术前预留屈光度对不同年龄LASIK手术患者的影响

Laser in situ Keratomileusis for Myopia Patients of Various Ages:Analysis of Long Effects

目的评价术前预留屈光度对不同年龄LASIK手术患者术后远期疗效和视觉症状的影响,并比较不同年龄近视患者行LASIK手术后的有效性、可预测性和稳定性,并观察术前预留屈光度对术后长期疗效和近距离工作的影响。方法对224例(448只眼)近视LASIK手术患者进行回顾性分析。所有病例按年龄分成3组:Ⅰ组(全矫组)205只眼,年龄18～27岁(21．73±2．65岁);Ⅱ组(预留-0．25 D组)147只眼,年龄28～36岁(32．08±2．66岁);Ⅲ组(预留-0．50 D～- 0．75 D组)96只眼,年龄36～50岁(39．17±2．84岁)。主要观察指标:手术后裸眼视力裸眼远视力、等值球镜屈光度,近距离工作疲劳症状评分主观视觉症状。随访时间≥5年。结果术后裸眼视力裸眼远视力≥1．0的Ⅰ组有172只眼(83．9％),Ⅱ组有121只眼(82．3％),Ⅲ组有69只眼(71．9％),其中Ⅰ组与Ⅱ组比较差异无显著意义(P>0．05),Ⅲ组与Ⅰ、Ⅱ组比较差异有显著意义(P<0．05)。术后裸眼远视力≥0．5的Ⅰ组有199只眼(97．2％),Ⅱ组有142只眼(96．6％),Ⅲ组有83眼(86．5％),Ⅰ组与Ⅱ组比较差异无显著性意义(P>0．05),Ⅲ组与Ⅰ、Ⅱ组比较差异有显著意义(P<0．05)。术后平均等值球镜屈光度:Ⅰ组(-1．08±0．93)D,Ⅱ组(-1．17±0．96)D,Ⅲ组(-1．40±0．85)D,Ⅰ组与Ⅱ组比较差异无显著意义(P>0．05),Ⅲ组与Ⅰ、Ⅱ组比较差异均有显著意义(P<0．05)。术后5年残余屈光度在-0．5～+0．5 D之间Ⅰ组有117只眼(57．1％),Ⅱ组有87只眼(59．2％),Ⅲ组有29只眼(30．2％);在-1．00～+1．00 D之间Ⅰ组的有187只眼(91．2％),Ⅱ组分别有138只眼(93．9％),Ⅲ组有69只眼(71．9％)。术后5年近距离工作疲劳症状评分:Ⅰ组2．10±2．11,Ⅱ组3．02±2．38,Ⅲ组5．94±3．46。Ⅰ组和Ⅱ组相比差异无显著意义(P>0．05),Ⅰ、Ⅱ和Ⅲ组比较差异均有显著意义(P<0．05)。结论对年龄较大特别是近距离用眼多的患者,术前预留一定量的屈光度可减轻其术后疲劳感,合适量的预留屈光度并未对不同年龄的患者术后行LASIK手术后都可获得较好的有效性,可预测性和稳定性产生明显影响。

Objective To evaluate the efficacy, predictability, and stability of the laser in situ keratomileusis （LASIK） procedure for myopic patients of various ages and to investigate the effects of uncorrection of patients part preoperation on the long effects postoperation and near-distance work postoperation. Methods Totally 224 patients（448 eyes） were continuously studied postoperation of LASIK for 5 years. All cases were divided into groups Ⅰ, Ⅱ arid Ⅲ, In group Ⅰ with ages from 18 to 27 years（21.73 ±2. 65 years） 205 eyes were corrected completely, in group Ⅱ with ages from 28 to 36 years（ 32. 08 ± 2. 66 years） 147 eyes were uncorrected -0. 25 diopter（D） ,in group Ⅲ with ages from 36 to 50 years old years（42. 17 ± 2. 84 years） 96 eyes were uncorrected -0. 50 - -0. 75 D. The mainly assessable indications included visual acuity, postoperative residual refractive error and fatigue symptom grades due to near-distance work. Results Five years after surgery, from 224 patients, the distance uncorrected visual acuity （UCVA） of 362 eyes （80. 8% ） was more than 1.0, the distance UCVA of 424 eyes（94. 6% ） was more than 0. 5. The mean postoperative spherical equivalent （SE） refraction： in group Ⅰ was （ - 1.08 ± 0. 93 ） D, in group Ⅱ was （ - 1.17 ± 0. 96 ） D and in group Ⅲ was （ - 1.40 ± 0. 85 ） D. The residual refractive error after surgery：233 eyes（52.0% ） were -0. 5- ＋0. 5 D and 394 eyes（87.9% ）were - 1.00- ＋ 1.00 D. The fatigue symptom grades due to near-distance work： in group Ⅰ was 2. 10 ± 2. 11, in group Ⅱ was 3.02 ± 2. 38 and in group Ⅲ was 5. 94 ± 3.46. Conclusions LASIK is effective, predictable and stable for myopia patients of various ages. It would makebe more comfortable uncorrecting preoperation for some old patients postoperation to uncorrect partly preoperation for old patients and the ones who need to neardistance work for a long time.