RK术后再次行LASIK术的临床疗效分析

Analysis of the safety and effectiveness of using LASIK surgery for corrective treatment after radial keratotomy surgery

目的探讨放射状角膜切开术（RK）后再次行准分子激光原位角膜磨镶术（LASIK）的安全性、有效性。方法回顾性系列病例研究。分析观察曾行RK术目前出现屈光回退或残存不规则散光的患者15例（28眼），应用EC．5000准分子激光手术系统对这部分患者行LASIK术进行治疗。术后随访6年以上，观察其术前、术后的远、近视力，角膜恢复情况，术后并发症等。结果行LASIK术6年后，裸眼视力达到术前最佳矫正视力的有26眼，占93％，术后2眼仍残存散光0．50-0．75D。故未达到术前最佳矫正视力；25眼（89％）近视力下降。10眼角膜瓣边缘延迟愈合，2眼表现为角膜瓣边缘线状混浊。结论RK术后发生屈光回退或残存低度不规则散光的患者行LASIK术进行屈光再矫正是安全、有效的，术后患者对手术效果较满意。

Objective To investigate the safety and effectiveness of using laser in situ keratomileusis （LASIK） for the treatment of refractive deterioration after radial keratotomy （RK） surgery. Methods Fifteen patients （28 eyes） in this retrospective study underwent repeat LASIK surgery after they had undergone RK surgery about ten years earlier. The vision of these patients had worsened so they wanted to acquire good vision through repeat LASIK surgery. The Nidek EC-5000 laser treatment system was used for the surgery. Patients were followed up for more than 6 years to monitor the changes in pre- and postoperative visual acuity, complications, corneal prosthetic condition, etc. Results During the 6-year follow-up period, uncorrected visual acuity was better than or equal to preoperative best corrected visual acuity （BCVA） in 26 eyes （93%）, but near visual acuity was worse in 25 eyes （89%）. Two eyes had low astigmatism （-0.50^-0.75 D） so these patients did not achieve preoperative BCVA. The corneal flap edge healed slowly in 10 eyes and the corneal flap edge had opaque-like lines in 2 eyes. Dry eye was a complication for about 98% of the patients so eye drops had to be used for a long ternr Conclusion LASIK surgery for the treatment of patients with deteriorated vision or low astigmatism after RK surgery is a safe and effective refractive surgery. Patients were satisfied with the treatment but must be informed that they need to be followed up for a long time.