屈光性角膜手术26743例回顾

Retrospective study on keratorefractive laser surgery in 26 743 cases

目的:总结准分子激光屈光性角膜手术的10a临床效果。方法:1993-05/2003-05包括行PRK,LASEK及LASIK的患者26743例(44580眼),应用数学模式建立数据库,进行数据统计分析。结果:男14691眼,女29889眼;年龄9～57(平均27.20)岁;左22443眼,右22137眼。术前裸眼视力0.10±0.07;矫正视力0.98±0.37,其中≥0.5者43794眼(98.23%),≥1.0者41066眼(92.11%),≥1.5者2218眼(4.98%);眼压15.76±7.25mmHg(1mmHg=0.133kPa);屈光度球镜-0.75～-18.00D(-5.65±3.24D),柱镜-0.25～-5.00D(–0.05±0.77D);角膜曲率(K)值K143.94±3.57,K242.98±3.50。筛选圆锥角膜0.99%,亚临床圆锥角膜0.93%;眼底病变及视网膜周边变性0.39%,排除系统疾病及不适宜激光手术者。术后情况裸眼视力0.98±0.34,其中≥0.5,44580眼(100%),≥1.0者44031眼(98.80%),≥1.5者4732眼(10.61%);矫正视力1.03±0.33;眼压14.87±7.06mmHg;屈光度球镜-0.001±0.06D,柱镜-0.00±0.03D;K值K138.07±9.83,K237.20±10.84。实际矫正度在预期矫正度±1.00范围内98.70%。临床、亚临床圆锥角膜及眼底病变者不手术;视网膜周边变性眼底激光1mo后可进行手术,以LASEK为主。三种手术长期效果没有统计学差异。PRK1wk内基质细胞明显减少,10d,1mo基质细胞数目增加,3mo减少。

AIM: To study retrospectively the clinical results of keratorefractive laser surgery in the last decade. · METHODS: A total of 26 743 subjects (44 580 eyes) who underwent keratorefract ive laser surgery in our hospital from May 1993 to May 2003 were studied. The su rgery included photorefractive keratectomy (PRK), laser in situ keratomileusis ( LASIK) and laser-assisted sub-epithelial keratomileusis (LASEK). A database was established with applied mathematics mode and the data were statistically analyz ed with SPSS 10.0 for windows. · RESULTS: The patients ranged in age from 9 to 57 years old (mean, 27.20 years ). There were 14 691 of male patients and 29 889 of female patients, 22 443 left eyes and 22 137 right eyes respectively. Before operation, the mean uncorrected visual acuity was 0.10±0.07, and corrected visual acuity was 0.98±0.37. There were 43 794 eyes (98.20%) with corrected visual acuity≥0.5, 41 066 eyes (92.10 %) ≥1.0 and 2 218 eyes (5.00%)≥1.5. Patients had mean intraocular pressures of 15.76±7.25 mmHg preoperatively. Patients had preoperative spherical changes fr om-0.75D to-18.00 D (mean,-5.65±3.24D), cylinder changes from-0.25D to-5.0 0D (mean,-0.05±0.77D). The preoperative corneal curvature was: K1 43.94±3.57, K2 42.98±3.50. Patients with systemic or ocular contraindications were eliminat ed or treated before operation: keratoconus 0.99%, subclinical keratoconus 0.93% , eyeground disorders and peripheral retinal degeneration 0.39%. After operation , the mean uncorrected visual acuity was 0.98±0.34, and 44 580 eyes (100%) had uncorrected visual acuity≥0.5, 44 031 eyes (98.80%)≥1.0, 4 732 eyes (10.61%) ≥1.5. The mean corrected visual acuity was 1.03±0.33D. Patients had mean intra ocular pressures of 14.87±7.06mmHg postoperatively. Patients had postoperative spherical changes of-0.001±0.06D, cylinder changes of 0.00±0.03D. The postope rative corneal curvature was: K1 38.07±9.83 K2 37.20±10.84. About 98.70% of th e patients had a difference between the achieved and the attempted correction le ss than 1.00D. Patients with keratoconus, subclinical keratoconus and eyeground disorders were eliminated; patients with peripheral retinal degeneration were tr eated with argon laser 1mo before the keratorefractive laser surgery, mainly wit h LASEK. The stromal cells of patients with PRK underwent a marked reduction wit hin 1wk and an increase in 10d and 1mo after the surgery, but then a reduction i n 3mo and eventually recovered in 6mo. There was no marked change in the number of corneal cells of patients with LASIK. The corneal nerves recovered in 3-6mo a fter the operation. The incidence of complications during or after operations wa s 0.20%, varying with the surgery choice and the operation duration. The common complications of early time (within 6mo after operation) were: steroid ocular hy pertension, Haze, corneal opacity and dry eye. The common complications of middl e period (6mo-3a after the surgery) were: refraction regression, glaring. The lo ng-term (more than 3a after the surgery) complications were: corneal opacity, re fractive regression. The incidences of refractive regression with PRK, LASEK and LASIK were 3.20%, 2.90%, 1.10% respectively. The common complications of PRK we re steroid ocular hypertension, refraction regression, Haze and steroid glaucoma , each accounting for 5.30%, 2.40%, 2.50%, 0.02% respectively. The complications of LASEK were: Haze, 1.50%; steroid glaucoma, 0.30%. The complications of LASIK were: opacity of corneal flap or beneath corneal flap, 0.18%; infection, 0.02%, subepithelial implantation, 0.18%. Dry eye and glaring occurred in all the 3 ty pes of surgery, more in patients with LASIK than those with PRK and LASEK. 95.00 % patients recovered about 1a later. High myopia, aging and steroid insufficienc y after the surgery were the main causes of Haze after PRK. Overdose of steroid, long duration of operation, bad compliance were the main causes of steroid ocul ar hypertension and glaucoma. Iatrogenic factors and concurrence of tinea were r isk factors of