摘要
18岁男性,因“双眼散光”,要求行手术矫正就诊。患者诉自幼高度散光,无戴镜史。裸眼视力:右眼0.05,左眼0.15。主觉验光:右眼-4.00/-6.75×175°→1.0-,左眼+1.00/-11.00×175°→0.8。外观双眼睑裂狭长。裂隙灯检查未见明显异常。诊断为双眼超高度散光,双眼屈光参差,圆锥角膜待排;予配框架镜,定期随访。1年后,双眼角膜曲率较前略增加,予双眼跨上皮角膜交联手术。2年后,患者再次随访,要求手术矫正。检查发现角膜情况稳定,决定采用首创的自体散光透镜重塑转位术进行矫正:首先应用飞秒激光进行散光透镜制作,之后采用准分子激光重塑透镜,再对透镜进行90°转位,最后将角膜瓣复位完成矫正。术后裸眼视力在术后1个月起稳定在0.8,最佳矫正视力与术前保持稳定。主觉验光:右眼0/-1.25×100°→1.0,左眼+1.50/-1.50×150°→0.8。对于高度散光寻求手术矫正的患者,首先需要通过全面的检查和必要的随访判断是否有圆锥角膜的可能,是否有术后发生角膜扩张性疾病的风险,对于存疑的,可尝试跨上皮角膜交联手术稳定角膜情况,对于常规手术方式难以矫正的超高度散光,在角膜条件稳定的情况下,可尝试自体散光透镜重塑转位术,可获得较为满意的视觉效果,且能最大限度保留角膜组织,安全性高。
An 18-year-old male came to our hospital for surgery to correct his astigmatism.The patient complained of high astigmatism since childhood and no history of wearing glasses.Uncorrected distance visual acuity(UDVA):R:0.05,L:0.15.Subjective refraction:R:-4.00/-6.75×175→1.0-,L:+1.00/-11.00×175→0.8.External appearance:Narrow and elongated palpebral fissures.The slit lamp examination showed no obvious abnormality.The patient was diagnosed with high astigmatism,anisometropia and suspected keratoconus.Frame glasses and regular follow-ups were scheduled.One year later,the corneal curvature of both eyes increased compared to before,and transepithelial corneal cross-linking surgery was performed on both eyes.Two years later,the patient returned for a follow-up and requested surgical correction with a stable corneal curvature.It was decided to apply the innovative autologous astigmatism lenticule reshaping and rotation surgery for correction:firstly,femtosecond laser was used to create an astigmatic lenticule,then excimer laser was used to reshape it.Subsequently,the lens was rotated 90 degree and repositioned followed by the corneal flap attached to complete the surgery.The postoperative UDVA stabled at 0.8 from 1 month after surgery,and the best corrected visual acuity(BCVA)remained stable compared to the preoperative.The subjective refraction was R:0/-1.25×100=1.0,L:+1.50/-1.50×150=0.8.For patients with high astigmatism,it is necessary to conduct comprehensive examination and long-term follow-up to determine with the possibility of keratoconus and assess the risk of postoperative corneal ectasia.For those in doubt,transepithelial corneal crosslinking surgery can be attempted to stabilize the cornea.For ultra-high astigmatism that is difficult to correct with conventional surgical methods,under stable corneal conditions,autogenous astigmatism lenticule reshaping and rotation surgery can be attempted to achieve satisfactory visual effects.
作者
尚建慜
黄佳
王晓瑛
周行涛
SHANG Jianmin;HUANG Jia;WANG Xiaoying;ZHOU Xingtao(Department of Ophthalmology,Eye&ENT Hospital of Fudan University,Shanghai 200031,China)
出处
《中国眼耳鼻喉科杂志》
2024年第S01期47-52,共6页
Chinese Journal of Ophthalmology and Otorhinolaryngology
关键词
高度散光
圆锥角膜
透镜重塑
透镜转位
High astigmatism
Keratoconus
Lenticule reshaping
Lenticule rotation
