准分子激光原位角膜磨镶术治疗近视眼的临床分析

Clinical analysis of laser in situ keratomileusis in treatment of myopia

目的 :评价准分子激光原位角膜磨镶术 (L ASIK)治疗轻、中、高度及超高度近视的预测性、稳定性及安全性。 方法 :使用 Technolas2 17C准分子激光治疗仪及 Hansatome微型角膜板层刀对 4 0 0 0只近视及近视散光眼行 L ASIK手术。根据术前近视程度 ,将有 2年随访结果的 114 8只眼分 3组 : 组 - 1.0 0～ - 6 .0 0 D(等值球镜 ,下同 ) 4 6 2眼 ; 组 - 6 .2 5～ - 10 .0 0D4 6 6眼 ; 组 - 10 .2 5～ - 15 .0 0 D2 2 0眼。 结果 :114 8只眼术后 2年裸眼视力≥ 1.0 (或≥术前最佳矫正视力 )在 组为97.8% , 组为 93.8% , 组为 90 .5 % ,裸眼视力≥ 0 .5 (或比术前最佳矫正视力下降少于等于 2行 )在 组为 10 0 % , 组为96 .4 % , 组为 94 .0 % ;剩余屈光度在 组为 (- 0 .2 4± 0 .31) D, 组为 (- 0 .5 5± 0 .6 3) D, 组为 (- 1.17± 0 .75 ) D;无 1眼最佳矫正视力下降 2行以上。 4 0 0 0只眼术中游离瓣及不完全瓣、不规则瓣发生率 0 .13% ,上皮植入发生率 0 .18% ,术后眼压轻度升高发生率 0 .4 8% ,无严重并发症发生。结论 :L ASIK治疗 - 15 .0 0 D以下轻、中、高度及超高度近视眼均可获得较好疗效 ,具有较好的安全性。

Objective:To evaluate the safety, efficacy, predictability and stability of laser in situ keratomileusis (LASIK) for low, moderate, high and super high myopia. Methods:A total of 4 000 myopia and compound myopic astigmatism eyes underwent LASIK with Bausch & Lomb Technolas 217 C excimer laser and Hansatome microkeratome, and 1 148 eyes were followed up for 2 years. The eyes were assigned into 3 groups according to pre operative myopia degree:guoup Ⅰ, 462 eyes ranging from -1.00 D to -6.00 D;group Ⅱ, 466 eyes from -6.25 D to -10.00 D;group Ⅲ, 220 eyes from -10.25 D to -15.00 D(spherical equivalent). Results: It was found that 97.8% of the eyes in group Ⅰ, 93.8% in group Ⅱ and 90.5% in group Ⅲ had the uncorrected visual acuity of 20/20 or better,or had pre operative best corrected visual acuity (BCVA);100% in group Ⅰ, 96.4% in group Ⅱ and 94.0% in group Ⅲ had 10/20 or better, or a drop within 2 lines of BCVA. Residual refraction was (-0.24±0.31) D in group Ⅰ, (-0.55±0.63) D in group Ⅱ and (-1.17±0.75) D in group Ⅲ. No eyes lost more than 2 lines of BCVA. Incidence of free cap and incomplete or irregular cap was 0.13%. Epithelial ingrowth was observed in 0.18% of the patients and increase of intraocular pressure occurred in 0.48% of the cases. No severe complications occurred.Conclusion: LASIK is a safe, effective, predictable and stable procedure for myopia and compound myopic astigmatism less than -15.00 D.