LASIK矫正体表瘢痕疙瘩者近视的临床研究

Clinical studies of excimer laser in situ keratomileusis correction of myopia in patients with keloids

目的:研究和观察准分子激光原位角膜磨镶术(LASIK)治疗体表伴瘢痕疙瘩近视患者的安全性、有效性和预测性。方法:前瞻性连续研究,在伦理委员会同意下,对16例32眼体表有瘢痕疙瘩的近视患者行LASIK矫正,年龄19～29(平均23.6)岁,裸眼远视力0.05～0.2,最佳矫正视力0.8～1.2,常规行裂隙灯显微镜,OrbscanⅡ眼前节分析系统、眼压、角膜厚度、电脑验光、散瞳检影、主观验光、对比敏感度和眩光等检查。患者均先行1眼手术,术后3mo无异常反应者再行对侧眼,术后随访2～6a,平均58.20±4.6mo。结果:术后2～6a,裸眼视力≥1.0者30眼(94%),0.8者2眼(6%)。术后最佳矫正视力高于或等于术前者31眼(97%),1眼有-0.75D屈光回退,术后屈光度与目标屈光度的差值平均为-0.25±0.35(-0.75～+0.75)DS。角膜透明,层间无haze形成及瘢痕愈合,无角膜扩张及角膜明显增厚。结论:LASIK治疗瘢痕疙瘩近视患者安全、有效;同时也说明,角膜瓣与基质层间愈合非瘢痕性愈合,但需大样本长期随访进一步证明。

AIM：To observe and research safety, effectiveness and predictability of excimer laser in situ keratomileusis surgery （LASIK） treatments of myopic patients with keloids. METHODS：Prospective consecutive study. Under the consent of Ethics Committee,16 myopic patients （32 eyes） with keloids underwent LASIK treatment. Their age ranged from 19 to 29 years （mean 23.6 years）. Uncorrected distance visual acuity was 0.05-0.2, best-corrected visual acuity（BCVA） was 0.8-1.2. Routine slit-lamp microscope, Orbscan Ⅱ anterior segment analysis system, intraocular pressure, corneal thickness, computer optometry, cycloplegic retinoscopy, subjective refraction, contrast sensitivity and glare as well as other tests were performed. Operation was performed on one eye first in all patients, then on the contralateral eye when no abnormal responses occurred 3 months later.Postoperative follow-up lasted for 2-6 years, average 58.20±4.6 months. RESULTS： Postoperative 2-6 years, visual acuity was equal to or greater than 1.0 in 30 eyes （94%）, 0.8 in 2 eyes （6%）. Postoperative BCVA was greater than or equal to the preoperative in 31 eyes （97%）, 1 eye had -0.75D refractive regression. The average difference between postoperative refraction and target refraction was -0.25±0.35 （-0.75~0.75） DS. The corneas were clear, no haze formation or scar healing and no corneal ectasia or corneal thickening occurred. CONCLUSION：LASIK treatment of myopia with keloids is safe and effective. It also shows that the corneal flap and stromal layer are non-scar healing, but a large sample of long-term follow-up is needed for further certification.