准分子激光原位角膜磨镶术治疗高度近视眼的远期疗效分析

Long-term effects of laser in situ keratomileusis for high myopia

目的评价准分子激光原位角膜磨镶术(LASIK)治疗高度近视眼的远期疗效。方法回顾性分析46例(92只眼)接受LASIK治疗的高度近视眼患者术前、术后1年和6年的裸眼视力、屈光度、回退发生率及夜间视觉症状等情况。结果术后1年和6年平均裸眼视力显著提高(4.65±0.23)vs.(3.21±0.28),(4.59±0.20)vs.(3.21±0.28),P<0.01;(4.65±0.23)vs.(4.59±0.20),P>0.05;术后1年和6年平均屈光度显著降低(-2.43±0.26)D vs.(-9.42±3.36)D,(-2.51±0.31 D)vs.(-9.42±3.36 D),P<0.01;(-2.43±0.26)D vs.(-2.51±0.31D),P>0.05;术后6年回退发生率14.13%较术后1年有升高趋势10.87%,但未见统计学差异(P>0.05),且均与预矫屈光度呈显著相关r1=0.97;r6=0.99;术后夜间不适症状与预矫屈光度相关(r1=0.47;r 6=0.59);≥-8.0 D的患者术后主诉夜间不适比率明显高于≤-8.0 D的患者(P<0.01)。结论LASIK治疗高度近视远期疗效稳定;但随屈光度增加术后稳定性及夜间视觉质量有下降趋势,建议超高度近视眼患者慎重选择。

Objective To evaluate the long-term effectiveness of laser in situ keratomileusis （LASIK）in the treat-ment of high myopia. Methods This was a retrospective analysis of 46 cases （92 eyes）of high myopia treated with LASIK. Average visual acuity,refraction degree,incidence of rollback,and night vision symptoms before surgery and 1 and 6 years after surgery were reviewed. Results Average visual acuity improved significantly at 1 year （4. 65 ± 0. 23） and at 6 years （4. 59 ± 0. 20）after surgery compared to baseline （3. 21 ± 0. 28;both P 〈 0. 01）. Average refraction re-duced significantly from baseline （- 9. 42 ± 3. 36 D）after 1 year （- 2. 43 ± 0. 26 D）and 6 years （- 2. 51 ± 0. 31 D;both P 〈 0. 01）. The incidence of rollback was higher at 6 years （14. 13%）than at 1 year （10. 87%）but the difference was not significant. The incidences were correlated with pre-correction diopter （r1 = 0. 97;r6 = 0. 99）. Pre-correction di-opters were also correlated with postoperative nocturnal symptoms （r1 = 0. 47;r6 = 0. 59）. In patients complaining noctur-nal discomfort,the rate of high pre-correction diopter （≥ - 8. 0 D）were significantly higher （P 〈 0. 01）. Conclusion The long-term effects of LASIK are steady. However,higher pre-correction diopter is associated with higher risk of rollback and night symptoms after surgery.