光迹追踪引导准分子激光原位角膜磨镶术后视觉质量的临床研究

doi:10.3877/cma.j.issn.2095-2007.2026.01.003

目的

探讨光迹追踪(RT)引导准分子原位角膜磨镶术(LASIK)术后患者的视觉质量变化及其影响因素。

方法

选取2023年8月至12月在首都医科大学附属北京同仁医院屈光中心就诊的近视眼散光患者78例(156只眼)作为研究对象。其中，男性24例(48只眼)，女性54例(108只眼)；年龄18~39岁，平均年龄28.5(25.0，34.0)岁。按屈光手术方式将患者分为LASIK组与RT组。LASIK组行LASIK术，RT组行RT引导的LASIK术。收集两组患者术前与术后6个月的视力、高阶像差及对比敏感度的检测结果。患者年龄经Kolmogorov-Smirnov检验不符合正态分布，以中位数和四分位数间距M(Q1，Q3)表示；等效球镜屈光度(SE)、高阶像差及对比敏感度符合正态分布，以±s表示；术前术后比较采用配对t检验，组间比较采用独立样本t检验。

结果

RT组37例(74只眼)中男性11例(22只眼)，女性26例(52只眼)；年龄18~39岁，平均年龄29.0(23.0，34.0)岁。LASIK组41例(82只眼)中男性13例(26只眼)，女性28例(56只眼)；年龄23~39岁，平均年龄28.0(26.0，33.0)岁。RT组患者术前等效球镜屈光度和裸眼视力分别为(-4.87±1.11)D和(1.21±0.26)最小分辨视角的对数(logMAR)；术后6个月时等效球镜屈光度和裸眼视力分别为(0.12±0.30)D和(-0.11±0.06)logMAR。LASIK组患者术前等效球镜屈光度和裸眼视力分别为(-5.19±1.05)D和(1.14±0.24)logMAR；术后6个月时等效球镜屈光度和裸眼视力分别为(0.06±0.43)D和(-0.12±0.07)logMAR。两组术前术后比较差异有统计学意义(t＝-36.79，-43.25，42.84，43.51；P<0.05)。RT组患者术前双眼高阶像差、彗差、三叶草及球差的均方根值分别为(0.40±0.17)μm、(0.21±0.13)μm、(0.20±0.10)μm及(0.14±0.11)μm；术后6个月时双眼高阶像差、彗差、三叶草及球差的均方根值分别为(0.59±0.20)μm、(0.44±0.20)μm、(0.15±0.08)μm及(0.16±0.12)μm。LASIK组患者术前双眼高阶像差、彗差、三叶草及球差的均方根值分别为(0.44±0.15)μm、(0.22±0.13)μm、(0.22±0.10)μm及(0.14±0.10)μm；术后6个月时双眼高阶像差、彗差、三叶草及球差的均方根值分别为(0.72±0.24)μm、(0.49±0.23)μm、(0.20±0.10)μm、及(0.29±0.25)μm。两组术前术后双眼高阶像差、彗差及三叶草的比较差异有统计学意义(t＝-6.24，-11.30，-8.41，-9.88，3.07，-2.52；P<0.05)，LASIK组术前术后球差比较的差异有统计学意义(t＝-5.57，P<0.05)。RT组患者术前右眼垂直彗差和水平彗差的Zernike系数分别为(0.04±0.21)μm和(0.01±0.11)μm；左眼分别为(0.03±0.23)μm和(-0.01±0.12)μm。术后6个月时右眼分别为(-0.31±0.26)μm和(-0.24±0.19)μm；左眼分别为(-0.34±0.21)μm和(0.16±0.19)μm。LASIK组患者术前右眼垂直彗差和水平彗差的Zernike系数分别为(-0.04±0.25)μm和(-0.02±0.12)μm；左眼分别为(-0.06±0.26)μm和(0.03±0.11)μm。术后6个月时右眼分别为(-0.37±0.28)μm和(-0.27±0.21)μm；左眼分别为(-0.32±0.28)μm和(0.22±0.21)μm。两组术前术后双眼垂直彗差和水平彗差Zernike系数的比较差异有统计学意义(t＝9.86，10.00，8.33，-6.13，6.80，6.72，8.38，-6.61；P<0.05)。LASIK组患者右眼术前与术后4阶球差分别为(0.02±0.18)μm和(-0.01±0.16)μm；左眼分别为(0.19±0.34)μm和(0.19±0.33)μm，术前术后比较的差异有统计学意义(t＝-4.27，-5.30；P<0.05)。RT组患者在3.0 c/d、6.0 c/d、12.0 c/d及18.0 c/d中高空间频率下对比敏感度术前分别为1.91±0.12、1.77±0.23、1.16±0.34及0.67±0.48；术后分别为2.06±0.13、2.06±0.16、1.53±0.35及0.87±0.42。LASIK组术前分别为1.89±0.23、1.71±0.35、1.05±0.53及0.57±0.42；术后分别为2.01±0.15、1.90±0.26、1.40±0.29及0.80±0.42。两组术前术后比较的差异有统计学意义(t＝-6.89，-9.07，-6.19，-3.08，-3.76，-4.85，-5.59，-4.10；P<0.05)。在3.0 c/d、6.0 c/d及12.0 c/d的中间空间频率下RT组对比敏感度的增加高于LASIK组，差异有统计学意义(t＝2.36，4.89，2.53；P<0.05)。

结论

RT引导的LAISK术后总高阶像差增加但低于LASIK组，主要表现为彗差增加，双眼变化呈对称性，球差变化不明显，术后中高频空间段对比敏感度比术前增加，在中频段优于LASIK组。

结论

关键词: 光迹追踪, 视觉质量, 高阶像差, 对比敏感度

Objective

The aim of this study is to investigate the changes of visual quality and influencing factors after ray tracing-guided (RT) laser in situ keratomileusis (LASIK).

Methods

From August 2023 to December 2023, a total of 78 patients (156 eyes) with myopic astigmatism were enrolled in the Refractive Surgery of Beijing Tongren Hospital Affiliated to Capital Medical University. There were 24 males (48 eyes) and 54 females (108 eyes) with the average age of 28.5 (25.0, 34.0) years (ranging from 18 to 39 years). Patients were divided into LASIK group and RT group according to the surgical method. LASIK was performed in LASIK group, and RT LASIK was performed in RT group. The changes of visual acuity, high-order aberrations and contrast sensitivity between two groups preoperation and 6 months postoperation were compared. The spherical equivalent, high-order aberrations and contrast sensitivity conformed to the normal distribution, and were expressed as ±s. Pared t-test were used for comparison at different time points before and after surgery, and independent sample t-test was used for comparison between groups. Age was represent by median and interquartile range M (Q1, Q3), which did not follow a normal distribution according to Kolmogorov-Smirnov test.

Results

Among the 37 patients (74 eyes) in the RT group, there were 11 males (22 eyes) and 26 females (52 eyes), with a mean age of 29.0 (23.0, 34.0) years (ranging from 18 to 39 years ). In the LASIK group consisting of 41 patients (82 eyes), there were 13 males (26 eyes) and 28 females (56 eyes), with a mean age of 28.0 (26.0, 33.0)years (ranging from 23 to 39 years). The spherical equivalent and uncorrected visual acuity in the RT group and LASIK group before surgery and at 6 months postoperatively were (-4.87±1.11)D, (0.12±0.30)D, (-5.19±1.05)D, (0.06±0.43)D, (1.21±0.26)logarithm of the minium angle of resolution (logMAR), (-0.11±0.06) logMAR, (1.14±0.24)logMAR and(-0.12±0.07)logMAR, respectively. There were statistically significant differences in the indexes within both groups before and after surgery (t=-36.79, -43.25, 42.84, 43.51; P<0.05). The root mean square values of total higher-order aberrations, coma, trefoil and spherical aberration of both eyes in the RT group and LASIK group before surgery and at 6 months postoperatively were (0.40±0.17)μm, (0.59±0.20)μm, (0.44±0.15)μm, (0.72±0.24)μm, (0.21±0.13)μm, (0.44±0.20)μm, (0.22±0.13)μm, (0.49±0.2)μm, (0.20±0.10)μm, (0.15±0.08)μm, (0.20±0.10)μm, (0.22±0.10)μm, (0.14±0.11)μm, (0.16±0.12)μm, (0.14±0.10)μm and (0.29±0.25)μm, respectively. There were statistically significant differences in the two groups before and after surgery( t=9.86, 10.00, 8.33, -6.13, 6.80, 6.72, 8.38, -6.61; P<0.05). The fourth-order spherical aberration of the right and left eyes in the LASIK group preopertion and postoperation were (0.02±0.18)μm, (0.19±0.34)μm, (-0.01±0.16)μm and (0.19±0.33)μm, respectively, and there were statistically significant differences (t=-4.27, -5.30; P<0.05). The contrast sensitivity values of the two groups at medium and high spatial frequencies of 3.0 c/d, 6.0 c/d, 12.0 c/d and 18.0 c/d before and after surgery were 1.91±0.12, 2.06±0.13, 1.77±0.23, 2.06±0.16, 1.16±0.34, 1.53±0.35, 0.67±0.48, 0.87±0.42, 1.89±0.23, 2.01±0.15, 1.71±0.35, 1.90±0.26, 1.05±0.53, 1.40±0.29, 0.57±0.42 and 0.80±0.42. There were statistically significant differences within both groups between preoperative and postoperative measurements (t=-6.89, -9.07, -6.19, -3.08, -3.76, -4.85, -5.59, -4.10; P<0.05). At the medium spatial frequencies of 3.0 c/d, 6.0 c/d and 12.0 c/d, the increase in contrast sensitivity was greater in the RT group than in the LASIK group, with statistically significant differences (t=2.36, 4.89, 2.53; P<0.05).

Conclusions

The high-order aberrations of RT LASIK group increase after surgery, but which are lower than those of the LASIK group. The main increase comes from coma with symmetrical change in both eyes, while spherical aberration shows no significant change. Contrast sensitivity of postoperation at medium and high spatial frequencies is higher than that of preoperation, and it is superior to the LASIK group at medium frequencies.

Key words: Ray tracing, Visual quality, Higher-order aberrations, Contrast sensitivity

表1 RT组与LASIK组患者术后6个月高阶像差均方根值、高阶像差Zernike系数及对比敏感度的比较(

±s)

组别	眼数(只眼)	总高阶像差(μm)	彗差(μm)	三叶草(μm)	球差(μm)	右眼垂直三叶草(μm)	左眼垂直三叶草(μm)
RT组	74	0.59±0.20	0.44±0.20	0.15±0.08	0.16±0.12	0.04±0.11	0.05±0.13
LASIK组	82	0.72±0.24	0.49±0.23	0.22±0.10	0.29±0.25	0.00±0.19	0.01±0.21
t值		-3.76	-1.43	-4.64	-4.22	1.14	1.22
P值		<0.05	>0.05	<0.05	<0.05	>0.05	>0.05
组别	眼数(只眼)	右眼垂直彗差(μm)	左眼垂直彗差(μm)	右水平彗差(μm)	左水平彗差(μm)	右斜向三叶草(μm)	左斜向三叶草(μm)
RT组	74	-0.31±0.26	-0.34±0.21	-0.24±0.19	0.16±0.19	0.01±0.12	-0.01±0.11
LASIK组	82	-0.37±0.28	-0.32±0.28	-0.27±0.21	0.22±0.21	-0.01±0.13	-0.01±0.15
t值		0.85	-0.36	0.64	-1.43	0.64	0.20
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	眼数(只眼)	右4阶球差(μm)	左4阶球差(μm)	1.5 c/d	3.0 c/d	6.0 c/d	12.0 c/d	18.0 c/d
RT组	74	0.06±0.19	0.08±0.18	1.90±0.12	2.06±0.13	2.06±0.16	1.53±0.35	0.87±0.42
LASIK组	82	0.19±0.34	0.19±0.33	1.89±0.14	2.01±0.15	1.90±0.26	1.40±0.29	0.80±0.42
t值		-2.00	-1.88	0.64	2.36	4.89	2.53	0.99
P值		＝0.05	>0.05	>0.05	<0.05	<0.05	<0.05	>0.05

表1 RT组与LASIK组患者术后6个月高阶像差均方根值、高阶像差Zernike系数及对比敏感度的比较(

±s)

组别	眼数(只眼)	总高阶像差(μm)	彗差(μm)	三叶草(μm)	球差(μm)	右眼垂直三叶草(μm)	左眼垂直三叶草(μm)
RT组	74	0.59±0.20	0.44±0.20	0.15±0.08	0.16±0.12	0.04±0.11	0.05±0.13
LASIK组	82	0.72±0.24	0.49±0.23	0.22±0.10	0.29±0.25	0.00±0.19	0.01±0.21
t值		-3.76	-1.43	-4.64	-4.22	1.14	1.22
P值		<0.05	>0.05	<0.05	<0.05	>0.05	>0.05
组别	眼数(只眼)	右眼垂直彗差(μm)	左眼垂直彗差(μm)	右水平彗差(μm)	左水平彗差(μm)	右斜向三叶草(μm)	左斜向三叶草(μm)
RT组	74	-0.31±0.26	-0.34±0.21	-0.24±0.19	0.16±0.19	0.01±0.12	-0.01±0.11
LASIK组	82	-0.37±0.28	-0.32±0.28	-0.27±0.21	0.22±0.21	-0.01±0.13	-0.01±0.15
t值		0.85	-0.36	0.64	-1.43	0.64	0.20
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	眼数(只眼)	右4阶球差(μm)	左4阶球差(μm)	1.5 c/d	3.0 c/d	6.0 c/d	12.0 c/d	18.0 c/d
RT组	74	0.06±0.19	0.08±0.18	1.90±0.12	2.06±0.13	2.06±0.16	1.53±0.35	0.87±0.42
LASIK组	82	0.19±0.34	0.19±0.33	1.89±0.14	2.01±0.15	1.90±0.26	1.40±0.29	0.80±0.42
t值		-2.00	-1.88	0.64	2.36	4.89	2.53	0.99
P值		＝0.05	>0.05	>0.05	<0.05	<0.05	<0.05	>0.05

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Visual quality after ray tracing-guided laser in situ keratomileusis

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Visual quality after ray tracing-guided laser in situ keratomileusis