摘要
目的分析疑难性准分子激光角膜屈光手术的原因、分类、方案设计及治疗效果。设计回顾性病例系列。研究对象非常规疑难性准分子激光屈光性角膜手术患者47眼。方法分析患者进行屈光手术的原因、方案设计及治疗效果。除视力(裸眼、矫正、小孔视力)、屈光度(散瞳和显然验光)、主视眼、角膜厚度、角膜地形图、像差检查等常规术前检查外,还要依据患者情况进行相应的特殊检查,包括角膜多点厚度、角膜曲率时间变化、眩光仪、对比敏感度、眼肌功能、VEP等检查。手术前对患者进行个性化手术设计以及可能的预后评估。主要指标治疗前角膜厚度、视力、角膜地形图变化、屈光度、手术次数。结果疑难角膜屈光手术的界定:除最佳矫正视力小于0.8,还伴有角膜形态、结构异常或屈光参差、弱视等异常,或曾行屈光角膜手术但效果不佳,最佳矫正视力低于0.5,需再次进行角膜屈光手术的患者。疑难角膜屈光手术分类:(1)根据角膜屈光手术史分为手术原性屈光状态异常性、手术原性角膜结构异常性;(2)根据角膜情况分为角膜结构异常性、角膜曲率异常性;(3)根据双眼屈光状态差异分为高度近视伴弱视性、屈光参差性疑难角膜屈光手术。治疗方法:个性化设计手术,地形图引导手术,角膜屈光手术方式包括准分子激光角膜屈光手术(PRK)、上皮下准分子激光角膜磨镶术(Epi-LASIK)、准分子激光角膜表层磨镶术(LASEK)、准分子激光原位角膜磨镶术(LASIK)、治疗性角膜屈光手术(PTK)以及联合手术等。治疗效果:所有患者达到预期最佳矫正视力,其中超过预期矫正视力2行以上者为51.1%(24眼),超过3行以上者为23.4%(11眼)。预期性:实际矫正度在预期矫正度±0.5 D之间者45眼。患者对手术效果满意,随访2年以上未出现异常情况。结论界定疑难屈光性角膜手术的原因、适应证,严�
Objective To analyze the causes, classification, operation design, and therapeutic effect of difficult excimer laser keratorefractive surgery. Design Retrospective case series. Participants Patients （47 eyes） who have received difficult corneal refractive surgeries （DCRS）. Methods The causes, classification, operation design, and therapeutic effect of those patients were studied. Routine pre-operation examinations included visual acuity （uncorrected, corrected, pin hole）, diopter （mydriasis, normal pupil）, dominate eye, corneal thickness, corneal topography, wavefront aberration, and so on. There were some specific examinations according to conditions of different patients, including muhipoint corneal thickness, time-related keratometry （TK）, glare, contrast sensitivity, function of muscular apparatus, VEP, and so on. Customized operation was designed and possible prognosis was estimated before operation. Main Outcome Measures Preoperative corneal thickness, visual acuity, changes of corneal topography, diopter, and number of operations. Results The concept of DCRS： patients needed keratorefractive surgery, whose best corrected visual acuity was lower than 0.8, with abnormalities of corneal morphology and structure, anisometropia, amblyopia, or previous keratorefractive surgery with unsatisfactory result. Classification of DCRS were based on： history of keratorefractive surgery： operation- originated refractive state abnormality and operationoriginated corneal structure abnormality; cornea condition： corneal structure abnormality and corneal curvature abnormality; binocular refractive state： high myopia with amblyopia, anisometropia. Treatment included customized ablation, topography guided ablation, PRK, Epi- LASIK, LASEK, LASIK, PTK and so on. Therapeutic effect： all the patients achieved expected best corrected visual acuity, 51.1% of them （24 eyes） were 2 lines better than expected, and 23.4% （11 eyes） were 3 lines better. Among 47 eyes, actual correction of 45 eyes was
出处
《眼科》
CAS
2009年第3期175-179,共5页
Ophthalmology in China
关键词
准分子激光
角膜
屈光手术
excimer laser
cornea, keratorefractive surgery
