analysis in postoperative 3 months follow-up. Results After 1 month， except for residual mild astigmatism （t=4.95， P<0.05） and more safety index （t=2.22， P<0.05） in ICL group， no significant differences were found between the groups in UCVA， BSCVA and equivalent sphere refraction. After 3 months， while no significant change of equivalent sphere refraction in ICL group compared with 1 month， 50% eyes in FS-LASIK group had an average refractive regression of -0.72±0.72 D. We also found no significant differences in the MTF cutoff frequency， Strehl ratio， 100%OVs， 20%OVs， and 9%OVs between groups after 1 and 3 months， only OSI of ICL surgery after 1 month was greater than FS-LASIK group （t=2.14， P<0.05）. Conclusion Either FS-LASIK or ICL implantation could effectively correct high myopia range from -6 D to -12 D； However， ICL implantation was safer and more stable when compared with FS-LASIK surgery. Although early objective intraocular scattering after ICL implanted was slightly higher， the overall results of postoperative optical quality were similar.
【Key words】 Myopia； Femtosecond laser； Keratomileusis，laser in situ； Phakic intraocular lenses； Optical quality； Intraocular scattering； Double-pass technique
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