准分子激光角膜切削术治疗近视和近视散光的临床研究(英文)

Evaluation of excimer laser photorefractive keratectomy for treatment of myopia and myopic astigmatism

目的 评价准分子激光角膜切削术矫正近视的结果。方法 我院自1996年9月到1997年10月,应用SVSAPEX型(SummitTechnologyInc.USA)准分子激光治疗仪,对168例近视患者(316只眼)行PRK手术,对其中的150例(260只眼,占84%)患者随诊至少3mo以上,最长1a;男68例(116只眼,占40.1%),女82例(144只眼,占59.9%)。150例(260只眼)近视患者术前等值球镜屈光度为-1.25～-10.00D(-4.67D±1.63D),散光0～-2.00D(-0.33D±0.45D);按屈光度分为两组:A组(-1.25～-5.90D),B组(-6.00～-10.00D)。结果 A组术后第10天,有68.9%(132/220)裸眼视力达到矫正视力,1、3、6和12mo分别为90%、96%、95%和94%.B组术后第10天,有35.9%(13/40)裸眼视力达到矫正视力,1、3、6和12mo分别为83%、87%、86%和84%.全组仅3只眼(0.64%)除外,均为0.5～1.0级的角膜上皮下雾状混浊,其出现的百分比手术后10d和1、3、6、12mo分别为32.9%、84.2%、62.4%、9.0%和2.8%.结论 提示准分子激光角膜切削术治疗-10.00D以内的近视是一种安全有效、稳定性好、预测性强的方法,-6.00D以下效果更好。

Objective To evaluate the efficacy and accuracy of photorefractive keratectomy(PRK) for myopia and myopic astigmatism.Methods SVS APEX PLUS excimer laser with a wave length of 193nm(Summit Technology Inc.Waltham,Mass,USA) was applied.Three hundred and sixteen myopic eyes of 168 patients were treated with PRK from Suptember 1996 to October 1997,and 260 eyes(84%) of 150 patients were followed up for more than three month,including male 68(116 eyes,40.1%) and female 82(144 eyes,59.9%).The preoperative spherical equivalent refractive errors ranged from -1.25D to -10.00D(mean -4.67D± 1.63D), and astigmatism ranged from 0 to -2.00D(mean -0.33D± 0.45 D). The patients were divided into two groups according to the refraction:group A(from -1.25D to -5.90D) and group B(from -6.00D to -10.00D).The number of eyes in the two groups were 220 and 40,respectively.Results In group A, After 10 days,68.9% had the uncorrected visual acuity(UCVA) equal to or one line better or lower than the preoperative best corrected visual acuity(BCVA).After 1 ,3,6 and 12 months, 90%,96%,95% and 94% had the UCVA equal to or one line better or lower than the preoperative BCVA,respectively.In group B,after 10 days, 1,3,6 and 12 months, UCVA equal to or one line better or lower than the preoperative BCVA occurred in 35.9%,83.0%,87.0%,86.0% and 84.0% of the patients respectively. Most of the haze showed 0.5~1 grades except 3 eyes with the haze of 2 grade at 3 or 6 months and it changed to l and 0.5 grade respectively at one year.after 10 days and 1,3,6,12 months postoperatively,the corneal haze was noted in 32.9%,84.8%,62.8%, 9.0%and 2.8% of the treated eyes respectively.Conclusion We found that the 193nm excimer laser PRK is a predictable, safe, stable,and effective refractive surgery for correcting myopia up to-10.00D in Chinese patients,and the effect is better in myopia lower than -6.00D.