个体化切削治疗标准LASIK不能完全矫正的近视

Customized ablation for myopia corrected incompletely by conventional LASIK

目的:观察个体化切削治疗标准LASIK不能完全矫正的近视的临床疗效。方法:对202例398眼实施波前像差引导的个体化切削术,术前屈光度-2.00～-12.00D,散光度0～4.00D。其中角膜厚度不足者136例269眼(67.6%);矫正视力不佳者(包括弱视,除外眼底病变)20例38眼(9.5%);瞳孔直径≥5mm者40例80眼(20.1%);患者本人要求行个体化切削者32例64眼(16.1%)。不同屈光组的平均切削直径不同,随着近视度数增加从6.2～5.3mm变化切削直径。手术后定期观察。结果:患者术后角膜无浸润,清亮,角膜瓣对位好。术后1d,1wk,1mo,3mo,视力≥0.5分别为86.2%,95.3%,96.6%,93.5%;≥1.0分别为43.3%,80.6%,77.9%,84.3%。6mo有27眼复查,视力均在0.5以上,1.0以上占85.2%。术后眼压平均下降7.38mmHg,3mo回退率1.8%(2/108)。术后角膜中央区厚度较术前平均减少134.6μm,减少的量与其屈光度成正比。术后角膜5mm区域曲率较术前平均减少6.03D。对比敏感度标准化组和个体化组术前无统计学差异(P>0.05),但术后3mo个体化组对比敏感度比标准化切削组有所增加,比较有统计学差异(P<0.05)。术后3mo和术后6mo患者手术满意度分别为100.0%和99.5%;不良反应分别为36.5%和6.5%,主要是干眼,其次眩光、复视和视觉疲劳。结论:个体化切削手术具有显著提高术后矫正视力,提高视觉敏感度,改善夜间视力,眩光和光晕发生率低的优点。特别是对于高度近视、弱视或角膜厚度不足、标准LASIK术后视觉质量不佳者的再次矫正可以获得较好的治疗效果。

· AIM: To observe the clinical effect of customized ablation in treating the myopia corrected incompletely by the conventional LASIK.· METHODS: A total of 398 eyes of 202 patients, with myopia of -2.00 to -12.00D and astigmatism of 0 to 4.0D, underwent customized ablation. Among them, 269 eyes (67.6%) had thinner corneal thickness, 38 eyes (9.5%) had bad corrected visual acuity, 80 eyes (20.1%) had pupil diameter≥5mm and 64 eyes (16.1%) were operated by request of patients themselves. The average ablation diameter varied with different refractive groups, ranging from 5.3 to 6.2mm.· RESULTS: At the postoperative 1d, 1 wk, 1mo and 3mo, the visual acuities of ≥0.5 were 86.2%, 95.3%, 96.6% and 93.5% respectively, and those of ≥1.0 were 43.3%, 80.6%, 77.9% and 84.3% respectively. The average postoperative intraocular pressure (IOP) reduced by 7.38mmHg and the corneal curvature in 5mm area reduced by 6.03D. The central corneal thickness lessened by 134.6μm. The main side effects were dry eye, glare, diplopia and asthenopia.· CONCLUSIONS: The method of customized ablation can markedly improve postoperative visual acuity, enhance visual sensitivity and meliorate night-vision especially for those with higher myopia, amblyopia, thinner corneal thickness and re-LASIK.·