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准分子激光角膜原位联合瓣背面磨镶术

2017/4/22 3:00:00
【摘要】【摘 要】 目的: 探讨准分子激光角膜原位联合瓣背面磨镶术(laser in situ & undersurface of flap keratomileusis, LASUK)治疗中、高度及超高度近视眼的有效性和安全性。方法:对32例角膜偏薄和/或近视度数偏大,单纯...
【摘 要】 目的: 探讨准分子激光角膜原位联合瓣背面磨镶术(laser in situ & undersurface of flap keratomileusis, LASUK)治疗中、高度及超高度近视眼的有效性和安全性。方法:对32例角膜偏薄和/或近视度数偏大,单纯行准分子激光原位角膜磨镶术(LASIK)有后发圆锥风险的患者行LASUK手术治疗。术前屈光度数(等效球镜度数)-3.25~-14.25D,平均-8.85±2.76D,散光(等效柱镜度数)0.00~-2.75D,平均-1.05±0.64D。其中角膜偏薄者13例,中央区厚度仅481.1±15.1μm,术前屈光度数-6.27±1.29D;角膜厚度大致正常,中央区厚度522.8±16.4μm,近视度数偏大者19例,术前屈光度数-10.62±1.98D。分别于术前,术后1d、10d,1个月、 3个月行裂隙灯显微镜、视力、屈光状态及Orbscan-Ⅱz检查。结果:术后随诊裂隙灯显微镜检查可见角膜瓣平整,复位良好,瓣中央区轻微环形皱折2例。裸眼视力(UCVA)术前,术后1d、10d,1个月、3个月分别为0.07±0.04,0.75±0.25,0.97±0.20,1.01±0.24,1.06±0.21;术后3个月时UCVA≥0.5、≥1.0的分别为30例(94%)、24例(75%)。最佳矫正视力(BCVA)无1眼下降,其中10例(31%)增加1行以上。术后3个月残余屈光度数≤±0.50D、≤±1.00 D的分别为20例(63%)、28例(88%),但根据验光度数插片患者并不接受。合并近视散光30例散光度由术前-1.05±0.64D减小至术后3个月时-0.32±0.38D,其中12例减至0.00D,差异有统计学意义(t=5.37, P<0.01)。角膜地形图检查结果示与lasik术后改变基本一致。结论:lasuk治疗中、高度及超高度近视眼安全、有效,明显扩大了角膜偏薄和 屈光度数过高的近视眼患者安全、无痛手术的适应证范围。术后疗效与lasik无差异,但与其他角膜屈光手术一样,其远期效果尚需进一步观察。="">

  【关键词】 近视眼 角膜瓣 激光切削 角膜磨镶术 激光原位
  Laser in situ and undersurface of flap keratomileusis
  Hy Longji,et al
  【Abstract】 Objective:To develop a novel technique, laser in situ and undersurface of flap keratomileusis (LASUK), and to study its efficacy and safety for the treatment of moderate and high myopia.Methods:Thirty-two cases with thin corneal stroma and (or) higher degree of myopia, which might lead to the development of keratectasia after laser in situ keratomileusis (LASIK), were treated by LASUK. Conventional examinations including slit-lamp microscopy, visual acuity, refraction and Orbscan-Ⅱz were performed before operation and 1 day, 10 day, 1 month and 3 months after operation.Results:After the operation, the corneas remained transparent and no displacement of the flap occurred.Microstriae were presented in 2 cases.The mean preoperative uncorrected visual acuity (UCVA), 0.07±0.04, was increased to 0.75±0.25, 0.97±0.20, 1.01±0.24, and 1.06±0.21 on 1 day, 10 days, 1 month and 3 months after operation, respectively. Thirty cases (94%) achieved 0.5 or better UCVA 3 months after operation and 24 (75%) achieved 1.0 or better. Best corrected visual acuity (BCVA) rose by 1 or more lines in 10 cases (31%). Mean spherical equivalent refraction decreased from -8.85±2.76D before treatment to -0.27±0.55D at last follow up (t=17.25, P<0.001). spherical="" equivalent="" refraction="" was="" within="" ±1.00d="" in="" 28="" cases="" (88%)="" and="" within="" ±0.50d="" in="" 20="" cases="" (63%).="" in="" 30="" cases="" with="" myopic="" astigmatism,="" the="" cylinder="" refraction="" was="" reduced="" from="" -1.05±0.64d="" preoperatively="" to="" -0.32±0.38d="" 3="" months="" after="" operation="" (t="5.37,"><0.01).astigmatism was="" completely="" disappeared="" in="" 12="" eyes.="" no="" keratectasia="" and="" off-center="" ablation="" developed="" after="" operation="" as="" evaluated="" by="" orbscan-ⅱz.conclusions:lasuk="" is="" an="" effective="" and="" safe="" procedure="" for="" treatment="" of="" moderate="" and="" high="" myopia,="" the="" indication="" can="" be="" extended="" to="" eyes="" with="" thinner="" cornea="" and="" or="" eyes="" with="" very="" high="" degree="" of="" myopia.="" the="" results="" are="" the="" same="" as="" lasik,="" but="" the="" long-term="" results="" need="" further="" observation.="">
  【Key words】 Myopia Corneal flap Laser ablation Keratomileusis Laser in situ
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