- 學位論文
比較各種近視雷射手術之角膜瓣製作方式對高階像差、對比敏感度及淚液機能分泌之影響
High Order Aberration, Contrast Sensitivity, and tear secretion after LASIK Surgery with Different Femtosecond Laser Platforms and Mechanical Microkeratome
摘要
雷射原位層狀角膜重塑術(Laser in situ keratomileusis, LASIK)為目前常見改善近視方式之一，成功製作高品質之角膜瓣為LASIK成功的重要關鍵，許多併發症都是在此步驟發生，進而影響視覺品質，角膜瓣之製作目前有不同製作方式，包括板層刀及飛秒雷射，故本研究探討不同角膜瓣製作方式對術後視覺品質及乾眼之影響。本研究回溯36位患者(70隻眼)，角膜瓣製作分別使用IntraLase FS60 飛秒雷射 (23眼11位患者)、Technolas 520F飛秒雷射 (19眼10位患者)、Ziemer FEMTO LDV飛秒雷射(16眼9位患者)及角膜板層刀(12眼6位患者)，且所有患者皆測量前導波數據並使用VISX STAR S4準分子雷射系統進行準分子雷射消融。評估所有患者術前及術後6個月之臨床檢查，包括視力、屈光狀態、對比敏感度、高階像差、淚液分泌機能以及角膜敏感度。結果顯示，四組於術後6個月視力及屈光度數皆無顯著差異(P >0.05)；而對比敏感度僅於中空間頻率(6 cpd) Femtec組顯著低於其於3組；而高階像差方面，Femtec組總高階像差顯著高於Ziemer組(P< 0.05)；彗星像差(Coma aberration)，Femtec組顯著高於IntraLase組、Ziemer組、MK組(皆P < 0.05)；球面像差(Spherical aberration)，MK組顯著高於飛秒雷射三組(皆P < 0.05)；淚液分泌機能各項評估皆無顯著不同，但角膜敏感測試，Femtec組則顯著低於其他3組(皆P<0.05)，根據上述結果得知不同角膜瓣製作儀器於術後6個月之視力及屈光度皆無明顯差異，但使用IntraLase FS60及Ziemer FEMTO LDV製作角膜瓣對術後視覺品質影響較少。
並列摘要
Laser in situ keratomileusis (LASIK) is one of the common ways to improve myopia. Producing a high quality corneal flap is the key to a successful LASIK, where complications usually take place thus affecting the visual quality. Different instruments and methods used would create different corneal flaps. In the past corneal flaps were produced using Mechanical Microleratome, but Femtosecond Laser has slowly took over Mechanical Microleratome recently. Therefore, this study was to evaluate the visual quality and dry eye after LASIK surgery by the means of IntraLase FS60 femtosecond laser, Technolas 520F femtosecond laser, Ziemer FEMTO LDV femtosecond laser and Microkeratome to create corneal flap. This retrospective study, seventy eyes of 36 patients underwent LASIK where IntraLase FS60 femtosecond laser were performed on twenty-three eyes of 11 patients, Technolas 520F femtosecond laser were performed on nineteen eyes of 10 patients, Ziemer FEMTO LDV femtosecond laser were performed on sixteen eyes of 9 patients, and Microkeratome were performed on twelve eyes of 6 patients. All eyes were examined with wavefront analysis and with the use of VISX STAR S4 Excimer Laser System (VISX Inc., Santa Clara, USA) to carry out the excimer laser ablation. All patients had undergone clinical examination 6 months prior to the surgery and 6 months after the surgery which includes Visual Acuity, Spherical refraction, Astigmatism, Spherical Equivalent (SE), Contrast Sensitivity, High Order Aberrations (HOAs), tear secretion and corneal sensation. The results show there were no significant difference between Uncorrected Distance Visual Acuity (UDVA), Corrected Distance Visual Acuity (CDVA), Spherical refraction, Astigmatism, SE, and Schirmer’s tear secretion 6 months after the surgery (all P > 0.05). Contrast sensitivity part, only 6 cpd in mesopic that Femtec group were significantly lower than others (P< 0.05). For the all HOAs, Femtec group were significantly higher than the Ziemer group (P < 0.05) ; for the Coma aberration, Femtec group were also higher than the IntraLase group, Ziemer group, MK group (all P < 0.05); for Spherical aberration, Ziemer group were higher than IntraLase group and MK group (all P < 0.05); for RMS3, Femtec group are higher than IntraLase group, Ziemer group, MK group (all P < 0.05) ; as for Trefoil aberration there are no significant difference between the RMS4, RMS5 and RMS6 group (all P > 0.05 ). For corneal sensation, Femtec group were significantly lower than others. (all P < 0.05). According to the results that there are no significant difference in the visual acuity and refractive errors with the use of different instruments to create corneal flap 6 months after surgery. However, there is a significant worse in the HOA with the use of Technolas 520F femtosecond laser to create corneal flap compare to the other instruments.