中高度近视患者LASIK术后屈光回退的临床分析

Clinical analysis of refractive regression after LASIK in moderate and high myopic eyes

目的:分析中高度近视患者准分子激光原位角膜磨镶术(LASIK)术后屈光回退的临床特征。方法:回顾性研究。选取2016-01/2018-01在我院行LASIK术后发生屈光回退患者30例60眼,按照术前屈光度分为中度近视组(<-6.00D),高度近视组(-6.00～-10.00D)和超高度近视组(>-10.00D),分析手术前后患者视力、屈光度、角膜曲率、CCT、眼压、眼轴、术后残余角膜基质厚度情况。结果:本组屈光回退率为8.6%(60/700眼)。中度、高度、超高度近视组患者术后6mo屈光回退量分别为:1.31±0.15、1.76±0.23、2.53±0.35D(P<0.05)。三组患者屈光度:术后6mo(-0.82±0.21、-1.03±0.27、-1.57±0.52D)与术前(-4.87±0.97、-7.46±1.03、-10.32±2.01D),术后1mo(+0.49±0.22、+0.73±0.17、+0.95±0.15D)均有差异(P<0.05)。三组CCT:术后6mo(499.80±33.78、458.89±36.93、451.93±24.52μm)较术前(523.80±23.00、527.24±25.47、525.80±22.36μm)减少(P<0.05),较术后1mo(487.92±38.13、440.65±33.92、429.35±20.14μm)增加。三组患者术后6mo眼轴(25.25±0.30、26.52±0.62、28.63±0.21mm)与术前(25.13±0.54、26.13±0.54、28.03±1.04mm)比较无差异(P>0.05),但三组间两两比较有差异(P<0.05)。中度近视组、高度近视组、超高度近视组剩余角膜基质厚度分别为332.27±21.87、292.71±22.71、273.38±20.99μm(P<0.05)。三组患者术后6mo角膜曲率、眼压无差异(P>0.05)。结论:LASIK术后屈光回退的发生与术前屈光度有关。高度近视和超高度近视可能因眼轴进行性增长发生屈光回退,中度近视可能因术后基质修复引起角膜厚度增加和角膜曲率变化发生屈光回退。

AIM:To analyse of refractive regression after laser in situ keratomileusis(LASIK) in moderate and high myopic eyes.METHODS:A retrospective study. Thirty patients(60 eyes) with refractive regression after LASIK in our hospital from January 2016 to January 2018 were selected for statistical analysis. According to preoperative refraction, they were divided into three groups: moderate myopia group(<-6.00 D), high myopia group(-6.00 to-10.00 D) and super high myopia group(>-10.00 D). The visual acuity, diopter, corneal curvature, CCT, intraocular pressure, ocular axis and residual corneal matrix thickness were analyzed before and after surgery.RESULTS:The refractive regression rate was 8.6%(60/700 eyes). At 6 mo after operation, the refractive regression of the patients were as follows: moderate myopia group, 1.31±0.15 D, high myopia group, 1.76±0.23 D, ultra-high myopia group: 2.53±0.35 D(P<0.05). At 6 mo after operation, the diopter(-0.82±0.21,-1.03±0.27,-1.57±0.52 D) of the three groups was different from that of the preoperative(-4.87±0.97,-7.46±1.03,-10.32±2.01 D) and 1 mo(+0.49±0.22, +0.73±0.17, +0.95±0.15 D) after operation(all P<0.05). At 6 mo after operation, the CCT of the three groups(499.80±33.78, 458.89±36.93, 451.93±24.52μm) decreased(P<0.05) compared with that before operation(523.80±23.00, 527.24±25.47, 525.80±22.36μm), and increased(487.92±38.13, 440.65±33.92, 429.35±20.14μm). There was no difference in ocular axis(25.25±0.30, 26.52±0.62, 28.63±0.21 mm) between the three groups at 6 mo after operation and before operation(25.13±0.54, 26.13±0.54, 28.03±1.04 mm)(P>0.05), but there was difference between the two groups(P<0.05). The thickness of residual corneal stroma in moderate myopia group, high myopia group and ultra-high myopia group were 332.27±21.87, 292.71±22.71 and 273.38±20.99μm, respectively(P<0.05). There was no difference in corneal curvature and intraocular pressure between the three groups at 6 mo after operation(P>0.05).CONCLUSION: The occurrence of refractive regression after LASIK is related to preoperative refraction. High myopia and ultra-high myopia may have refractive regression due to progressive growth of eye axis, while moderate myopia may have refractive regression due to increased corneal thickness and corneal curvature changes caused by post-operative matrix repair.