激光性角膜手术与眼内屈光手术矫治超高度近视眼

Selection of refractive surgery in high myopia

目的:评价及探讨矫治超高度近视眼的各类屈光手术的有效性、稳定性和安全性。方法:随机选择临床中观察到的超高度近视患者行各类屈光手术者108眼,近视范围-10.00～-24.50D,术前屈光度平均为(-12.25±1.53)D,散光平均为(-1.52±0.55)D;手术方式的选择:(1)I组52眼,行LASIK术:(2)II组23眼,行透明晶状体超声乳化摘除加后房型人工晶状体植入术。(3)III组33眼行有晶状体眼虹膜固定型人工晶状体植入术。术后随访观察平均6mo,主要观察术后裸眼视力、最佳矫正视力、屈光度、眼压及眼前段、眼底情况。结果:三组术后裸眼视力均比术前提高,术后裸眼视力≥0.5者分别是42眼(80.8%),20眼(87.0%),28眼(84.8%),术后屈光度分别为(-2.10±2.38)D,(-1.75±1.33)D,(0.83±1.16)D,主要并发症I组术后6mo黄斑出血1眼,II组术后15mo视网膜脱离1眼,III组平均角膜内皮细胞丢失率为4.5%。结论:对于超高度近视,晶状体性屈光手术效果优于LASIK术。对超高度近视行屈光手术,要根据患者年龄,眼部情况,手术医师的技术等,选择安全、有效、稳定性好的手术。

AIM： To compare and evaluate the efficacy, safety and stability of the selection of corneal or lens refractive surgery in high myopia. METHODS： The results of treating 108 eyes in high myopia were analyzed retrospectively. The mean preoperative spherical equivalent and astigmatis was （-12.25±1.53）D and （-1.52 ± 0.55） D. Fifty-two eyes treated with LASlK were as group 1. Twenty-three eyes in group 2 were treated with clear lens extraction and intraocular lens （IOL） implantation. Thirty-three eyes in group 3 were treated with phakic IOL for high myopia. The follow-up time was 6 months. Postoperative uncorrected visual acuity （UCVA）, best corrected visual acuity （BCVA）, diopter, intraocular pressure anterior segment and fundus （lOP） and the condition of were observed. RESULTS： The UCVA improved in all cases postoperatively, including 42 eyes （80.8%）, 20 eyes （87.0%）, and 28 eyes （84.8%） of group 1,2 and 3 achieving 〉 0.5, respectively. The mean postoperative shpherical equivalent and astigmatism was （-2.10±2.38）, （-1.75±1.33） D, and （0.83±1.16） D, respectively. Complication of macular hemorrhage was found in group 1 after 6 months, retinal detachment presented in group 2 after 15 months. The average loss rate of corneal endothelial cell in group 3 was 4.5%. CONCLUSION： Treating with IOL and phakic IOL implantation is better than with LASIK for high myopia. The selection of refractive surgery in patients with high myopia should be based on age, condition of lens, degree of myopia, doctor＇s level and so on.