飞秒激光辅助准分子激光原位角膜磨镶术治疗超高度近视眼的疗效观察

Observation on effects of femtosecond laser assisted laser in situ keratomileusis for ultra-high myopia

目的观察飞秒激光辅助准分子激光原位角膜磨镶术(FS-LASIK)矫正超高度近视眼的疗效,以及术后不同时间段的有效性和安全性。方法纳入2013年1月~2016年1月在山西省眼科医院行FS-LASIK且术后连续随访1年以上的超高度近视眼患者106例(211只眼)的临床资料。其中,男性50例(100只眼),女性56例(111只眼)。年龄17~43岁,平均(24.09±5.32)岁。患者术前与术后1个月、3个月、6个月及1年均进行常规眼部检查。术前行常规视力检查,包括裸眼视力(UCVA)和最佳矫正视力(BCVA)。视力记录均以log MAR计数法表示。检查屈光度,包括球镜、柱镜及等效球镜度。采用裂隙灯显微镜检查眼前节、采用非接触式眼压计测量眼压、散瞳后采用双目间接检眼镜行眼底检查、采用综合验光仪验光、采用角膜地形图检查角膜形态及采用AB型超声扫描和生物测量仪测量角膜厚度和眼轴长度。采用飞秒激光系统及准分子激光机对角膜进行切削。分别于术后不同时间段进行UCVA、BCVA、安全性指数、有效性指数及屈光度等项目的检查。有效性指数=术后UCVA/术前BCVA;安全性指数=术后BCVA/术前BCVA。患者手术前后的视力、安全性指数、有效性指数及屈光度采用均数±标准差(±s)表示。手术前后不同时间点各指标的总体差异比较采用单因素重复测量方差分析,组内多重比较采用LSD-t检验。术后不同时间点屈光回退率的比较采用卡方检验。结果将患者术前与术后不同时间点的UCVA进行比较,差异均有统计学意义(F_(时间)=2767.01,P<0.05)。术后各时间点的UCVA均高于术前的BCVA,术后3个月患者的视力趋于稳定。将患者术后不同时间点的安全性指数进行比较,差异均有统计学意义(F_(时间)=7.63,P<0.05)。术后各时间点的安全性指数均>1,术后3个月时最佳,至6个月左右略有下降,之后回升。将患者术后不同时间点的有效性指数进行比较,差异均有统计学意义(F_(时间)=5.25,P<0.05)。术后各时间点的有效性指数均>1,术后3个月时最佳,之后趋于稳定。术后不同时间点等效球镜度的差异均无统计学意义(F_(时间)=1.34,P>0.05)。术后各时间点屈光回退率的差异有统计学意义(χ~2=13.69,P<0.05)。结论 FS-LASIK对超高度近视眼的治疗有效。术后1年内各时间点的UCVA好于术前BCVA。随着时间的推移,屈光回退率增加,术后1年时达到7.58%。

Objective To evaluate the effect and safety of femtosecond laser assisted LASIK( FSLASIK) in the treatment of ultra-high myopia,and to evaluate the efficacy and safety of different times after the operation. Methods The clinical data of 106 patients( 211 eyes) with ultra-high myopia who were followed up for more than 1 year,was conducted between January 2013 and January 2016 in Hospital of Shanxi Province. Among them,there were 50 males( 100 eyes) and 56 females( 111 eyes). Age from17 to43,average( 24.09±5.32) years old. Routine ophthalmologic examinations were performed before and after surgery at 1 month,3 months,6 months and 1 year. Routine visual acuity was performed before surgery,including uncorrected visual acuity( UCVA) and corrected visual acuity( BCVA). The visual acuity records were indicated by the log MAR. The range of refraction,including balloon,column,and equivalent spherical lenses were examined. Exclusion of anterior segment disease,using non-contact tonometer,using binocular indirect ophthalmoscope after mydriasis fundus examination,using phoropter,using corneal topography exam and corneal shape by AB ultrasound scanning and biological measurement of corneal thickness and axial length by slit lamp microscope examination. The cornea was cut by femtosecond laser system and excimer laser. UCVA,BCVA,safety index,effective index and diopter were examined at different time after operation. Validity index = postoperative UCVA/preoperative BCVA,safety index = postoperative BCVA/preoperative BCVA. The visual acuity,safety index,effective index and diopter before and after the operation were indicated by mean ± standard deviation( ±s). The overall difference between the indexes at different time points before and after the operation was compared by single factor repeated measures analysis of variance,and the multiple comparisons in the group were checked by LSD-t test. The comparison of refraction regression at different time points after operation was performed by chi square test. Results There were significant differences in UCVA at different time points before and after operation( F_(time)= 2767.01,P<0.05). The UCVA at each time point after operation were higher than that of preoperative BCVA,and the visual acuity was stable at 3 months after operation. The safety index of patients at different time points after operation was compared,the difference was statistically significant( F_(time)= 7.63,P<0.05). The safety index at each time point after operation was greater than 1,the optimum time was 3 months after operation,and decreased slightly after 6 months,then recovered. The validity index of patients at different time points after operation was compared,the differences were statistically significant( F_(group)= 7. 52,P < 0. 05). The validity index at each time point after operation was greater than 1,which was the best at 3 months after operation,and then stabilized. There were no significant differences in equivalent spherical lenses at different time points after surgery( F_(time)= 1. 34,P > 0. 05). There were significant differences in refractive regression at different time points( χ~2= 13.69,P<0.05). Conclusions FS-LASIK are effective in the treatment of ultrahigh myopia. UCVA at each time point after 1 year was better than preoperative BCVA. With the increase of time,refractive regurgitation rate increased,after 1 year to reach 7.58%.