角膜缘松弛切开治疗角膜散光
摘要
目的
研究角膜缘松弛切开术对角膜散光矫治作用，试图从临床应用的角度为角膜散光的治疗寻找一种简便易行、安全可靠的新方法。
方法
1．在临床工作中筛选出角膜散光≥2.50D的病例12例(12只眼)其中包括手术源性角膜散光5例(5只眼)；非手术源性角膜散光7例(7只眼)；复性近视散光6例(6只眼)；单纯近视散光4例(4只眼)；复性远视散光1例(1只眼)；单纯远视散光1例(1只眼)。
2．对所选病例行角膜曲率检查，其中2例行角膜地形图检查，并进行主觉验光，测定裸眼视力、矫正视力与散光度数、散光轴，确定角膜最高屈折力的径线位置指导手术设计。
3．根据角膜最高屈折力径线位置，在角膜缘标记切口长度，用瑞士迈高金刚刀以角膜陡峭径线为轴，在角膜缘Vogt栅栏区前，沿标记做一对弧形切口，深度为600—650μm，长度按每矫正1D需2mm计算切口。
4．术后随访裸眼视力、矫正视力及屈光度的变化，作手术后的对比、评价、结果分析。
结果
12例术前裸眼平均视力0.25±0.09，术后视力提高至0.78±0.18；术前角膜散光为3.44±0.57D，术后散光度下降至0.60±0.27D，平均下降2.84D。
结论
角膜缘松弛切开术是一种安全简捷、行之有效的角膜散光矫治术式。
To investigate the correction effect on the corneal astigmatism after being implemented by the surgery of limbal relaxing incisions, with the expectation to seek a safe and practical therapy method to the curing of corneal astigmatism by easy facility from the point of view of clinical application.
Method
1. By selection of twelve cases (12 eyes) of corneal astigmatism^ 2.5D out of the clinical cases, among which there are 5 cases of corneal astigmatism arising of operational source (5 eyes), 7 cases of which are of non-operational source (7 eyes), 6 cases are of compound myopic astigmatism (6 eyes), 4 cases are of simple myopic astigmatism (4 eyes), 1 case of compound hyper astigmatism (1 eye ), and one case of simple hypermetropic astigmatism (1 eye).
2. By implementation of examination the corneal curvature to the above mentioned selecting cases, two of which received corneal topography checking, and further to the subjective optometry for the ascertainment of uncorrected visual acuity, corrected visual acuity, the degree of astigmatism and astigmatism axis so as to locate the position of the
4
comeal meridian at the top refractive powef, thus to direct the design of
the surgery.
3. Basing on the position of the comeal meridian at the top refractive
power, mark the incision length on the limbus. With the adOPtion of the
Swiss made Meyco diamond scalpel, tdeng the corneal precipitous
meridian as an eds to undergo a pair of arch incision to the depth of
600-650pm in front of the limbal VOgt's zone, while the length of which
is on the calculation of 2mm incision for correcting lD.
4. Make comParison, evaluation and analysis to the sllfgery result by
following-uP reviews on the thectional movemellts of the patiellts'
uncorrected visual acuity corrected visual acuity and diopter
ReSUft
The average uncorrected visual acuity of the l2 cases Pre-surgery
wasf0.25 f0.09. The borovemellt post the surgery has reached to 0.78
f0.l8.
The comal anigInatism pre-surgery was 3.44l0.57D. The comeal
astigmatism post-surgery is reduced to 0.60t0.27D, with 2.84D drop on
average.
Conclusion
Relaxing incisions at limbus is a safe and effective surgical orientation
for correcting astigInatism.
研究角膜缘松弛切开术对角膜散光矫治作用，试图从临床应用的角度为角膜散光的治疗寻找一种简便易行、安全可靠的新方法。
方法
1．在临床工作中筛选出角膜散光≥2.50D的病例12例(12只眼)其中包括手术源性角膜散光5例(5只眼)；非手术源性角膜散光7例(7只眼)；复性近视散光6例(6只眼)；单纯近视散光4例(4只眼)；复性远视散光1例(1只眼)；单纯远视散光1例(1只眼)。
2．对所选病例行角膜曲率检查，其中2例行角膜地形图检查，并进行主觉验光，测定裸眼视力、矫正视力与散光度数、散光轴，确定角膜最高屈折力的径线位置指导手术设计。
3．根据角膜最高屈折力径线位置，在角膜缘标记切口长度，用瑞士迈高金刚刀以角膜陡峭径线为轴，在角膜缘Vogt栅栏区前，沿标记做一对弧形切口，深度为600—650μm，长度按每矫正1D需2mm计算切口。
4．术后随访裸眼视力、矫正视力及屈光度的变化，作手术后的对比、评价、结果分析。
结果
12例术前裸眼平均视力0.25±0.09，术后视力提高至0.78±0.18；术前角膜散光为3.44±0.57D，术后散光度下降至0.60±0.27D，平均下降2.84D。
结论
角膜缘松弛切开术是一种安全简捷、行之有效的角膜散光矫治术式。
To investigate the correction effect on the corneal astigmatism after being implemented by the surgery of limbal relaxing incisions, with the expectation to seek a safe and practical therapy method to the curing of corneal astigmatism by easy facility from the point of view of clinical application.
Method
1. By selection of twelve cases (12 eyes) of corneal astigmatism^ 2.5D out of the clinical cases, among which there are 5 cases of corneal astigmatism arising of operational source (5 eyes), 7 cases of which are of non-operational source (7 eyes), 6 cases are of compound myopic astigmatism (6 eyes), 4 cases are of simple myopic astigmatism (4 eyes), 1 case of compound hyper astigmatism (1 eye ), and one case of simple hypermetropic astigmatism (1 eye).
2. By implementation of examination the corneal curvature to the above mentioned selecting cases, two of which received corneal topography checking, and further to the subjective optometry for the ascertainment of uncorrected visual acuity, corrected visual acuity, the degree of astigmatism and astigmatism axis so as to locate the position of the
4
comeal meridian at the top refractive powef, thus to direct the design of
the surgery.
3. Basing on the position of the comeal meridian at the top refractive
power, mark the incision length on the limbus. With the adOPtion of the
Swiss made Meyco diamond scalpel, tdeng the corneal precipitous
meridian as an eds to undergo a pair of arch incision to the depth of
600-650pm in front of the limbal VOgt's zone, while the length of which
is on the calculation of 2mm incision for correcting lD.
4. Make comParison, evaluation and analysis to the sllfgery result by
following-uP reviews on the thectional movemellts of the patiellts'
uncorrected visual acuity corrected visual acuity and diopter
ReSUft
The average uncorrected visual acuity of the l2 cases Pre-surgery
wasf0.25 f0.09. The borovemellt post the surgery has reached to 0.78
f0.l8.
The comal anigInatism pre-surgery was 3.44l0.57D. The comeal
astigmatism post-surgery is reduced to 0.60t0.27D, with 2.84D drop on
average.
Conclusion
Relaxing incisions at limbus is a safe and effective surgical orientation
for correcting astigInatism.
引文
[1]汪芳润．视力与屈光的关系．中国实用眼科杂志，2000，18(10)：579
[2]刘奕志，李绍珍．人工晶体手术源性角膜散光的术中控制．中华眼科杂志，1993，29(6)：323-325
[3]刘奕志，陈家祺，李绍珍．角膜切开术治疗人工晶体术后角膜散光．中华眼科杂志，1993，29(2)：97-99
[4]胡隆基，谢立信，Richard Lomas，等．松解性角膜切开术治疗角膜散光．中国实用眼科杂志，1997，15(11)：689
[5]阎洪禄，于秀敏，主编．眼生理学．第一版，北京：人民卫生出版社，2001，53
[6]朱志忠．角膜缘潜在性功能的开发应用．眼科研究，2000，18(4)：375-378
[7]朱志忠，耿海丽．短切口放射状角膜切开术．中国实用眼科杂志，1997，15(9)：538
[8]张金嵩，主编．眼屈光手术学．第一版，郑州：河南科学技术出版社，1996，145-190
[9]Troutman RC. Microsurgery of the anterior segment of the eye, Vol Ⅱ The C. V. Mosby Company Saint Louis, 1999, 18-34
[10]龚岚，邱孝芝．松解性角膜切开术治疗术后中高度散光的临床观察．中国实用眼科杂志，2001，19(8)：596-597
[11]Smith SE. Animal study examines healing, leakage of clear corneal vs. limbal incisions．Ocular Surg News, 1997, 8: 6
[12]孙丰源，贾振华，田文芳．超声测量正常人眼角膜厚度．中华眼科杂志，1991，27(1)：51-52
[13]张欣，龚向明，许丽英，等．正常眼一日内角膜厚度变化．中国实用眼科杂志，1996，14(9)：560-561
[14]李镜海，周芳，周树安，等．正常眼与近视眼多方位角膜厚度研究．中华眼科杂志，1994，30(6)：445-447
[15]陆道炎，张效房，陆国生，等．国外白内障与人工晶体手术的进展．中华眼科杂志，1993，29(1)：8-12
[16]富名水，袁佳琴，孙惠敏．人工晶体术后角膜散光的变化．实用眼科杂志，1993，11(4)：212-213
[17]刘奕志，李绍珍．后房型人工晶体植入术后角膜散光的改变．中华眼科杂志，1994，30(1)：22-24
[18]夏丽坤，高殿文，郭汝汾．后房型人工晶体术后角膜散光的动态检测．中国眼耳鼻喉科杂志，1998，3(6)：180-181
[19]张移，赖宗白，金玉梅．白内障超声乳化折叠式人工晶体植入术后的角膜形态变化．中国实用眼科杂志，2001，19(11)：832-834
[20]张琦，盛耀华，李增琦．小切口超声乳化白内障吸除术后角膜散光的变化．中华眼科杂志，2000，36(6)：452-454
[21]肖伟，薛龙全，吕涛，等．三种切口的白内障术后角膜屈光状态临床研究．中国实用眼科杂志，1998，16(4)：208-210
[22]Budak K, Friedman NJ, Koch DD. Limbal relaxing incisions with cataract surgery. J Cataract Refract Surg, 1998, 24(1):503-508
[23]Muller Jensen K, Fischer P, Siepe U. Limbal relaxing incisions to correct astigmatism in clear corneal cataract surgery. J Refract Surg, 1999,15(5):586-589
[24]Muller Jensen K, Fischer P, Siepe U. Sutureless corneal cataract surgery. Limbal release incisions for correcting astigmatism. Ophthalmology, 1999,96(7):432-436
[25]Spineanu L. The incision in the surgery of cataract and postoperative astigmatism. Oftalmologia, 1997,41(1): 53-56
[26]南莉，汤欣，孙慧敏，等．角膜地形图仪与曲率计测量角膜散光的对比观察．中国实用眼科杂志，2000，18(12)：804-805
[27]龚岚，邱孝芝．手术治疗散光的最新进展．国外医学眼科学分册，1996，20(5)：272-278
[28]Black H. Limbal relaxing incisions correct astigmatism predictably. Ocular Surg News, 1997,10:49
[29]Kronemyer B. Limbal arcuate keratotomy corrects up to 3D of astigmatism. Ocular Surg News, 1997,8:19
[2]刘奕志，李绍珍．人工晶体手术源性角膜散光的术中控制．中华眼科杂志，1993，29(6)：323-325
[3]刘奕志，陈家祺，李绍珍．角膜切开术治疗人工晶体术后角膜散光．中华眼科杂志，1993，29(2)：97-99
[4]胡隆基，谢立信，Richard Lomas，等．松解性角膜切开术治疗角膜散光．中国实用眼科杂志，1997，15(11)：689
[5]阎洪禄，于秀敏，主编．眼生理学．第一版，北京：人民卫生出版社，2001，53
[6]朱志忠．角膜缘潜在性功能的开发应用．眼科研究，2000，18(4)：375-378
[7]朱志忠，耿海丽．短切口放射状角膜切开术．中国实用眼科杂志，1997，15(9)：538
[8]张金嵩，主编．眼屈光手术学．第一版，郑州：河南科学技术出版社，1996，145-190
[9]Troutman RC. Microsurgery of the anterior segment of the eye, Vol Ⅱ The C. V. Mosby Company Saint Louis, 1999, 18-34
[10]龚岚，邱孝芝．松解性角膜切开术治疗术后中高度散光的临床观察．中国实用眼科杂志，2001，19(8)：596-597
[11]Smith SE. Animal study examines healing, leakage of clear corneal vs. limbal incisions．Ocular Surg News, 1997, 8: 6
[12]孙丰源，贾振华，田文芳．超声测量正常人眼角膜厚度．中华眼科杂志，1991，27(1)：51-52
[13]张欣，龚向明，许丽英，等．正常眼一日内角膜厚度变化．中国实用眼科杂志，1996，14(9)：560-561
[14]李镜海，周芳，周树安，等．正常眼与近视眼多方位角膜厚度研究．中华眼科杂志，1994，30(6)：445-447
[15]陆道炎，张效房，陆国生，等．国外白内障与人工晶体手术的进展．中华眼科杂志，1993，29(1)：8-12
[16]富名水，袁佳琴，孙惠敏．人工晶体术后角膜散光的变化．实用眼科杂志，1993，11(4)：212-213
[17]刘奕志，李绍珍．后房型人工晶体植入术后角膜散光的改变．中华眼科杂志，1994，30(1)：22-24
[18]夏丽坤，高殿文，郭汝汾．后房型人工晶体术后角膜散光的动态检测．中国眼耳鼻喉科杂志，1998，3(6)：180-181
[19]张移，赖宗白，金玉梅．白内障超声乳化折叠式人工晶体植入术后的角膜形态变化．中国实用眼科杂志，2001，19(11)：832-834
[20]张琦，盛耀华，李增琦．小切口超声乳化白内障吸除术后角膜散光的变化．中华眼科杂志，2000，36(6)：452-454
[21]肖伟，薛龙全，吕涛，等．三种切口的白内障术后角膜屈光状态临床研究．中国实用眼科杂志，1998，16(4)：208-210
[22]Budak K, Friedman NJ, Koch DD. Limbal relaxing incisions with cataract surgery. J Cataract Refract Surg, 1998, 24(1):503-508
[23]Muller Jensen K, Fischer P, Siepe U. Limbal relaxing incisions to correct astigmatism in clear corneal cataract surgery. J Refract Surg, 1999,15(5):586-589
[24]Muller Jensen K, Fischer P, Siepe U. Sutureless corneal cataract surgery. Limbal release incisions for correcting astigmatism. Ophthalmology, 1999,96(7):432-436
[25]Spineanu L. The incision in the surgery of cataract and postoperative astigmatism. Oftalmologia, 1997,41(1): 53-56
[26]南莉，汤欣，孙慧敏，等．角膜地形图仪与曲率计测量角膜散光的对比观察．中国实用眼科杂志，2000，18(12)：804-805
[27]龚岚，邱孝芝．手术治疗散光的最新进展．国外医学眼科学分册，1996，20(5)：272-278
[28]Black H. Limbal relaxing incisions correct astigmatism predictably. Ocular Surg News, 1997,10:49
[29]Kronemyer B. Limbal arcuate keratotomy corrects up to 3D of astigmatism. Ocular Surg News, 1997,8:19