LASIK与透明晶状体摘除人工晶状体植入术矫正远视的长期观察

Long term effect of laser in situ keratomileusis and clear lens extraction with IOL implantation for hyperopia

目的比较LASIK与透明晶体摘除人工晶状体植入术矫正远视的长期疗效。方法将远视屈光性手术后12月以上病人，分为2组：A组：行LASIK矫正远视者110例211只眼，年龄（51．1±8．8）岁，术前等效球镜为（＋2．70±1．4）D，预计矫正（＋3．20±1．4）D。采用尼德克EC-5000常规切削。B组：透明晶状体摘除人工晶状体植入术者53例100只眼，平均（54．4±6．5）岁，术前平均等效球镜为（＋3．86±1．9）D，预计矫正（＋4．27±2．0）D。采用最陡峭方向2~3mm透明角膜切口，超声乳化，折叠型人工晶状体植入。术中均无并发症。观察手术前后的视力、屈光状态、并发症等。结果A组平均年龄较B组小（P〈0．05）；B组术前屈光度、预计矫正屈光度均比A组高（P〈0．05）。A、B两组分别随访（25．49±9．6）月和（24．10±12）月，无差异（P〉0．05）。A、B两组术后裸眼视力达到20／40的分别为93．8％（198只眼）和94％（94只眼）；达20／20分别为69．7％（147只眼）和65％（65只眼），差异无显著统计学意义（P〉0．05）；术后屈光度与目标屈光度误差分别为0．74D和0．17D，A组高于B组（P〈0．05）；术后A组48只眼发生干眼症等并发症，B组有28只眼后囊轻度混浊等。结论两种手术长期有效性和安全性均好，相比较，透明晶状体摘除联合人工晶状体植入术的预测性及稳定性优于LASIK。

Objective To compare the long term effects of laser in situ kemtomileusis （LASIK） with that of clear lens extraction （CLE） with intraocular lens （IOL） implantation for the correction of hyperopia. Methods Subjects were divided into 2 groups with post-operative follow up of at least 12 months. Group A： 111 hyperupic LASIK subjects （211 eyes） aged （51.1± 8.8）y un.derwent conventional ablation with Nidek EC-5000. The pre-op refraction and refractive correction were （＋2.70 ± 1.4）D and （＋3.20 ± 1.4）D, respectively. Group B： 53 subjects （100 eyes） aged （54.4± 6.5）ys underwent CLE ＆ foldable IOL implantation using phacoemulsification. The 2-3mm clear corneal incision were made at the steeper meridian of the cornea. All surgeries were uncomplicated. The pre and post-up UCVA,BCVA,refraetion and post-op complications were evaluated. Results The average age for Group A was younger than Group B. The pre-op refraction and refractive correction for Group B were greater than Group A （P 〈0.05）. The follow up for Group A and B were （25.49± 9.6）m and（24.10±12）m （P〉0.05）. 93.8%（198 eyes）and 94% （94 eyes）got UCVA of 20/40, 69.7%（147eyes） and 65%（65 eyes）got UCVA of 20/20 for A and B group, respectively.（P 〉0.05）. 48 eyes in Group A had dry eye and other complications.28 eyes in Group B had posterior capsular opacification and other complications.Conclusions Both procedures showed good efficiency and safety. Comparing to LASIK, CLE ＆ IOL implantation had better predictability and stability.