儿童高度近视性屈光参差LASIK术后视力屈光度及角膜地形图分析

Vision acuity,refraction and corneal topography after LASIK for anisometropia of high myopia in children

目的分析儿童高度近视性屈光参差准分子激光原位角膜磨镶术（laser in situ keratomileusis，LASIK）后视力、屈光度及角膜地形图的动态变化。方法对41例患儿（6～14岁）42只高度近视性屈光参差眼LASIK术后1、3、6及12个月进行视力、屈光度及角膜地形图的随访。结果术后各阶段的平均裸眼远视力和平均矫正远视力都明显好于术前；模拟角膜镜度数（simulated keratoscope reading，Sim k）的等效值和球镜屈光度术后第1个月较术前分别平均减少6．50D和8．25D，术后3个月之内均表现一定的回退，在术后3～6个月仍见部分回退，在6～12个月才趋于稳定；Sim k的差值与柱镜屈光度的变化相符：术后较术前明显减少，术后各阶段相比较无统计学差异。结论LASIK矫治儿童高度近视性屈光参差术后恢复快、疗效可靠，角膜地形图的检查可准确显示术后角膜的形态变化：在成人LASIK术后角膜地形图的形态变化基础上具有一定的自身特点，掌握这些特点对手术设计的改进和手术疗效的预测具有重要的临床意义。

Objective To analyze the dynamic changes of vision acuity, refraction and corneal topography after LASIK for anisometropia of high myopia in children. Methods Forty-one patients aged 6 to 14 years old （42 eyes） with anisometropia of high myopia underwent LASIK, and vision acuity, refraction and corneal topography were evaluated at postoperative 1, 3, 6, 12 months during follow up. Results The average uncorrected and best corrected distance vision acuity after surgery decrease of equivalent value of simulated keratoscope reading was better than that before operation. The average （ Sim k） and spherical refraction were 6.50D and 8.25D in postoperative 1 month, decreased within 3 months, still decreased slightly from 3 to 6 month and stabilized from 6 to 12 month. The margin of Sim k accorded with the changes of the cylindrical refraction, decreased significantly after surgery and had no significant changes in different periods. Conclusion The visual acuity recovers quickly after LASIK for anisometropia of high myopia in children. The corneal topography could display the modality of cornea accurately that was similar to adults＇ but of its own characteristics. The corneal topography is of clinical importance for the improvement and predictability of surgery.