老视前期近视患者LASIK术后单眼调节幅度的变化

Investigation of amplitude of accommodation after LASIK in pre-presbyopic myopia

目的探讨老视前期近视患者准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)后单眼调节幅度的变化。方法随机选择接受LASIK手术治疗的老视前期近视患者29例(58眼),按平时戴镜情况分为两组:角膜接触镜组(13例26眼)和框架眼镜组(16例32眼),比较术前,术后第10天、第1个月和第3个月的单眼调节幅度(负镜片法),并将第10天的调节幅度下降程度与术前屈光度数作相关分析。结果角膜接触镜组术前,术后第10天、第1个月和第3个月的调节幅度分别为(7.15±1.02)D、(6.14±1.32)D、(6.69±1.43)D和(7.17±1.15)D;框架眼镜组术前、术后第10天、第1个月和第3个月的调节幅度分别为(6.32±1.07)D、(5.49±1.06)D、(5.90±1.33)D和(6.31±1.19)D。术后第10天、第1个月的调节幅度与术前相比,两组均有显著性下降,差异有统计学意义(P<0.05);到术后第3个月时已恢复到术前水平,差异无统计学意义(P>0.05)。术前角膜接触镜组的调节幅度明显高于框架眼镜组(P=0.004),但是术后第10天调节幅度的下降值两组间差异无统计学意义(P=0.464)。术后第10天调节幅度的下降程度与术前屈光度数呈正相关(r=0.52,P<0.01)。结论老视前期近视患者LASIK术后早期单眼调节幅度的降低是暂时性的,不会引起患者老视的提早出现。

Objective To study the changes in amplitude of accommodation （AMP） after LASIK for myopia in pre-presbyopes. Methods Fifty-eight myopic eyes in pre-presbyopes who underwent LASIK were enrolled in this study. Patients were divided into two groups （contact lens group and spectacle group） according to their habitual correction style. Monocular AMP was measured with a minus lens to blur preoperatively, and 10 days, 1 month and 3 months postoperatively. Results At prcoperation and 10 days, 1 month and 3 months postoperation, the AMPs in the contact lens group were （7.15±1.02）D, （6.14±1.32）D, （6.69±1.43）D and （7.17± 1.15）D, respectively; while in the spectacle group the values were （6.32±1.07）D, （5.49±1.06）D, （5.90±1.33）D and （6.31±1.19）D, respectively. The differences for each group were significant between preoperation and postoperation at 10 days （P〈0.05）, and between preopcration and postoperation at 1 month （P〈0.05）. No significance difference was found between preoperation and postoperation at 3 months （P〉0.05） in each group. Although the AMP of the contact lens group was better than that of the spectacle group before surgery, there were no significant differences between the two groups （P〉0.05） in the decrease in AMP at 10 days after surgery. The decrease in AMP at 10 clays correlated with the refractive error before surgery （r=0.52, P〈0.01）. Conclusion The decrease in the accommodative amplitude caused by LASIK in pre-presbyopic myopes is temporary and the LASIK procedure does not induce presbyopia to start earlier than normal.