| Objective:To compare visual quality among wavefront optimized,corneal topography guided,and Q value guided Femtosecod Laser-assisted Laser in situ keratomileusis(FS-LASIK)in treating high,moderate and low myopia and myopic astigmatism.Method:In this retrospective case-observational study,patients with ametropia treated in the Zigong First People’s Hospital from May 2020 to February 2021 were divided into groups A,B and C according to different surgical schemes.Group A underwent wavefront aberration optimized FS-LASIK surgery,17 cases(33 eyes).According to diopter,they were divided into low myopia group(3 cases,5 eyes),moderate myopia group(9 cases,18 eyes)and high myopia group(5 cases,10 eyes),Group Bunderwent FS-LASIK surgery guided by corneal topography,14 cases(28 eyes)were divided into low myopia group(2 cases,4 eyes),moderate myopia group(10 cases,19 eyes),high myopia group(3 cases,5 eyes,);C group),43 cases(85 eyes).According to diopter,they were divided into low myopia group(12 cases,24 eyes),moderate myopia group(18 cases,3 5 eyes),high myopia group(13 cases,26 eyes).The axial length and the largest dark pupil were examined before operation,and the uncorrected visual acuity(UCVA),diopter,modulate transfer function cutoff frequency(MTF cut off),objective scatter index(OSI),total refraction difference value(TRDV),refraction difference value-15°(RDV-15°),corneal higher order aberration(HOA)and Q value were examined before operation,1 week and 1 month after operation.The correlation among diopter,axial length,spherical aberration and TRDV,the correlation between,MTF cut off,OSI and RDV-15°,the correlation between pupil diameter,HOA and MTF cut off,and the correlation between diopter,Q value and corneal spherical aberration were analyzed.The counting data were analyzed by chi-square test.The measurement data accorded with normal distribution and uniform variance,which was expressed by mean±standard deviation,repeated measurement data was expressed by repeated measurement analysis of variance,pairwise comparison was made by LSD method at different time points,and independent sample t-test was used for comparison at the same time point between groups.Ranksum test was used for non-normal distribution data.Pearson correlation analysis was used to analyze the correlation between them.Result:l Group A,B and C:there was no significant difference in uncorrected visual acuity among the three groups 1 week and 1 month after operation(P>0.05).One month after operation,the equivalent spherical(SE)of group A was 0.039±0.382D,that of group B was 0.229±0.466D,and that of group C was 0.129±0.469D,and the proportion of SE in the±0.50D of group C was the highest.There was no significant difference in the overall average value of SE among the three groups(P>0.05).There was no significant difference in the overall average value of MTF cut off,OSI,TRDV,RDV-15°,peripheral defocus,HOA and Q value among the three groups before operation(P>0.05).There was no significant difference in the overall average value of MTF cut off at each time point in group A,group B and group C.There was significant difference in the overall average value of MTF cut off among the three groups at 1 week and 1 month after operation.The MTF cut off at 1 week and 1 month after operation:group C>group A>group B.The postoperative OSI in group B was higher than that before operation.The postoperative OSI in group A and group C was lower than that before operation.There were significant differences in the overall average value of OSI among the three groups after operation(P<0.05).The OSI at 1 week after operation:group C<group B<group A,the OSI at 1 month after operation:group C<group A<group B.There was no significant difference in the overall average value of TRDV at each time point among the three groups,but the postoperative TRDV-15 in the three groups was lower than that before operation,and the difference was statistically significant(P<0.05).The postoperative peripheral defocus in group A and in group B was higher than that before operation,and there was no significant difference in the overall average value of peripheral defocus at each time point in the group C(P>0.05).There was no significant difference in the overall average value of TRDV and RDV-15° peripheral defocus among the three groups at each time point.There were significant differences in total corneal HOA,horizontal coma,vertical coma and spherical aberration among the three groups at each time point,and all increased after operation.There was no significant difference in total corneal HOA,horizontal coma,vertical coma and spherical aberration among the three groups before operation.The total average value of total corneal HOA among the three groups after operation:group A<group B<group C,the average value of horizontal coma:group A<group B<group C,the overall average value of vertical coma:group C<group B<group A,spherical aberration:group C<group A<group B,the difference was statistically significant.There was significant difference in the overall average value of corneal Q value among the three groups at each time point(P<0.05).The overall average value of corneal Q value in group C<group A and group C<group B after operation was significantly higher than that before operation(P<0.05).The difference was statistically significant(P<0.05).2 Group A,high,moderate and low myopia group:there was no significant difference in the overall average values of MTF cut off,OSI,TRDV,RDV-15° and peripheral defocus among the three groups(P>0.05).There was no significant difference in MTF cut off,OSI,TRDV,RDV-15° and peripheral defocus among the three groups at each time point(P>0.05).There were significant differences in total corneal HOA,horizontal coma and spherical aberration among the three groups at each time point(P<0.05),and increased after operation.There was no significant difference in the overall average value of corneal vertical coma among the three groups at each time point(P>0.05).There was no significant difference in total corneal HOA,horizontal coma,vertical coma and spherical aberration among the three groups before operation(P>0.05).The overall average value of total corneal HOA among the three groups after operation:low myopia group<moderate myopia group<high myopia group,the difference was statistically significant(P<0.05).The overall average value of postoperative corneal bulb aberration among the three groups:low myopia group<moderate myopia group<high myopia group,the difference was statistically significant(P<0.05).There was no significant difference in the overallaverage values of horizontal and vertical corneal coma among the three groups after operation(P>0.05).There was significant difference in the overall average value of corneal Q value at each time point among the three groups(P<0.05).The overall average value of corneal Q value among the three groups was as follows:low myopia group<moderate myopia group<high myopia group(P<0.05).The difference was statistically significant(P<0.05).3 Group B,high,moderate and low myopia group:there was no significant difference in the overall average values of MTF cut off,OSI,TRDV,RDV-15°,peripheral defocus,total corneal HOA,horizontal coma,vertical coma and spherical aberration among the three groups before operation(P>0.05),but the postoperative MTF cut off in the moderate myopia group was significantly higher than that before operation in the moderate myopia group(P<0.05).The postoperative OSI in high and low myopia groups was higher than that before operation,and the difference was statistically significant(P<0.05).There was no significant difference in the overall average values of MTF cut off and OSI among the three groups at each time point(P>0.05).There was no significant difference in the overall average values of TRDV and peripheral defocus among the three groups(P>0.05).The TRDV in the low myopia group was significantly lower than that in the high myopia group.The postoperative RDV-15° in the low myopia group was significantly lower than that in the high myopia group(P<0.05).There was no significant difference in the overall average value of RDV-15° among the three groups(P>0.05).The postoperative peripheral defocus in low myopia group was significantly lower than that in high myopia group(P<0.05).There were significant differences in total corneal HOA,horizontal coma,vertical coma and spherical aberration among the three groups at each time point.The overall average value of total corneal HOA among the three groups was as follows:low myopia group<high myopia group,moderate myopia group<high myopia group.The overall average value of corneal spherical aberration among the three groups after operation:low myopia group<high myopia group.There was significant difference between moderate myopia group and high myopia group(P<0.05).There was no significant difference in the overall average values of horizontal and vertical comet difference among the three groups after operation(P>0.05).There was significant difference in the overall average value of corneal Q value at each time point among the three groups(P<0.05).The overall average value of corneal Q value among the three groups was as follows:low myopia group<moderate myopia group<high myopia group(P<0.05).The difference was statistically significant(P<0.05).4 Group C,high,moderate and low myopia group:there was no significant difference in the overall average values of MTF cut off,OSI,TRDV,RDV-15°,peripheral defocus,total corneal HO A,horizontal coma,vertical coma and spherical aberration among the three groups before operation(P>0.05)and there was no significant difference in the overall average values of MTF cut off and OSI among the three groups at each time point(P>0.05).The MTF cut off of low myopia group was significantly higher than that of high myopia group(P<0.05).The overall average value of OSI among the three groups was as follows:low myopia group<high myopia group,moderate myopia group<high myopia group,the difference was statistically significant(P<0.05).There was no significant difference in the overall average value of TRDV among the three groups.The TRDV in the low myopia group was significantly lower than that in the high myopia group(P<0 05).The postoperative RDV-15° in the low myopia group was lower than that in the high myopia group,and the difference was statistically significant(P<0 05).The RDV-15° in the posterior low myopia group was lower than that in the high myopia group,and the difference was statistically significant(P<0 05).There was no significant difference in the overall average value of peripheral defocus among the three groups at each time point(P>0.05).The overall average value of postoperative peripheral defocus was as follows:low myopia group<high myopia group,moderate myopia group<high myopia group,the difference was statistically significant(P<0.05).There were significant differences in total corneal HOA,horizontal coma,vertical coma and spherical aberration among the three groups.The overall average values of vertical comet and spherical aberration at each time point in the three groups were significantly higher than those before operation.The overall average value of total corneal HOA among the three groups after operation was as follows:low myopia group<moderate myopia group<high myopia group.The difference was statistically significant(P<0.05).The overall average value of postoperative corneal spherical aberration among the three groups was as follows:low myopia group<moderate myopia group<high myopia group,the difference was statistically significant(P<0.05).There was no significant difference in the overall average values of horizontal and vertical comet difference among the three groups at different time points(P>0.05).There was significant difference in the overall average value of corneal Q value at each time point among the three groups(P<0.05).The overall average value of corneal Q value among the three groups was as follows:low myopia group<moderate myopia group<high myopia group(P<0.05).The difference was statistically significant(P<0.05).5 There was a negative correlation between preoperative SE and TRDV at 1 week and 1 month after operation(r=-0.320,-0.245,P<0.001,=0.002),and a positive correlation between axial length and TRDV at 1 week after operation(r=0.207,P=0.003).The globular aberration of cornea at 1 week and 1 month after operation was positively correlated with TRDV(r=0.166,0.197,P=0.021,0.013),and RDV-15° at 1 week and 1 month after operation was negatively correlated with MTF cut off(r=0.231,-0.245).RDV-15° before operation,l week and 1 month after operation was positively correlated with OSI(r=0.152,0.213,0.277),and preoperative SE was negatively correlated with peripheral defocus at 1 week and 1 month after operation(r=0.301,0.271,P<0.001),while peripheral defocus was positively correlated with spherical aberration at 1 week and 1 month after operation(r=0.246,0.244,P=0.001,0.002),and there was a positive correlation between OSI before operation,1 week and 1 month after operation(r=0.152,0.213,0.277,P=0.017,0.003,<0.001).The diameters of dark pupil were negatively correlated with MTF cut off(r=-0.142,P=0.026).Th he total corneal HOA before and 1 week after operation was negatively correlated with MTF cut off(r=-0.161,-0.168,P=0.011,0.020),and the corneal globular aberration was positively correlated with Q value before operation,l week and 1 month after operation(r=0.580,0.576,0.558,P<0.001).The corneal globular aberration was positively correlated with Q value before operation,1 week and 1 month after operation(r=0.580,0.576,0.558,P<0.001).There was a negative correlation between preoperative SE and corneal Q value at 1 week and 1 month after operation(r=-0.903,-0.885,P<0.001).Conclusion:1 Wavefront optimizatied,corneal topography guided and Q value guided FS-LASIK have good safety,predictability and effectiveness,in which the OSI,spherical aberration and Q value of Q value guided FS-LASIK are lower than wavefront optimizatied group and corneal topography guided group,the MTF cut off of Q value guided group are higher than others’,among which Q value guided FS-LASIK patients have better visual quality.2 The HOA and Q value after FS-LASIK with wavefront optimizatied,corneal topography guidaed and Q value guided were higher than those before operation,and the wavefront optimizatied group introduced smaller HO A,which was more suitable for patients with larger corneal HOA before operation.3 Corneal topography guided FS-LASIK moderate myopia group postoperative MTF cut off increased compared with preoperative,moderate myopic patients with irregular cornea can choose this method of surgery,may obtain better visual quality than before surgery.4 The postoperative corneal HOA,Q value and peripheral defocus in patients with high myopia are more than those in patients with moderate myopia and low myopia,which is to some extent related to more corneal ablation during operation.5 The diopter,axial length and spherical aberration of the patients after FS-LASIK are positively correlated with TRDV,the larger the diopter,the longer the axial length,the greater the spherical aberration,the greater the postoperative TRDV,the greater the possibility of refractive regression;the pupil diameter is positively correlated with RDV-15,and the larger the dark pupil diameter is,the larger the RDV-15 is,the worse the postoperative visual quality of the patients is.There was a positive correlation between preoperative diopter and postoperative corneal Q value.the greater the preoperative diopter,the greater the postoperative corneal Q value,however,the postoperative Q value of the Q value guidance group was lower than that of the wavefront optimization group and the corneal topography guidance group,so the patients with higher diopter can choose Q value guided FS-LASIK.6 Multispectral refractive topography can be used as a routine examination before FS-LAIK,which has a certain guiding significance for the selection of surgical methods. |
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