准分子激光原位角膜磨镶术治疗远视眼老视的临床观察

Clinic observation of laser in situ keratomileusis for treatment of presbyopia with hypermetropia

目的探讨准分子激光原位角膜磨镶术（LASIK）治疗远视眼老视的临床效果。方法回顾性病例分析研究。收集32例（64只眼）因远视眼老视行LASIK患者的资料。术前屈光度数：球镜为＋0．75-＋3．00 D，柱镜为0．00～＋1．75D。术后预期目标屈光度数：主视眼为0．00～-0．50D视远，非主视眼为-1．50～-2．50D视近，目标近视力等于或高于J3。术后随访时间12个月，观察术后双眼裸眼远近视力、角膜形态、屈光度数及对比敏感度等。本研究采用t检验、X^2检验、SNK—q检验方法对数据进行统计学分析。结果LASIK术后12个月双眼裸眼远视力≥0．8且近视力等于或高于J3及等于或高于J4的患者分别为53．1％（17／32）及87．5％（28／32）。术后不同时间角膜屈光力较术前[角膜直径3mm区域为（44．12±1．38）D、5mm区域为（43．42±1．53）D]均有明显增加，且对应的角膜非球面参数Q值，如主视眼术后1、3、6、12个月分别为-0．514±0．053、-0．416±0．065、-0．389±0．076、-0．368±0．087，亦呈负值增加（t=19．25，12．14，9．82，8．11；P〈0．01）。术后12个月等效球镜屈光度数与预期目标差值在±0．50D和±1．00D以内者主视眼分别为87．5％（28／32）、100．0％（32／32），非主视眼分别为56．2％（18／32）、90．6％（29／32）。术后6个月双眼各空间频率对比敏感度与术前比较，差异均无统计学意义（t=0．63，0．45，0．37，1．06，0．64；P〉0．05）；术后12个月主诉有干眼症状的患者占15．6％（10／23），满意度调查84．4％（27／32）患者对疗效满意。结论根据单眼视原理采用LASIK治疗远视眼老视可获得较好的临床效果，但其远期疗效和稳定性有待进一步观察。

Objective To investigate the effects of Laser in situ keratomileusis （LASIK） for treatment of presbyopia with hypermetropia. Methods 32 presbyopia patients（64 eyes） with hypermetropia were treated by LASIK and follow-up 1 year. The preoperative sphere was ＋ 0. 75 to ＋ 3. 00 D and cylinder was 0. 00 to ＋ 1.75 D. For distance vision correction, the target refraction was O. 00 to - 0. 50 D in the dominant eye. And for near vision, the target refraction was - 1.50 to - 2. 50 D in the non-dominant eye. The measurement including refraction, uncorrected visual acuity（ UCVA）, near vision, Q factor of cornea and contrast sensitivity were recorded. Results At 1 year after surgery a total of 53.1% （17/32） of all patients had binocular distance UCVA of 20/25 or better along with J3 or better near, and along with J4 or better near was 87.5% （28/32）. The postoperative corneal refractive power was significant higher than preoperative[ 3 mm： （44. 12 ± 1.38） D,5 mm： （43.42 ± 1.53） D] and Q factor became more negative. At 1 year 87. 5% （28/32） and 100. 0% （32/32） of the dominant eyes treated for distance had a manifest refractive spherical equivalent within 4- 0. 50 and ± 1.00 D of intended correction, respectively;of the nondominant eyes treated for near,56. 2% （18/32） and 90. 6% （29/32） had a manifest refractive spherical equivalent within ± 0. 50 and ± 1.00 D of intended correction respectively. The difference of sensitivity was no statistically significant between preoperative and 6 months after surgery. There were 15.6% of the eyes had dry eye syndrome and 84. 4% of the patients were satisfied with LASIK at 1 year after surgery. Conclusions LASIK was a effect surgery for treatment of presbyopia with hypermetropia.