LASIK手术对不同戴镜情况的近视患者隐斜度的影响

Effects of LASIK on Phoria for Patient with Myopia of Different Habits of Wearing Glasses

【目的】研究准分子激光原位角膜磨镶术(LASIK)对不同戴镜情况的近视患者隐斜度的影响。【方法】入选对象为2008年3-8月间来我院行LASIK手术矫正双眼近视及近视散光的患者84例(168只眼),男性40例(80只眼),女性44例(88只眼),年龄(26±6)岁。按等效球镜度分为低、中、高度近视组。选取年龄性别均与实验组匹配的屈光正常者30例作为正常对照组。根据术前戴镜状况分为持续、间断和未戴镜组。随诊3个月者有67例(134只眼),低度近视组16例(32只眼)、中度近视组17例(34只眼)和高度近视组14例(28只眼)。比较不同戴镜组各屈光度组别的术前裸眼、术前戴镜、术后10 d和术后3个月的远、近隐斜度。【结果】持续戴镜组:术前裸眼近隐斜度-8.2±4.6(低度近视)、-11.7±5.5(中度近视)、-11.5±3.8(高度近视)均高于正常对照组-2.1±2.1(P=0.00);术前戴镜及术后3个月与正常对照组无明显差异(P>0.05);术前裸眼、术前戴镜及术后3个月的远隐斜度均与正常对照组(2.0±0.9)无明显差异(P>0.05)。间断戴镜组:低、中度近视组术前裸眼近隐斜度(-8.3±2.9,-10.0±2.1)、远隐斜度(3.2±0.7,3.0±1.1)均高于正常对照组(P=0.00);术前戴镜及术后3个月与正常对照组无明显差异(P>0.05)。未戴镜组:低度近视组术前裸眼近隐斜度-7.8±2.6、中度近视组近隐斜度-12.3±2.3、远隐斜度3.4±1.5均高于正常对照组(P=0.00);术前戴镜及术后3个月与正常对照组无明显差异(P>0.05)。高度近视组的间断戴镜组和未戴镜组,术前戴镜及术后3个月近外隐斜度虽明显缩小,但仍未恢复正常;远隐斜度与正常对照组差异不明显。【结论】近视患者不坚持配戴合适的眼镜会出现调节聚散关系失衡和眼位的改变。LASIK术后调节聚散功能渐趋正常,特别是对于间断戴镜组、未戴镜组的近视患者,有利于调节聚散关系的协调、眼位的平衡。

[ Objective ]To investigate the effects on phoria divergence after LASIK for myopic patients with different habits of wearing glasses, in order to evaluate the clinic value of LASIK from binocular vision function. [ Methods ] A total of 30 emmetropia and 84 myopia patients who wanted LASIK from March 2008 to August 2008, aged （26 ±6）years old were selected from clinic. 84 （168 eyes） myopia including 40 male （80 eyes） and 44 female （88 eyes） were divided into 3 groups by equivalent spherical power, which were low-grade, moderate-grade and high-grade myopia. According to status of wearing glasses, they were devided into three groups of continued wearing glasses, interrupted wearing glasses and not wearing glasses. Follow- up 3 months, there were 67 cases （134 eyes） which were 16 （32 eyes） low-grade myopia patients, 17 （34 eyes） moderate-grade myopia patients and lg （28 eyes） high-grade myopia patients, compared phoria before and 3 months after surgery in turn according to their status of wearing glasses and their diopters. [ Results ] In continued wearing glasses group, there were higher than the control group （-2.1 ± 2.1 ） in near phoria which were low-grade （-8.2 ± 4.6）, moderate-grade （-11.7 ± 5.5） and high-grade （-11.5± 3.8） without wearing glasses preoperative （P = 0.00）. However, there were no differences in near phoria among the control group and wearing glasses preoperative group （P 〉 0.05）.Similarly, no significant differences were revealed in near phoria between the control group and 3 months postoperative group （P 〉 0.05）. Compared with the control group （2.0 ± 0.9）, the difference in far phoria among the 3 conditions with and without wearing glasses preoperative and 3 month postoperative were negligible （P 〉 0.05）. In interrupted wearing glasses group, there were higher than the control group in near phoria which were low-grade （-8.3 ±2.9）, moderate-grade （-lO.0 ± 2.1 ） and in far phoria which were low-grade （3.2± 0.7）, moderate-grade （3.0±1.1） without wearing glasses preoperative （P= 0.00）. However, no significant differences were revealed between the control group and two other groups which were wearing glasses preoperative group and 3 months postoperative group in both near and far phoria （P 〉 0.05）. In never wear glasses group, there were higher than the control group in near phoria which were low-grade （-7.8 ± 2.6）, moderate-grade （-12.3 ± 2.3） and in far phoria was （3.4 ±1.5） without wearing glasses preoperative （P = 0.00）. While there were no significant differences between wearing glasses preoperative group in near and far phoria and the control group, the same as 3 months postoperative group in near and far phoria （P〉O.05）. Although reduced apparently, near exophoria were not normal in wearing glasses preoperative and 3 months postoperative in high-grade myopia of interrupted wearing glasses group and not wearing glasses group. There were non-significant difference among the control group, high-grade myopia of interrupted wearing glasses group and not wearing glasses group in distant phoria. [ Conclusions ] Uncontinued wearing glasses would induce their accommodative and vergent parameters such as distant and near level phoria abnormally. Postoperatively, their distant and near phoria will normalize gradually especially for myopia with interrupted wearing glasses and not wearing glasses.