高角膜曲率近视患者准分子激光术后长期安全性观察

The research on the long-term security of LASIK on myopia with high corneal curvature

目的评估高角膜曲率近视患者准分子激光术后长期的安全性、有效性和稳定性。方法临床病例对照研究。选择2006年7月至2009年7月在河北医科大学第二医院眼科行LASIK手术的近视患者70例（138只眼），根据角膜曲率分为研究组和对照组。研究组35例（69只眼）为单纯高角膜曲率（角膜曲率范围47.0～49.0D，排除亚临床期圆锥角膜其他诊断条件）近视患者；对照组35例（69只眼）为正常角膜曲率（即角膜曲率范围40.9～46.4D）近视患者。对比分析术后3、4、5、6年的裸眼视力、屈光度、角膜厚度、角膜地形图（角膜曲率、角膜前表面高度、角膜后表面高度），观察并记录术后并发症的情况。其中术前角膜地形图采用OrbscanⅡ眼前节分析诊断仪，术后采用Pentacam三维眼前节诊断分析系统进行测量。结果研究组与对照组在术后3、4、5、6年的对比分析中，裸眼视力（t=-0.976、P=0.329）、屈光度（t=-1.485、P=0.137）、角膜厚度（t=-0.858、P=0.391）、角膜前表面高度（t=-0.289、P=0.773）、角膜后表面高度（t=-1.264、P=0.206），其差异比较均无统计学意义（P〉0.05）。结论单纯高角膜曲率的近视患者行LASIK手术经长期观察，具有较好地安全性、有效性、可预测性和稳定性，是可行的。

Objective To evaluate the long-term security, effectiveness, stability of LASIK performed on myopia with high-corneal curvature. Methods A clinical case-control study. Retrospective analyzed 70 cases （138 eyes） of LASIK surgery in the treatment center of the Second Hospital of Hebei Medical University from July 2006 to July 2009, and were divided into study group and control group according to the corneal curvature. Thirty-five cases （69 eyes） with high corneal curvature were selected as study group （the anterior surface corneal curvature were from 47.0D to 49.0D, other diagnostic conditions of subclinical keratoconus were ruled out）; and 35 cases （69 eyes） with normal corneal curvature were selected as control group （the anterior surface corneal curvature were from 40.9D to 46.4D）. UCVA （uncorrected visual acuity）, refraction, comeal topography （central corneal thickness, corneal curvature, anterior corneal surface height, and posterior comeal surface height） and postoperative complications were observed and compared 3 to 6 years after LASIK sur- gery. Moreover, the examination of corneal curvature was executed by Orbscan H system and Pentacam system on pre- and post-operation. Results There was no significant difference （P 〉0.05） between these two groups in UCVA （t =-0.976, P =0.329）, refraction （t =-1.485, P =0.137）, central corneal thickness （t =-0.858, P =0.391）, anterior corneal surface height （t =-0.289, P =0.773） and posterior corneal surface height （t =-1.264, P =0.206） 3 to 6 years after LASIK surgery. Conclusions Myopia patients with simple high corneal curvature are safe, effective, predictive, and stable after LASIK surgery.