高度近视LASEK术后预留一定屈光度的疗效观察

Impact of predictive refraction on postoperative vision after LASEK in high myopia patients

目的:观察高度近视患者准分子激光角膜上皮瓣下角膜磨镶术(LASEK)后预留一定屈光度的临床疗效。方法:对80例高度近视患者常规行双眼LASEK手术。根据角膜厚度、屈光度将其分为两组。预留组:对40例80眼手术者预留一定屈光度(-1.00DS);普通组:40例80眼手术患者全矫。定期对两组患者术后的眼部症状、视力、屈光度、眼压、角膜厚度等进行随访观察。结果:观察发现,两组患者术后6mo视力均最佳,术后1,3a视力均稍有下降,术后3a裸眼视力基本稳定。两组术前屈光度平均在-8.25±1.23D,屈光度有平均-0.75±0.12D的回退,两组的屈光度接近。两组角膜平均曲率、角膜厚度无明显的变化,基本稳定。术后两组眼压均稳定,无继发性高眼压及青光眼等并发症发生。角膜地形图检查提示,两组术后3a无圆锥角膜症状。术后6mo;1a两组均有轻度haze出现,至术后3a均无haze发生。结论:高度近视患者LASEK术后在相对安全角膜厚度的前提下,预留一定的近视度数,为患者保留更多的基质床厚度,同样能达到预期的治疗效果,扩大了近视的矫治范围。

AIM： To analyze the clinical results of predictive refraction after Laser - assisted Subepithelial Keratomileusis （LASEK） in high myopia patients. Q METHODS： Totally, 80 patients （160 eyes） with high myopia treated by LASEK were divided into two group according to the different corneal thickness and predictive refraction. Forty patients （80 eyes） in reservation group were reserved a certain diopter （- 1. 00DS）. Other 40 patients （80 eyes） in general group were fully corrected. Ocular symptoms, visual acuity, refraction, and intraocular pressure （lOP） was followed up and observed postoperatively and regularly. ~ RESULTS：The postoperative visual acuity after 6 month was all the best in two groups, which appeared a slight decline 1 year and 3 years after surgery. Three years later, uncorrected visual acuity was basically stable. The preoperative refraction in two groups was - 8.25 ＋ 1.23D with an average of -0. 75 ＋ 0. 12D fallback. The mean corneal curvature and corneal thickness had no significantly change, lOP after surgery was stable in two groups with no complications as secondary high lOP or glaucoma, etc. The results of corneal topography indicated that keratoconus was not occurred 3 years postoperatively in two groups. Six months and 1 year after surgery, mild haze appeared in both groups which were disappeared 3 years postoperatively. CONCLUSION： On the premise of safe corneal thickness, we predict a certain degrees of myopia after LASEK in high myopia patients. Through preserving more matrix bed thickness, it will achieve the same expected effect and expand the range of correction.