飞秒激光辅助角膜原位磨镶术与角膜塑形镜治疗中低度近视的视觉质量对比研究

Comparison of changes in visual quality after FS-LASIK or orthokeratology in patients with low to moderate myopia

摘要:

目的 比较飞秒激光辅助角膜原位磨镶术（FS-LASIK）与角膜塑形镜（OK）治疗中低度近视患者的长期视觉质量变化。方法 选取2018年10月—2019年8月广西壮族自治区人民医院收治的中低度数成人近视患者86例，分为FS-LASIK组和OK组，各43例，均选取右眼为研究对象。在治疗前和治疗后1个月、3个月、6个月、12个月，分别采集两组的裸眼视力（UCVA）、球镜、柱镜，采用双通道系统视觉质量分析仪（OQAS）检查客观视觉质量，包括散射指数（OSI）、调制传递函数（MTF）、斯特列尔比（SR）、不同对比度下OQAS值（OV100%、OV20%、OV9%）。结果 FS-LASIK组与OK组治疗前和治疗后1个月、3个月、6个月、12个月的UCVA在不同时间点有差异（P <0.05），组间及变化趋势上无差异（P >0.05）。FS-LASIK组与OK组治疗前和治疗后1个月、3个月、6个月、12个月的球镜和柱镜比较：①不同时间点的球镜和柱镜有差异（P <0.05）；②两组间的球镜无差异（P >0.05），而柱镜有差异（P <0.05）；③两组球镜变化趋势无差异（P >0.05），而柱镜变化趋势有差异（P <0.05）。FS-LASIK组与OK组治疗前和治疗后1个月、3个月、6个月、12个月的MTF、OSI、SR、OV100%、OV20%、OV9%比较：①不同时间点MTF、OSI、SR、OV100%、OV20%、OV9%有差异（P <0.05）；②两组MTF、OSI、SR、OV100%、OV20%、OV9%有差异（P <0.05）；③两组MTF、SR、OV100%、OV20%、OV9%变化趋势无差异（P >0.05），而OSI变化趋势有差异（P <0.05）。结论 FS-LASIK和OK镜治疗后患者早期均出现客观视觉质量下降，但随着时间延长有改善趋势。FS-LASIK和OK镜对中低近视患者的裸眼视力改善无明显差异，但FS-LASIK的柱镜矫正及客观视觉质量更好。

Abstract:

Objective To compare the long-term changes of visual quality for patients with low to moderate myopia after femtosecond laser-assisted in-situ keratomileusis (FS-LASIK) or orthokeratology (OK).Methods A total of 86 adult patients with low to moderate myopia admitted to our hospital from October 2018 to August 2019 were selected and divided into FS-LASIK group (n = 43) and OK group (n = 43), and measurements were made on the right eyes. The uncorrected visual acuity (UCVA), spherical power, cylindrical power and objective visual quality parameters including objective scatter index (OSI), modulation transfer function (MTF), Strehl ratio (SR) and optical quality analysis system (OQAS) values (OV100%, OV20%, and OV9%) were measured at baseline and 1, 3, 6 month(s) and one year after treatment, respectively.Results The repeated measures analysis of variance was used to compare parameters at different time points between the FS-LASIK group and OK group. The results showed that there was a significant difference in UCVA among different time points (P < 0.05), while there was no significant difference in UCVA between the two groups (P > 0.05) or in the change trend of UCVA (P > 0.05). The spherical and cylindrical powers were significantly different respectively at different time points (P < 0.05). There was no significant difference in spherical powers between the two groups (P > 0.05), while cylindrical powers exhibited significant differences between the two groups (P < 0.05). Similarly, the change trend of cylindrical powers (P < 0.05) rather than that of spherical powers (P > 0.05) was different, Furthermore, MTF, OSI, SR, OV100%, OV20% and OV9% were statistically different between the two groups (P < 0.05), and also different among different time points in each group (P < 0.05). There was no difference in the change trends of MTF, SR, OV100%, OV20% and OV9% (P > 0.05), while the change trend of OSI showed significant differences between the two groups (P < 0.05).Conclusions Patients treated with FS-LASIK and OK both showed a decline in objective visual quality in the early stage after treatment, and there was a trend of improvement over time. There was no significant difference in the improvement of UCVA after FS-LASIK or OK in patients with low to moderate myopia, but FS-LASIK had better effects on cylindrical refractive correction and objective visual quality.