准分子激光散光性角膜切削术治疗复合性近视散光

Clinical analysis of photoastigmatic refractive keratectomy for compound myopic astigmatism

目的 探讨准分子激光散光性角膜切削术 (photoastigmatic refractive keratectomy,PARK )矫治复性近视散光的有效性、准确性和预测性。方法 采用 Comm pak- 2 0 0型准分子激光机 ,对 34例 46眼复性近视散光行角膜椭圆形切削 ,根据散光度大小分为 2组 :A组(- 1.75～ - 2 .75 D) ,B组 (- 3.0 0～ - 5 .2 5 D) ,并随访 0 .5 a以上 ,观察手术前后的视力、屈光度、散光轴夹角的变化。结果 术后 0 .5 a视力≥ 0 .8者 44眼 (95 .7% ) ,屈光度在± 1.0 0 D内者 39眼 (84.8% ) ,其中 B组屈光度 (- 0 .6 6± 0 .5 2 D)明显高于 A组 (- 0 .19± 0 .6 7D)。 46眼散光及角膜散光矫正比例分别为 44 .2 %和 46 .2 % ,散光及角膜散光轴变化分别为 11.6 1°±9.97°和 12 .78°± 9.15°。B组被矫正的散光度明显高于 A组 ,但 A组角膜散光被矫正的比例(5 2 .8% )明显高于 B组 (30 .4% )。结论 PARK矫正复合性近视散光效果明显 ,但散光度越高 ,欠矫及回退的可能性越大。

Objective To study the effects,accuracy and predictability of photoastigmatic refractive keratectomy(PARK) for correction of compound myopic astigmatism.Methods Compak 200 Laser was used to correct compound myopic astigmatism on 46 eyes of 34 cases by the elliptical ablations.All patients were followed up for more than six months.Visual acuity,refraction,astigmatism and axis of astigmatism were evaluated.Meanwhile,all eyes were divided into two groups according to the preoperative astigmatism:Group A(-1.75D^-2.75D),Group B(-3.00D^-5.25D).Results Of all the eyes treated,95.7% had uncorrected visual acuities of 20/25 or better and 84.8% were within 1D of the intended correction six months after PARK.The correction rate of myopic astigmatism and corneal astigmatism were 44.2% and 46.2%. The change of the angle of astigmatic axes was 11.61°±9.97°,and the change of the angle of corneal astigmatic axes was 12.78°±9.15°. The correction rate of group A was 52.8%,group B was 39.4%.Conclusion The correction of compound astigmatism with PARK is effective and accurate,but some undercorrection and regression have been observed in those with high preoperation astigmatism.