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研究生:孫涵瑛
研究生(外文):Sun, Han-Ying
論文名稱:利用虹膜紋路辨識定位系統及飛秒雷射施行前導波準分子雷射手術後高階像差變化之研究
論文名稱(外文):How important is iris registration and femtosecond laser (Intralase)technology in postoperative high order aberrations (HOAs) afterWavefront-Guided laser situ keratomileusis (W G LASIK)?
指導教授:張正忠張正忠引用關係
學位類別:碩士
校院名稱:國防醫學院
系所名稱:航太醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:111
中文關鍵詞:像差前導波像差分析儀低階像差高階像差前導波導引準分子雷射屈光手術放射狀的角膜切開術準分子雷射屈光角膜成型虹膜指紋辨識定位系統無刀雷射
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中文摘要
前 言:
因近年來近視盛行率的提高,導致達到高視力標準飛行員缺乏以及現役飛行員需要配鏡者增加。目前雷射屈光矯正手術中前導波導引準分子雷射手術(wavefont guided LASIK;W G LASIK)為高安全性且復原快的手術,術後不僅消除低階像差(球面和散光度數),更減少高階像差產生。但施行W G LASIK步驟中仍會引起高階像差的產生,Villa等學者指出高階像差和術後的視覺抱怨有很大的關聯。本研究針對WG LASIK流程(雷射治療及角膜皮瓣製造)深入探討,利用兩種最新科技,其一為利用虹膜纹路辨識定位系統(iris registration ;IR)校正因測量和施行手術時姿勢不同,造成之眼睛轉動量(cyclotorsion);二為改用無刀雷射(Intralase)取代傳統版層刀(microkeratome systems; M2)製作角膜皮瓣,之後比較利用上述新式科技接受WG LASIK受測者,術後視力以及高階像差變化和傳統手術方式是否有臨床以及統計上差異。
實 驗 目 的:
1.比較國人於坐姿和躺姿不同時,眼球轉動量(Cyclotorsion)之差異?
2.分析比較利用虹膜紋路辨識定位(IR)系統施行前導波導引之準分子雷射手術,術後高
階像差變化與傳統未使用虹膜纹路辨識定位(NIR)系統之差異?
3.分析比較利用無刀雷射(Intralase)和傳統之版層刀(M2)不同方式製作角膜瓣,施行前導波導引之準分子雷射手術,術後視力表現以及高階像差變化之差異?
實 驗 方 法:
實驗1:先利用傳統人為方式標記病人於坐姿時的角膜記號,再利用前導波像差儀之虹膜
紋路辨識定位系統擷取病人坐姿時的虹膜雯路特殊定位點,之後受測者平躺於準分子雷
射儀,先以人為方式進行雷射儀之十字網對應角膜上記號,再由虹膜紋路辨識定位系統
利用虹膜辨識點比對,計算出眼睛的轉動量。
實驗2:對照組利用傳統人為標記角膜方式,實驗組利用前導波像差儀虹膜紋路辨識定位
系統,比較兩組受測者術後高階像差變化量統計學上之差異。
實驗3:施行前導波準分子手術步驟中,對照組採用傳統版層刀製作角膜皮瓣,實驗組利
用無刀雷射製作角膜皮瓣,比較兩組受測者術後視力以及高階像差變化量統計學上之差
異。
統計方法:採用SPSS 12.0版統計軟體進行分析,各組前後比較使用Wilicoxon
Signed-Rank test;術後引起之像差組間比較利用student paired t-test。
結 果:
實驗1:
1. 54位受測者(52隻右眼53隻左眼),球面度數為+2.0D~-7.0D,柱面度數-3.0D以下。
2. 右眼(52隻眼)平均值為逆時針轉動2.4±3.8度,左眼(53隻眼)平均值為順時針轉動2.7±2.9度,平均外旋的量為2.7±2.9度。
實驗2:
1. IR組12隻眼及NIR組16隻眼,球面度數為-2.50D~-7.50D,柱狀面度數為-3.00D
以下。
2. IR組和NIR組之術後總像差皆有統計上顯著降低(p<0.01);高階像差皆有統計上顯
著的增加(p<0.01);第三階及第六階像差皆有統計上顯著的增加(p<0.01);第三階
中分項Z3-1、第四階中分項Z40術後比術前有統計上顯著的增加(p<0.01)。
3. IR組和NIR組之術後增加量相比,高階像差中之Z3-1以及Z40IR組比NIR組統計
上有顯著增加(p<0.05)。
實驗3:
1. Intralase組18隻眼及M2組12隻眼,球面度數為-1.00D~-8.00D,柱狀面度數為-3.00
D以下。
2. Intralase組和M2組之術後總像差都有顯著降低(p<0.01);高階像差有顯著的增加
(p<0.01)。
3. Intralase組和M2組之術後總像差減少量、引起之高階像差增加量、第三、四、五、
六、高階像差中各分項像差增加量皆無統計上差異。
結 論:
國人於坐姿和躺姿不同時,眼球會產生2.6±2.0度轉動量(Cyclotorsion)。利用虹膜紋路辨識定位(IR)系統施行前導波導引準分子雷射手術,術後高階像差之垂直彗星像差Z3-1 (Vertical Coma(J7))以及第四階中球面像差Z40 (spherical aberration(J12))像差引起量有統計上顯著的減少。利用無刀雷射製作角膜瓣組,施行前導波準分子雷射手術術後一星期及一個月視力較傳統版層刀組佳,但兩組之術後高階像差並無統計上的差異,其他複雜之相關因素,仍待近一步分析研究。
Introduction: It has long been appreciated that vision is limited by both optical and neural factors, but that only optical factors can be easily and effectively corrected for. Chief among these optical factors are spherical refractive error and astigmatism. Recent advances in wavefront technique make it possible to reduce postoperative order aberrations (HOAs) via modern refractive surgery such as wavefront guided laser in situ keratomileusis (WG LASIK). The goal of this research is to clarify an important question that has implications for both clinical and applied vision in aviation. “How important is iris registration and femtosecond laser (Intralase) technology in postoperative HOAs after WG LASIK?”
Purpose: (1) To quantify the cyclotorsion occurring between upright sitting (measurement) position and supine (surgical) position in Taiwanese. (2) To compare the HOAs change after WG LASIK with iris registration (IR) and without iris registration (NIR) system. (3) To compare HOAs change after WG LASIK using a corneal flap with Moria microkenatome (M2) group and Intralase group based on the Hartmann-Shack wavefront aberrometer.
Methods: (1) To determine the amount of cyclotorsion of eyeball between the measurement and surgery in 105 eyes (54 patients). (2) Twenty-eight eyes from 14 patients (refraction range -2.50D~-7.50D) treated by W G LASIK with IR group (12 eyes) or NIR group (16 eyes). Root-mean-square (RMS) of coma-like aberration, spherical aberration, total 3rd to 6th order HOAs were compared between the two groups. (3) M2 group (18 eyes) and Intralase group (12 eyes) whose degrees of myopia were-1.00 to –8.00 diopters (D) were treated with W G LASIK. Root-mean-square (RMS) of coma-like aberration, spherical aberration, total 3rd to 6th order HOAs were compared between the two groups.
Result: (1) For all 105 eyes, mean ± standard deviation (SD) cyclotorsional deviation was 2.6 ± 2.0 degrees (right eye 2.4 ± 3.8 degrees counterclockwise, left eye 2.7 ± 2.9 degrees clockwise). (2)Compared with preoperative aberrations, both IR and NIR group showed postoperative decreased of total aberration (p<0.01) and increased of HOAs, vertical coma, and spherical aberration (p<0.01). Compared with NIR group, significant reduction of HOAs, vertical coma, and spherical aberration was observed in IR group. (3) There were no significant differences in RMS of coma-like aberration, spherical aberration, total 3rd to 6th order HOAs between M2 and Intralase group.
Conclusions: (1) The difference of cyclotorsional eye movement was assessed significantly in the transition from seated to supine position with IR technology. (2) The WG LASIK with IR system significantly decreased postoperative induction of the amount of HOAs, vertical coma, and spherical aberration. (3) Although postoperative visual acuity improved significantly in Intralase group, there was no significant difference in all items of HOAs between the M2 group and Intralase group. Further study of multiple variants affecting postoperative HOAs after Intralase flap creation is mandatory. In summary, our study demonstrated that using IR system is essential element for reduction of postoperative HOAs after WG LASIK.
【碩士論文目次】 頁次
正文目錄 I
表目錄 II
圖目錄 Ⅲ
中文摘要 Ⅴ
英文摘要 Ⅶ
第一章 緒論……………………………………………………………1
第二章 材料與方法……………………………………………………39
第三章 實驗結果………………………………………………………52
第四章 討論……………………………………………………………80
第五章 結論……………………………………………………………97
第六章 參考文獻………………………………………………………101

表目錄
頁次
表1 NIR組及IR組實驗受測者基本資料………………………………52
表2 NIR組以及IR組術前術後度數變化………………………………54
表3 Intralase組及M2組實驗受測者基本資料………………………68
表4 Intralase組和M2組術前術後度數變化…………………………71
表5 Intralase組和M2組術後引起之像差比較………………………79

圖目錄
頁次
圖1-1視覺影像傳導路徑……………………………… ………………4
圖1-2:眼睛屈光不正示意圖……………………………………………7
圖1-3:前導波像差儀及原理……………………………………………12
圖1-4: Zernike多項式分析表………………………………………13
圖1-5:眼球總像差示意圖(低階像差以及高階像差)…………………14
圖1-6:屈光不正之雷射治療過程示意圖………………………………22
圖1-7:虹膜紋路辨識定位系統示意圖…………………………………29
圖1-8:雷射屈光矯正手術中角膜皮瓣製造示意圖……………………32
圖3-1:受測者之雙眼轉動度數眼數量分布圖…………………………48
圖3-2:受測者之右眼轉動度數眼數量分布圖…………………………49
圖3-3:受測者之左眼轉動度數眼數量分布圖…………………………50
圖3-4術前術後總像差變化………………………………………………56
圖3-5:術前術後高階像差變化…………………………………………58
圖3-6:術後引起高階像差變化量比較…………………………………59
圖3-7:第三、四、五、六階像差術前術後變化………………………63
圖3-8:第三階之J6、J7、J8、J9像差術前術後變化…………………64
圖3-9:第四階之J10、J11、J12、J13像差術前術後變化……………65
圖3-10:術後引起J6、J7、J8、J12像差量變化………………………66
圖3-11:Intralase組和M2組術後一星期以及一個月視力變化………70
圖4-1眼睛轉動對術後視力影響示意圖……………………………………84
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