飞秒激光制瓣的准分子激光角膜原位磨镶术治疗不同屈光度近视的疗效分析

Femtosecond laser-assisted LASIK for myopia of different diopters

目的评价Ziemer’s Femto LDV飞秒激光制瓣联合准分子激光角膜原位磨镶术(LASIK)治疗不同屈光度近视的临床疗效。方法将行Femto LDV制瓣的LASIK近视患者203例共401眼按术前屈光度分成3组,A组:-0.5^-6.0 D,284眼;B组:-6.25^-10.0 D,107眼;C组:-10.25^-14 D,10眼。观察术后12个月内其裸眼视力、矫正视力、屈光度及术后并发症的发生。结果虽然3组术后3个月的裸眼视力达0.5以上者均为100%,但1.0以上者分别为100.0%、99.1%及70.0%,其中C组患者显著低于A、B组(P<0.05)。而且C组患者术后12个月裸眼视力逐渐出现低于术前的最佳矫正视力的发生率明显高于A、B组(P<0.05),但3组的术后最佳矫正视力均无明显下降(P>0.05)。术后12个月各组平均屈光度A组为(-0.19±0.43)D,B组(-0.37±0.63)D,C组(-1.02±1.16)D,其中≤±0.5 D的分别为98.9%、83.2%和40.0%(C组明显低于A、B组,P<0.05)。所有患者基质床切削区均匀,偏离中心率低,角膜后表面高度差异无统计学意义,泪膜破裂时间、眼压差异均无统计学意义(P<0.05),未见严重并发症发生。结论使用Femto LDV制瓣的LASIK对于不同近视度数的患者均有好的治疗效果,术后视力好,预测性高,效果稳定及安全性高等,但对于超高度近视患者术后12个月视力预测性明显低于其他近视患者。

[Objective] To evaluate the laser in situ keratomileusis assisted femto-second in the treatment of low, high and excessively myopic eyes. [Methods] 401 eyes were treat with LASIK assisted femto-second laser （Ziemers Femto LDV） and divided into three groups. Group A： -0.5 --6.0 D, 284 eyes; group B： -6.25 D--10.0 D, 107 eyes; group C： -10.25 D--14 D, 10 eyes. Visual acuity, refraction, corneal eccentricity, the posterior corneal elevation, intraocular pressure and postoperative complications were observed. [Results] At 3 months postoperatively, the percentages of UCVA≥0.5 were 100% in three groups, BCVA -1.0 were 100%, 99.1%, 70% respectively. The mean diopter was -0.19 ± 0.43 D （group A）, -0.37±＋ 0.63 D （group B）, - 1.02 ± 1.16D （group C）, and the percentages -〈±0.5 D were 98.9%, 83.2%, 40.0% respectively. The ablation zone and off-center zone are uniform. The posterior corneal elevation, intraocular pressure were no significant differentiation （P〈0.05）. No serious complications occurred postoperatively. [Conclusions] LASIK assisted with Femto-second laser （Ziemer＇s Femto LDV） for myopia makes good effect, which can achieve good visual qual- ity, high predictability, long stability and high security. However, the visual predictability is the worst in the extremely-high myopia group during the 12 months observation postoperatively.