LASIK治疗近视远期疗效的观察分析
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摘要
目的:评价准分子激光角膜原位磨镶术(laser in situ keratomileusis,LASIK)治疗近视的远期疗效,探讨影响疗效的相关因素。
方法:选取2002年1月～2002年12月在大连医科大学附属第一医院准分子激光治疗中心应用德国科医人公司的鹰视准分子激光治疗系统WaveLight进行LASIK治疗的近视眼患者,对其进行随访复查,资料完整者37例(71眼),平均年龄25.42±5.97岁。其中男性18人,35眼,占49.30%;女性19人,36眼,占50.70%。术前屈光度-2.25D～-11.75D,平均屈光度-6.06±3.20D。比较手术前后裸眼视力、屈光度的变化,分析影响术后远期疗效的相关因素。
结果:(1)所有术眼术后10年裸眼视力平均值为0.82±0.28,术后10年裸眼视力较术前均显著提高(P=0.000),术后10年裸眼视力≥1.0和0.5的百分比分别为46.38%和91.30%,视力有效指数为0.86。(2)所有术眼术后10年屈光度平均值为-0.79±1.42D,术后屈光度较术前均显著降低(P=0.000),术后10年屈光度在±1.O0D和±O.50D以内的百分比分别为72.50%和50.70%。(3)术后10年平均最佳矫正视力为0.97±0.14D,达到术前最佳矫正视力(P﹥0.05),视力安全指数为1.02。术后10年最佳矫正视力与术前最佳矫正视力保持不变者占70.42%(50/71);较术前上升1行者占18.31%(13/71);下降1行者占8.45%(6/71);下降2行及以上者占2.82%(2/71)。(4)术后10年主诉眼干、易疲劳、异物感6眼。(5)术后10年有28.17%(20/71)出现屈光回退,屈光回退率与术前屈光度、术前术后角膜厚度差值有相关性。(6)术后10年发现圆锥角膜1例1眼。
结论:(1)LASIK治疗近视术后10年的有效性和安全性好。(2)随术后时间的推移,有部分患者发生屈光回退。影响屈光回退的因素为术前屈光度、术前术后角膜厚度差值。(3)LASIK术后10年发现继发圆锥角膜的病例,虽然详细的术前筛查,术中角膜瓣制作良好和预留足够厚基质床厚度,以及术后的定期随访等是预防继发性圆锥角膜的重要措施,但其病因仍需要我们进一步研究。
Objective: To evaluate the long-term outcomes of laser in situ keratomileusis (LASIK) for myopia and analyse the factors influencing outcomes.
Methods: The study included 37 patients (71 eyes) from January to December, 2002 at the laser treatment center, First Affiliated Hospital of Dalian Medical University who has undergone LASIK with the German Eagle Wavelight excimer laser. Refraction at-2.25D ~-11.75D, the average refraction was -6.06±3.2D. The average age was 25.42±5.97. 18were male, 35eyes, accounting for 49.30%; female 19, 36eyes, accounting for 50.70%.The main outcome measures were visual acuity, refraction, best corrected visual acuity (BCVA), postoperative complications of extremely relevant factors on the impact of outcomes.
Results: (1) The mean uncorrected visual acuity (UCVA) of all eyes after surgery for ten years was 0.82±0.28.The postoperative UCVA of all eyes had obvious elevation compared with the preoperative UCVA. At 10 years, 49.19% of eyes had uncorrected visual acuity of l.0 or better and 83.2% of 0.5 or better, the effective index of visual acuity was 0.86. (2) The mean refractive of all eyes after surgery for ten years was -0.79±1.42D. All of the postoperative refraction had obvious descent. At 10 years, 72.5% of all eyes were within -1.00 D and 50.7% were within -0.50 D. (3) The mean best corrected visual acuity (BCVA) for ten years was 0.97±0.14D, the effective index of visual acuity was 1.02. At ten years 70.42% (50/71) of all eyes postoperative best corrected visual acuity(BCVA) remained unchanged compared with preoperative BCVA, 18.31% increase in 1 line (13/71); 8.45% (6/71)lost 1 line ; 2.82% (2/71)decreased by 2 lines or more. postoperative complications for ten years were dry eyes(6 eyes), one Keratoconus after 10 years. (4) After ten years 28.17% (20/71) appeared refractive regression, was positively correlated with preoperative spherical equivalent refraction, with the changes in corneal curvature.
Conclusion: (1) At ten years, LASIK treatment for myopia is predictability, safety and predictable. (2) After surgery, some eyes have refractive regression with time. Preoperative spherical equivalent refraction and the changes in corneal curvature were the related factors. (3) After ten years found that cases of secondary keratoconus, although the details of the preoperative screening, intraoperative flap thickness produced a good and sufficient stromal bed thickness, and regular follow-up after secondary prevention such as keratoconus Important measures, but its etiology still need further study.
方法:选取2002年1月～2002年12月在大连医科大学附属第一医院准分子激光治疗中心应用德国科医人公司的鹰视准分子激光治疗系统WaveLight进行LASIK治疗的近视眼患者,对其进行随访复查,资料完整者37例(71眼),平均年龄25.42±5.97岁。其中男性18人,35眼,占49.30%;女性19人,36眼,占50.70%。术前屈光度-2.25D～-11.75D,平均屈光度-6.06±3.20D。比较手术前后裸眼视力、屈光度的变化,分析影响术后远期疗效的相关因素。
结果:(1)所有术眼术后10年裸眼视力平均值为0.82±0.28,术后10年裸眼视力较术前均显著提高(P=0.000),术后10年裸眼视力≥1.0和0.5的百分比分别为46.38%和91.30%,视力有效指数为0.86。(2)所有术眼术后10年屈光度平均值为-0.79±1.42D,术后屈光度较术前均显著降低(P=0.000),术后10年屈光度在±1.O0D和±O.50D以内的百分比分别为72.50%和50.70%。(3)术后10年平均最佳矫正视力为0.97±0.14D,达到术前最佳矫正视力(P﹥0.05),视力安全指数为1.02。术后10年最佳矫正视力与术前最佳矫正视力保持不变者占70.42%(50/71);较术前上升1行者占18.31%(13/71);下降1行者占8.45%(6/71);下降2行及以上者占2.82%(2/71)。(4)术后10年主诉眼干、易疲劳、异物感6眼。(5)术后10年有28.17%(20/71)出现屈光回退,屈光回退率与术前屈光度、术前术后角膜厚度差值有相关性。(6)术后10年发现圆锥角膜1例1眼。
结论:(1)LASIK治疗近视术后10年的有效性和安全性好。(2)随术后时间的推移,有部分患者发生屈光回退。影响屈光回退的因素为术前屈光度、术前术后角膜厚度差值。(3)LASIK术后10年发现继发圆锥角膜的病例,虽然详细的术前筛查,术中角膜瓣制作良好和预留足够厚基质床厚度,以及术后的定期随访等是预防继发性圆锥角膜的重要措施,但其病因仍需要我们进一步研究。
Objective: To evaluate the long-term outcomes of laser in situ keratomileusis (LASIK) for myopia and analyse the factors influencing outcomes.
Methods: The study included 37 patients (71 eyes) from January to December, 2002 at the laser treatment center, First Affiliated Hospital of Dalian Medical University who has undergone LASIK with the German Eagle Wavelight excimer laser. Refraction at-2.25D ~-11.75D, the average refraction was -6.06±3.2D. The average age was 25.42±5.97. 18were male, 35eyes, accounting for 49.30%; female 19, 36eyes, accounting for 50.70%.The main outcome measures were visual acuity, refraction, best corrected visual acuity (BCVA), postoperative complications of extremely relevant factors on the impact of outcomes.
Results: (1) The mean uncorrected visual acuity (UCVA) of all eyes after surgery for ten years was 0.82±0.28.The postoperative UCVA of all eyes had obvious elevation compared with the preoperative UCVA. At 10 years, 49.19% of eyes had uncorrected visual acuity of l.0 or better and 83.2% of 0.5 or better, the effective index of visual acuity was 0.86. (2) The mean refractive of all eyes after surgery for ten years was -0.79±1.42D. All of the postoperative refraction had obvious descent. At 10 years, 72.5% of all eyes were within -1.00 D and 50.7% were within -0.50 D. (3) The mean best corrected visual acuity (BCVA) for ten years was 0.97±0.14D, the effective index of visual acuity was 1.02. At ten years 70.42% (50/71) of all eyes postoperative best corrected visual acuity(BCVA) remained unchanged compared with preoperative BCVA, 18.31% increase in 1 line (13/71); 8.45% (6/71)lost 1 line ; 2.82% (2/71)decreased by 2 lines or more. postoperative complications for ten years were dry eyes(6 eyes), one Keratoconus after 10 years. (4) After ten years 28.17% (20/71) appeared refractive regression, was positively correlated with preoperative spherical equivalent refraction, with the changes in corneal curvature.
Conclusion: (1) At ten years, LASIK treatment for myopia is predictability, safety and predictable. (2) After surgery, some eyes have refractive regression with time. Preoperative spherical equivalent refraction and the changes in corneal curvature were the related factors. (3) After ten years found that cases of secondary keratoconus, although the details of the preoperative screening, intraoperative flap thickness produced a good and sufficient stromal bed thickness, and regular follow-up after secondary prevention such as keratoconus Important measures, but its etiology still need further study.
引文
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