LASIK手术屈光预测性与年龄的关系

Relationship between age and refractive predictability of excimer laser in situ keratomileusis

目的探讨LASIK手术屈光预测性与年龄的关系。设计回顾性病例系列。研究对象362例(703眼)LASIK手术患者。方法按年龄将患者分为18～30岁,31～34岁,35～39岁,≥40岁4组,于LASIK术前,术后1、10天,1、3、6个月,1、2年用自动验光仪结合显然验光的方法检查患者的屈光状态,并与预期屈光度进行比较。根据患者术前屈光状态,分为中低度组(≤-6.00D)、高度组(-6.25～-12.00D)、超高度组(≥-12.25D)。术后2年屈光度数≥-1.00D者为回退眼。主要指标屈光度。结果<40岁各组术后6个月屈光度(-0.32D±0.07D,-0.15D±0.06D,-0.20D±0.14D)与预期屈光度(-0.07D±0.04D,-0.19D±0.06D,-0.25D±0.07D)比较差异无统计学意义(P值分别为0.059,0.368,0.546),而≥40岁组的术后6个月屈光度(-0.25D±0.48D)与预期屈光度(-0.88D±0.60D)比较差异有统计学意义(P=0.001);不同年龄组间回退率比较差异有显著性;中低度、高度、超高度近视组间比较,回退率差异有统计学意义,近视回退量与术前屈光度呈正相关;57.83%患者回退发生于术后6个月内。结论LASIK手术屈光预测性受年龄、屈光度、术后时间等因素影响,对于年龄较大的高度近视患者应严格掌握手术适应证,并根据年龄、术前屈光度、用眼习惯等调整预期矫正度数。(眼科,2007,16:333-335)

Objective To explore the relationship between age and refractive predictability of excimer laser in situ keratomileusis （LASIK）for the correction of myopia. Design Retrospective case series. Participants 362 patients （703 eyes） who had performed LASIK. Methods According to the age, patients were divided into four groups （≤30y, 31-34y, 35-39y and ≥40y）. Their preoperative and postoperative refractive powers examined with automatic refactor as well as manifest optometry were analysed and followed up from 6 months to 2 years. According to pre-operative refractive power, patietns were divided into low and moderate myopia group（≤-6.00D）, high myopia group（-6.25-12.00D） and super-high myopia group（≥-12.25D）. The eyes with refractive power at post-operative 2 years -1.00D were regressive eyes. Main Outcome Measures Refractive error before surgery, intended residual refractive power and 3, 6,12, 24 months post-operative refractive powers. Results There were no significant differences between intended residual refractive powers and refractive powers at post-operative 6 month in 3 groups （〈40y） （P= 0.059, 0.368, 0.546）, while there were significant differences in the group of ≥40y （P=0.001）. There were significant differences on the rate of regression among groups according to age or refractive power. A significant positive correlation was found between regression and refractive error before surgery. Regression in 57.83% patients was found among post-operative 6 months. Conclusions The refractive predictability of LASIK was influenced by age, refractive error and postoperative-time. For older high myopic patients, indication for LASIK should be well known strictly. Attempted correction should be adjusted according to age, the degree of myopia, habit of eye using to get more satisfactory effects.