准分子激光表层切削手术前后裸眼远视力及眼调节功能的变化

Observation and study on uncorrected distance visual acuity and ocular adjustment function before and after excimer laser photorefractive keratectomy

目的:观察分析准分子激光屈光性角膜切削术(PRK)手术前后裸眼远视力(UCDVA)及眼调节功能的变化。方法:选择2017-12/2019-12在我中心行PRK手术病例120例240眼进行回顾性研究,按等效球镜(SE)分为低中度近视组(SE≤-6.00D)70例及高度近视组(-6.00D<SE≤-9.00D)50例。测量术前及术后1wk,1、3mo UCDVA(LogMAR)、单眼的调节幅度(AMP)、负相对性调节(NRA)、正相对性调节(PRA)及单眼的调节灵敏度(AF)。结果:低中度近视组及高度近视组PRK术后1wk,1、3mo的UCDVA较术前明显提高(均P<0.01)。术后3mo低中度近视组UCDVA的提高幅度优于高度近视组(P<0.05)。单眼的AMP,两组患者术后都呈现先下降后上升的趋势,术后1wk,1mo较术前明显下降(均P<0.01),到术后3mo均达到并优于术前水平(均P<0.01),低中度近视组较高度近视组提高的幅度大、提升的速度快。低中度近视组患者术后1wk PRA较术前下降(P<0.01),术后1mo恢复至术前水平(P>0.05),术后3mo优于术前(P<0.05);高度近视组术后1wk,1mo与术前相比无明显变化(均P>0.05),至术后3mo也优于术前水平(P<0.01)。低中度近视组术前术后NRA变化均无差异,高度近视组与术前相比术后1wk NRA有短暂的增加(P<0.01),术后1mo恢复至术前水平(P>0.05),术后3mo较术前明显增加(P<0.01)。两组患者术后1wk单眼AF与术前相比均明显下降,术后1mo恢复并优于术前,术后3mo提升的更加明显(均P<0.01);低中度近视组较高度近视组提升的幅度更大。结论:PRK对于-9.00D以下的近视的矫正效果好,低中度近视较高度近视组术后UCDVA矫正更佳。术后短期内眼调节功能会出现异常,低中度近视组各调节参数恢复和改善的时间较高度近视组快,但在术后3mo时均可恢复或优于术前水平。

·AIM:To analyze the changes of uncorrected distance visual acuity(UCDVA)and ocular accommodation before and after excimer laser photorefractive keratectomy(PRK).·METHODS:A retrospective study.There were 120 patients(240 eyes)who underwent PRK surgery in our center from December 2017 to December 2019 divided into two groups according to the diopter of spherical equivalent(SE):70 cases with SE≤-6.00D in the mild to moderate myopia group and 50 cases with-6.00D<SE≤-9.00D in the high myopia group which were observed and analyzed.The UCDVA(LogMAR),monocular accommodative amplitude(AMP),negative relative accommodation(NRA),positive relative accommodation(PRA)and monocular accommodative flipper(AF)were measured before and after operation at 1wk,1 and 3mo.·RESULTS:In the group of low-moderate myopia and high-myopia group,the UCDVA at 1wk,1 and 3 mo after operation was significantly increased compared with those before operation(all P<0.01).The increase of UCDVA of low to moderate myopia group was better than that in the high myopia group at 3mo after operation(P<0.05).Monocular AMP in the both groups firstly decreased and increased afterwards,and there was a significant decrease than that before operation at 1wk and 1mo after operation(P<0.01).AMP reached and was better than that before operation at 3mo after operation(P<0.01).The increase of low to moderate myopia group was both higher and faster than that of high myopia group.Compared with PRA before operation,the patients of low to moderate myopia group decreased at 1wk after operation(P<0.01),postoperative levels at 1mo recovered to preoperative level(P>0.05)and postoperative at 3mo was superior to preoperative operation(P<0.05);High myopia group did not change significantly at 1wk and 1mo after operation compared with preoperative operation(P>0.05),and increased at 3mo after operation compared with preoperative level(P<0.01).For low to moderate myopia group,there was no significant difference in preoperative and postoperative NRA,and at 1wk after operation,NRA of high myopia group temporarily increased compared with preoperative operation(P<0.01).At 1mo after operation,it returned to the preoperative level(P>0.05),and significantly increased at 3mo after operation compared with preoperative operation(P<0.01).Monocular AF for both groups significantly decreased at 1wk after operation compared with preoperative operation,recovered at 1mo after operation and was significantly better at 3mo after operation(all P<0.01);The low-to-moderate group increased more than the high-myopia group.·CONCLUSION:PRK has a good correction effect for myopia below-9.00D,and people in low to moderate myopia have a better postoperative UCDVA correction effect than those in high myopia.The eye accommodation will be abnormal in a short period after operation.The recovery and improvement time of accommodative function in low-moderate myopia group are shorter than that in high myopia group,but both groups can recover and improve at 3mo after operation compared with the preoperative levels.