Clinical outcomes of transepithelial photorefractive keratectomy versus femtosecond laser assisted keratomileusis for correction of high myopia in South Egyptian population

AIM: To evaluate the safety and efficacy of transepithelial photorefractive keratectomy(t-PRK) with adjuvant mitomycin C(MMC) versus femtosecond laser assisted keratomileusis(Femto-LASIK) in correction of high myopia.METHODS: Prospective randomized comparative study including 156 eyes of 156 patients with high myopia and a spherical equivalent refraction(SER) <-6.00 D. They were divided randomly into two groups: Group A included 72 eyes treated with t-PRK with adjuvant MMC and Group B included 84 eyes treated with Femto-LASIK. Visual acuity, SER, corneal topography, pachymetry and keratometry were assessed for 12 mo postoperatively.RESULTS: The preoperative mean SER was-8.86±1.81 and-9.25±1.70 D in t-PRK MMC group and Femto-LASIK respectively(P=0.99) which improved to-0.65±0.43 D and-0.69±0.50 D at 12 mo follow up. Mean SER remained stable during the 12 mo of follow-up, with no statistically significant difference between the two groups(P=0.64). In t-PRK MMC group, only six eyes needed retreatment after six months of follow up. And two eyes showed haze(one reversible haze grade 2, while the other had dense irreversible haze grade 4).CONCLUSION: t-PRK MMC provides safe and satisfactory visual outcomes and acceptable risk as Femto-LASIK in patients with high myopia.

Optical and visual quality comparison of implantable collamer lens and femtosecond laser assisted laser in situ keratomileusis for high myopia correction

AIM:To compare clinical outcomes and refractive stability of implantable collamer lens(ICL)implantation and femtosecond laser assisted laser in situ keratomileusis(FSLASIK)for high myopia correction.METHODS:The Optical Quality Analysis System(OQAS)was used to evaluate clinical outcomes objectively after operation for high myopia correction.We compared the two procedures in terms of 1-year changes in uncorrected distance visual acuity(UDVA),corrected distance visual acuity(CDVA),safety index,efficacy index,spherical equivalent,modulation transfer function(MTF)cutoff frequency,strehl ratio(SR)and objective scatter index(OSI).RESULTS:At 1 y postoperatively,the safety indices were 1.33±0.27 in ICL group,and 1.17±0.24 in FS-LASIK group.39.58%in the ICL group and 27.59%in the FS-LASIK group gained CDVA in 2 lines or better than that in preoperative CDVA.The efficacy indices were 1.28±0.22 in ICL group,and 1.13±0.26 in FS-LASIK group.The changes of spherical equivalent from 1 wk to 1 y postoperatively was-0.12±0.37 D in ICL group,and-0.79±0.58 D in FS-LASIK group(P<0.05).Spherical equivalent within±0.50 D was achieved in 97.92%in ICL group and 68.97%in FS-LASIK group.MTF cutoff frequency were higher with ICL as compared to FSLASIK(P<0.05)at each postoperative follow-up stage;for postoperative 1 mo later,SR was statistically significant difference between two groups(P<0.05);with no statistically significant difference in OSI between two groups(P>0.05)in postoperative 3 mo later.CONCLUSION:ICL implantation and FS-LASIK procedures both provide good safety and predictability in high myopia correction.ICL implantation provides better clinical outcomes and refractive stability than FS-LASIK.

Early changes in corneal densitometry after FS-LASIK combined with accelerated corneal cross-linking for correction of high myopia

AIM:To observe the effects of femtosecond laserassisted excimer laser in situ keratomileusis combined with accelerated corneal cross-linking(FS-LASIK Xtra)on corneal densitometry after correcting for high myopia.METHODS:In this prospectively study,130 patients underwent FS-LASIK or FS-LASIK Xtra for high myopia.Their right eyes were selected for inclusion in the study,of which 65 cases of 65 eyes in the FS-LASIK group,65 patients with 65 eyes in the FS-LASIK Xtra group.Patients were evaluated for corneal densitometry at 1,3,and 6mo postoperatively using Pentacam Scheimpflug imaging.RESULTS:Preoperative differences in corneal densitometry between the FS-LASIK and FS-LASIK Xtra groups in different ranges were not statistically significant(P>0.05).Layer-by-layer analysis revealed statistically significant differences in the anterior(120μm),central,and total layer corneal densitometry between the FS-LASIK and FS-LASIK Xtra groups at 1 and 3mo postoperatively(all P<0.05),the FS-LASIK Xtra group is higher than that of the FS-LASIK group.Analysis of different diameter ranges showed statistically significant differences between the FS-LASIK group and the FS-LASIK Xtra group at 1mo postoperatively in the ranges of 0–2,2–6,and 6–10 mm(both P<0.05);At 3mo postoperatively,the FS-LASIK Xtra group is higher than that of the FS-LASIK group in the ranges of 0–2 and 2–6 mm(P<0.05).At 6mo postoperatively,there were no statistically significant differences in corneal densitometry between the FS-LASIK group and the FS-LASIK Xtra group in different diameter ranges(all P>0.05).CONCLUSION:There is an increase in internal corneal densitometry during the early postoperative period after FS-LASIK Xtra for correction of high myopia.However,the densitometry values decreased to the level of conventional FS-LASIK at 6mo after surgery,with the most significant changes observed in the superficial central zone.

Comparison of correcting myopia and astigmatism with SMILE or FS-LASIK and postoperative higher-order aberrations

AIM:To compare the effect of myopia and astigmatism correction and postoperative change in higher-order aberration as results of receiving small-incision lenticule extraction(SMILE)and femtosecond laser-assisted in situ keratomileusis(FS-LASIK).METHODS:A prospective and non-randomized controlled study was conducted.The subjects are divided into two groups according to different operations received:229 eyes of 116 patients in the SMILE group and 168 eyes of 86 patients in the FS-LASIK group.All subjects were followed up for 3 mo by monitoring their uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA),spherical equivalent,higher-order aberrations,and the preoperative and postoperative complications.RESULTS:At 1 wk,1,and 3 mo post-surgery,224 eyes(97.8%),227 eyes(99.1%)and 229 eyes(100%)had UCVA≥20/20 in the SMILE group,while 165 eyes(98.2%),167 eyes(99.4%)and 167 eyes(99.4%)had UCVA≥20/20 in the FS-LASIK group,respectively(χ^(2)=0.146,2.135,and 1.124;all P>0.05).BCVA reduction was not observed in both groups at 1 and 3 mo of post-surgery(χ^(2)=0.734 and 1.898,P>0.05).There was no statistically significant difference in the spherical equivalent between the two groups at 1 and 3 mo post-surgery,though the percentage of the spherical equivalent within±0.50 D at 3 mo postsurgery was 98%in the SMILE group,which was higherthan that of the FS-LASIK group(92%,χ^(2)=1.872,P>0.05).The root mean square(RMS)values of total high-order aberration,coma,and spherical aberration of the two groups increased significantly in the early postoperative period and decreased after 3 mo,but the values were still higher than the preoperative levels(P<0.05);there was no significant difference between the two groups in the RMS values of total higher-order aberrations and specific higherorder aberrations(P>0.05).The incidence of complications in the SMILE group was lower than that in the FS-LASIK group(χ^(2)=14.52,P<0.05).CONCLUSION:SMILE and FS-LASIK can effectively treat myopia,significantly improve visual acuity,and increase the total high-order aberration,spherical aberration,and coma.The incidence of complications after SMILE is relatively low.

Study of Krypton Laser-Induced Choroidal Neovascularization in a Guinea Pig Model of High Anisometropia

Purpose:To investigate the association between high anisometropia and the area of choroidal neovascularization (CNV) induced by krypton laser in guinea pigs and better understand the pathogenesis and prevention of myopic CNV. Methods:.Nine 3-week old male guinea pigs with anisometropia > 6.00D were randomly assigned to three groups according to examination date after laser photocoagulation (7d, 14d and 28d). All animals underwent refraction. The eye with higher myopia was used as the experimental eye, and the other as the control eye..All eyes received repeated multi-wavelength krypton laser photocoagulation treatments (wavelength: 532 nm; laser power: 400 mW; spot diameter: 50 μm; exposure time: 0.1s). Fundus photography and indocyanine green angiography (ICGA) were performed. Afterwards, the animals were sacrificed immediately,.and the eyes were enucleated and processed for histopathologic examination and flat mounts. Results: CNV appeared at 7d after laser treatment. The area of CNV peaked at 14d, and decrease in area and the presence of scarring was noted at 28 d..CNV was present in 66.7% of eyes by ICGA at 14 d..CNV could be observed under light microscopy at all three time points..At 14 d,.flat mount showed the neovascular plexus around the lesion. Semi-quantitative analysis revealed that the area of CNV in treated eyes was greater than that of control eyes. Conclusion:.Since the mechanism of CNV in this study resembles that of CNV in pathological myopia, this model can be used to investigate the etiology, pathogenesis and treatment of CNV in pathological myopia.

Efficacy of ICL combined with Trans-PRK on corneal endothelial cell density in patients with high myopia

Objective:To explore the efficacy of implantable collamer lense (ICL) combined with laser keratectomy via corneal epithelium Trans-PRK in the treatment of patients with high myopia and its effect on corneal endothelial cell density.Methods: A prospective analysis was performed on patients with ultra-high myopia admitted to the department of ophthalmology of our hospital from March 2014 to March 2017. Six months after ICL implantation, the patients still had myopia and received Trans PRK treatment again. The number of cases was 30 and 52 eyes. Patients were followed up postoperatively. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), dioptre (D), intraocular pressure, ICL arch height, anterior chamber volume, anterior chamber depth, and changes in corneal endothelial cell counts were observed preoperatively, 6 months after ICL implantation and 6 months after Trans PRK so as to assess the effectiveness and safety of the surgery.Results: UCVA and BCVA of the eyes were significantly higher 6 months after ICL implantation and 6 months after Trans-PRK than those before the surgery, and UCVA of the eyes 6 months after Trans-PRK was significantly higher than that 6 months after ICL implantation. There was no increase in intraocular pressure in all patients after surgery. There was no significant difference in intraocular pressure preoperatively, 6 months after ICL implantation and 6 months after Trans PRK. The ICL arch height of the eyes 6 months after Trans-PRK was slightly lower than that 6 months after ICL implantation, but the difference was not statistically significant. Both anterior chamber volume and anterior chamber depth were significantly lower 6 months after ICL implantation and 6 months after Trans PRK than whose before the surgery, and anterior chamber depth 6 months after Trans PRK was significantly lower than that 6 months after ICL implantation. The number of corneal endothelial cells 6 months after ICL implantation was slightly less than that before surgery, but it was not statistically significant. The number of corneal endothelial cells 6 months after Trans PRK was higher than that 6 months after ICL implantation and close to the preoperative level.Conclusion: Trans PRK can effectively improve the eye diopter of patients with high myopia and residual myopia after ICL implantation. It has little effect on the density of corneal endothelial cells, can significantly improve visual acuity, and achieve the expected operation effect with safe operation, which is worthy of clinical promotion.

Comparison of choroidal thickness in high myopic eyes after FS-LASIK versus implantable collamer lens implantation with swept-source optical coherence tomography

AIM:To investigate the changes in choroidal thickness(CT)in high myopic eyes after femtosecond laser-assisted in situ keratomileusis(FS-LASIK)surgery or central hole implantable collamer lens(ICL V4c)implantation using swept-source optical coherence tomography(SS-OCT).METHODS:We examined the right eyes of 116 patients with high myopia who were candidates for FS-LASIK surgery and ICL implantation.Sixty eyes underwent ICL V4c implantation and 56 eyes were subjected to FS-LASIK surgery.The CT was measured with SS-OCT.All data were recorded preoperatively and 2 h,1 wk,1 and 3 mo postoperatively.Other demographic information was collected,including age,sex,uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),spherical equivalent(SE),intraocular pressure(IOP)and axial length(AL).RESULTS:The UCVA improved in both groups and showed no significant differences between groups.There also were no significant differences between the two groups in postoperative BCVA and SE(P=0.581 and 0.203,respectively).The foveal CTs,inner nasal and outer nasal CTs were significantly thicker at 2 h postoperatively in both groups(P<0.05)but returned to baseline levels in 1 wk;after 1 mo,no significant differences were found relative to the preoperative values.At 3 mo in each group,nine regions showed variations in the CT as compared with preoperative thickening,but only the foveal and nasal area CTs preoperative differences were statistically significant(P<0.05).In addition,there was no significant difference in 9 regions of CT between the two groups at all follow-up times(P>0.05).CONCLUSION:The CTs after ICL implantation and FSLASIK surgery are significantly thicker than those before operation,especially in the foveal and nasal areas,but there is no significant difference between the two methods.

基于Corvis ST分析飞秒LASIK联合快速交联矫正高度近视术后角膜生物力学变化

目的应用Corvis ST评估飞秒激光辅助准分子激光原位角膜磨镶术(LASIK)联合快速角膜交联术(FS-LASIK Xtra)矫正高度近视术后角膜生物力学的变化。方法前瞻性病例对照研究。选取2020年7月至2022年7月在山东中医药大学附属眼科医院行手术矫正高度近视的患者185例(185眼)为研究对象,所有患者均将右眼纳入研究,其中行FS-LASIK Xtra者93例为FS-LASIK Xtra组,行FS-LASIK者92例为FS-LASIK组,术后随访6个月,记录患者的裸眼视力、等效球镜度、平均角膜曲率(Km)、最薄点角膜厚度(TCT)、角膜生物力学参数[2 mm处变形幅度比(DAR 2 mm)、综合半径(IR)、第一次压平刚度系数(SP-A1)、应力应变指数(SSI)]和手术前后角膜生物力学参数变化量(术后6个月与术前的差值,即ΔDAR 2 mm、ΔIR、ΔSP-A1、ΔSSI)。采用独立样本t检验和Mann-Whitney U检验对组间数据进行比较。结果术后3个月等效球镜度FS-LASIK组和FS-LASIK Xtra组患者分别为(-0.21±0.31)D和(-0.04±0.36)D,差异有统计学意义(t=3.49,P=0.001);术后6个月两组分别为(-0.33±0.31)D、(-0.14±0.37)D,差异均有统计学意义(t=4.00,P<0.001)。术后6个月时FS-LASIK组与FS-LASIK Xtra组患者手术的有效性指数和安全性指数差异均无统计学意义(均为P>0.05)。术前两组患者DAR 2 mm、IR、SP-A1、SSI等角膜生物力学参数比较差异均无统计学意义(均为P>0.05);术后6个月,FS-LASIK组与FS-LASIK Xtra组患者角膜生物力学参数变化量ΔIR分别为3.03±0.78、2.67±0.80,ΔSP-A1为-35.93±12.04、-30.43±12.44,ΔSSI为-0.09±0.10、-0.03±0.06,两组相比差异均有统计学意义(均为P<0.05)。结论FS-LASIK Xtra矫正高度近视术后患者视力、等效球镜度稳定,具有良好的安全性和有效性,角膜生物力学稳定性较术前降低,但优于常规FS-LASIK,长期效果需要进一步观察。

高曲率近视患者行FS-LASIK和LASEK屈光术后对患者角膜、前房形态变化的影响

目的分析高曲率近视患者行飞秒激光辅助原位角膜磨镶术(FS-LASIK)和准分子激光上皮下角膜磨镶术(LASEK)屈光术后对患者角膜、前房形态变化的影响。方法选取2021年5月至2022年2月在本院行屈光手术治疗的75例(150眼)近视患者纳入研究。根据角膜前表面陡峭曲率将其分为正常曲率组(30例60眼)和高曲率组(45例90眼)。所有患者均进行FS-LASIK或LASEK屈光手术治疗。术后对患者进行为期1年的随访,比较两组临床疗效、角膜形态、前房形态、眼表状态及安全性。结果两组临床疗效及安全性比较差异无统计学意义(P>0.05)。两组术前、术后1、3、12个月的角膜后表面高度、中央前房深度(ACD)、前房容积(ACV)、房角宽度(ACA)及术后12个月与术前变化量比较差异均无统计学意义(P>0.05)。两组术后1个月、3个月、12个月与术前后表面曲率变化量比较差异均无统计学意义(P>0.05)。两组术后泪膜破裂时间(BUT)、基础泪液分泌实验(LST)下降,角膜荧光素染色实验(FL)、眼表疾病指数(OSDI)升高(P<0.05),但观察组与对照组比较差异无统计学意义(P>0.05)。结论单纯高曲率和正常曲率近视患者临床进行FS-LASIK或LASEK治疗,患者术后均可达到安全、有效的手术效果。

FS-LASIK矫正中高度近视术后1年屈光回退危险因素及其预测模型构建

目的:探讨飞秒激光辅助准分子激光原位角膜磨镶术(FS-LASIK)矫正中高度近视术后1 a屈光回退的危险因素并构建预测模型。方法:回顾性分析2017-06/2018-11于西安高新医院行FS-LASIK手术矫正中高度近视患者400例800眼临床资料,将患者按照3∶1的比例随机分为建模组(n=300例)和验证组(n=100例),依照患者术后1 a屈光回退发生情况将建模组分为回退组与未回退组两个亚组,观察其角膜曲率和角膜厚度变化情况,采用Logistic回归分析筛选FS-LASIK矫正中高度近视患者术后1 a屈光回退的危险因素,基于回归系数构建预测模型,采用受试者工作特征曲线(ROC)评估模型区分度。结果:建模组44眼、验证组15眼于术后1 a发生屈光回退。建模组中未回退组术后6、12 mo时角膜前表面曲率低于回退组(均P<0.05);术后1、3、6、12 mo时回退组角膜增生程度大于未回退组(均P<0.05);FS-LASIK矫正中高度近视患者术后1 a屈光回退发生概率值回归方程为:P=1/[1+e^(-(-5.989+0.127×年龄+2.019×术前屈光度-0.022×术前角膜中央厚度+0.043×切削深度-1.569×切削光学区直径))],Hosmer-Lemeshow检测回归方程拟合优度(P=0.818),利用建模组数据进行内部验证,ROC曲线下面积为0.890(95%CI 0.843-0.937),灵敏度为81.82%,特异度为84.71%;利用验证组数据进行外部验证,ROC曲线下面积为0.838(95%CI 0.717-0.959),灵敏度为80.00%,特异度为87.57%。结论:构建的风险模型判别效度良好,可用于识别中高度近视患者行FS-LASIK术后1 a屈光回退高危人群。

Retinal nerve fiber layer in primary open-angle glaucoma with high myopia determined by optical coherence tomography and scanning laser polarimetry

Background Fundus changes associated with high myopia （HM） may mask those associated with primary open-angle glaucoma （POAG）. This study aim to determine the characteristics of RNFL thickness changes in patients with both POAG and HM and compare these to changes in patients with only HM. The diagnostic capabilities of both OCT and GDxVCC in this subset of patients are also evaluated. Methods Twenty-two eyes with POAG and HM （spherical equivalent （SE） between -6.0 and -12.0 D） were evaluated, and 22 eyes with HM were used for comparison. Characteristic retinal nerve fiber layer （RNFL） thickness profiles in patients with POAG and HM were examined using optical coherence tomography （OCT） and scanning laser polarimetry with variable corneal compensation （GDxVCC）, and the diagnostic capabilities of these imaging modalities were compared. RNFL parameters evaluated included superior average （Savg-GDx）, inferior average （lavg-GDx）, temporal-superior-nasal- inferior-temporal （TSNIT） average, and nerve fiber indicator （NFI） on GDxVCC and superior average （Savg-OCT）, inferior average （lavg-OCT）, nasal average （Navg-OCT）, temporal average （Tavg-OCT）, and average thickness （AvgThick-OCT） on OCT （fast RNFL scan）. Visual field testing was performed and defects were evaluated using mean defect （MD） and pattern standard deviation （PSD）. Results The RNFL parameters （P 〈0.05） significantly different between groups included Savg-GDx, lavg-GDx, TSNIT average, NFI, Savg-OCT, lavg-OCT, Tavg-OCT, and AvgThick-OCT. Significant correlations existed between TSNIT average and AvgThick-OCT （r=0.778）, TSNIT average and MD （r=0.749）, AvgThick-OCT and MD （r=0.647）, TSNIT average and PSD （r=-0.756）, and AvgThick-OCT and PSD （r=-0.784）. The area under the receiver operating characteristic curve （AUROC） values of TSNIT average, Savg-GDx, lavg-GDx, NFI, Savg-OCT, lavg-OCT, Navg-OCT, Tavg-OCT, and AvgThick-OCT were 0.947, 0.962, 0.973, 0.994, 0.909, 0.917, 0.511, 0.906, and 0.913, respectively. The NFI AUROC was the highest value. Conclusions RNFL thickness was significantly lower in all but the nasal quadrant in patients with POAG and HM, compared to patients with only HM. Measurements with OCT and GDxVCC were well-correlated, and both modalities detected RNFL thickness chanaes. However. GDxVCC was better than OCT in detectina POAG in HM Datients.

SMILE和超薄瓣FS-LASIK矫正中度近视疗效比较

目的比较飞秒激光小切口角膜基质透镜取出术(SMILE)和超薄瓣飞秒激光辅助准分子激光原位角膜磨镶术(FS‐LASIK)矫正中度近视的临床疗效。方法回顾性病例对照研究。本研究纳入了年龄、性别和角膜厚度匹配合适的中度近视(等效球镜度-3.00~-6.00 D)患者,36例接受SMILE治疗患者的72只眼和36例接受超薄瓣FS‐LASIK治疗患者的72只眼。分别于术前及术后3个月记录所有患者的视力、屈光度及角膜高阶像差等变量,最后进行统计学分析以评估手术疗效。结果在术后随访3个月时,SMILE组和超薄瓣FS‐LASIK组疗效指数和安全指数比较,差异无统计学意义(t=1.179和-0.255,P=0.242和0.800)。SMILE组和超薄瓣FS‐LASIK组术后屈光度呈正视并相对稳定,术后等效球镜度比较差异无统计学意义(t=0.206,P=0.837)。SMILE组和超薄瓣FS‐LASIK组患者的角膜后表面曲率和非球面因子Q值比较,差异无统计学意义(t=-1.852和0.576,P=0.066和0.566)。SMILE组和超薄瓣FS‐LASIK组患者术前的总高阶像差、球差及彗差与术后比较,差异均具有统计学意义(均P<0.05)。在术后3个月时,SMILE组患者的总高阶像差及球差明显低于超薄瓣FS‐LASIK组(均P<0.05)。结论SMILE和超薄瓣FS‐LASIK两种术式矫治中度近视均安全有效,但SMILE组患者的术后总高阶像差及球差增加量低于超薄瓣FS‐LASIK组。

SMILE、FS-LASIK和ICL矫正高度近视术后视觉质量的比较

目的比较小切口角膜基质透镜取出术(SMILE)、飞秒激光辅助准分子激光原位角膜磨镶术(FS-LASIK)与有晶体眼人工晶体植入术(ICL)矫正高度近视的效果及视觉质量。方法回顾性分析2017年1月至2019年1月在该院近视手术中心接受屈光矫正的高度近视手术患者102例(180眼)的临床资料,术后随访时间为6个月。根据手术方式的不同将患者分为3组:SMILE组35例(60眼)、FS-LASIK组30例(60眼)、ICL组37例(60眼)。使用视觉质量分析仪(OPD-ScanⅢ)测量3组患者术前及术后6个月6 mm瞳孔直径的全眼总像差、全眼总高阶像差、全眼彗差、全眼三叶草差、全眼球差和4个空间频率(10、15、30、45 cpd)的对比敏感度,同时收集并比较患者裸眼视力(UCVA)、最佳矫正视力(BCVA)、等效球镜度数(SE)、安全性指数和有效性指数等视觉指标。结果术前3组患者的UCVA、BCVA、SE、全眼总像差、全眼总高阶像差、全眼彗差、全眼三叶草差、全眼球差和4个空间频率(10、15、30、45 cpd)的对比敏感度比较,差异均无统计学意义(P>0.05)。术后6个月,3组患者的SE绝对值、全眼总像差均较术前明显降低,UCVA、BCVA、全眼总高阶像差、全眼彗差、全眼球差均较术前增加,差异均有统计学意义(P<0.05)。术后6个月,3组患者UCVA和BCVA比较,差异均无统计学意义(P>0.05)。术后6个月,3组全眼总像差、全眼总高阶像差、全眼彗差、全眼球差、全眼三叶草差比较,差异均有统计学意义(P<0.05)。术后6个月,ICL组全眼总像差、全眼彗差低于其余两组,差异均有统计学意义(P<0.05);SMILE组全眼球差低于其余两组,差异均有统计学意义(P<0.05);FS-LASIK组全眼三叶草差低于其余两组,差异均有统计学意义(P<0.05)。结论SMILE、FS-LASIK和ICL 3种屈光矫正手术方式矫正高度近视安全性高、术后屈光预测性佳、视觉质量好。

SBK对高度近视患者泪液功能及视力的影响

目的分析前弹力层下准分子激光原位磨镶术(SBK)对高度近视患者泪液功能及视力的影响。方法本院2017年6月至2022年6月收治的60例高度近视患者分为进行准分子激光上皮角膜磨镶术(LASEK)治疗的对照组和进行SBK治疗的观察组,均每组30例(60眼),分组方法为随机抽签法,两组术后均观察12个月。比较两组泪液功能、视网膜厚度(RT)、角膜前表面像差、视力。结果对照组术前及术后1、3个月平均泪膜破裂时间(BUT)呈先缩短后延长趋势,术后6个月长于术后1个月(P<0.05);观察组术前及术后3、6个月平均BUT均长于术后1个月(P<0.05);观察组术后1、3个月平均BUT长于对照组(P<0.05)。两组整体RT术后1个月与术前比较,升高,观察组高于对照组(P<0.05)。观察组术后1、3个月总高阶像差均方根、四阶球差低于对照组(P<0.05)。观察组术后1、3、6个月视力高于对照组(P<0.05)。结论SBK治疗高度近视对患者总高阶像差均方根、四阶球差影响较小,有助于患者整体RT的改善,且术后患者泪液功能和视力恢复更快。

飞秒激光辅助超声乳化白内障摘除联合CTR植入治疗高度近视白内障

目的飞秒激光辅助超声乳化白内障摘除联合CTR植入治疗高度近视白内障术后的疗效分析及安全性评价。方法收集2019年1月至2021年11月于我院行白内障手术的高度近视白内障患者共52例。随机分成两组:飞秒组和传统组各26例。飞秒组行FLACS+CTR,传统组行超声乳化+CTR。观察术前、术后1天、1周、1月裸眼远视力、MTF、主观视觉质量量表评分、DLI值,IOL偏心量、屈光漂移量及术后并发症发生情况。结果1.术后飞秒组1d、1w、1m的UCVA-D分别为4.62±0.37、4.59±0.43、4.64±0.43较传统组4.58±0.43、4.58±0.43、4.65±0.49视力提升更显著,差异有统计学意义(P<0.05)。2.两组术后眼压飞秒组19.38±2.99较传统组18.40±3.83无明显差异(P>0.05)。飞秒组术后DLI9.04±1.30较对照组7.99±1.52比较差异无统计学意义(P>0.05)。3.术后1m人工晶体偏心量飞秒组0.13±0.09明显小于传统组0.20±0.17,差异有统计学意义(P<0.05);术后1m屈光漂移飞秒组0.28±0.12较传统组0.95±0.27差异有统计学意义(P<0.05)。4.术后1月MTF-AH飞秒组0.54±0.19较传统组0.25±0.06明显提高,差异有统计学意义(P<0.05)。5.术后1月主观视觉质量评分飞秒组4.77±0.42传统组1.42±0.57差异有统计学意义(P<0.05)。6.术后角膜水肿情况飞秒组明显少于传统组,差异有统计学意义(P<0.05)。结论飞秒激光辅助超声乳化白内障摘除联合CTR植入治疗高度近视白内障安全有效高、并发症少、并能获得较好的视觉质量。

准分子激光原位角膜磨镶术治疗重度近视临床观察

目的研究准分子激光角膜磨镶术（ＬＡＳＩＫ）治疗重度近视的效果。方法对２６８眼（１４５例）－１２．００～－２９．００Ｄ的重度近视患者进行ＬＡＳＩＫ手术治疗并随访１２个月。结果术后１２个月视力≥术前矫正视力者占９４．８％，术后屈光度在±２．００Ｄ以内占９５．５％，术后１２个月与术后６个月的平均屈光度相比较，经统计学处理无显著差异。结论ＬＡＳＩＫ是治疗重度近视的有效方法。

高度近视LASIK术后双眼调节聚散及近立体视功能的变化

目的探讨高度近视患者准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)后双眼调节聚散及近立体视功能的变化。方法将34例高度近视患者于术前及术后1个月、3个月、6个月分别用综合验光仪和随机点立体视图检查双眼调节聚散及近距离立体视功能,双眼调节聚散指标包括调节幅度、正负相对调节(positive and negative relative accommodation,PRA/NRA)、调节滞后、水平隐斜视、调节性集合与调节的比率(accommodative convergence/accomodation,AC/A)。结果 LASIK术后1个月、3个月单眼调节幅度分别为(9.52±1.69)D、(11.53±3.48)D,低于术前(13.14±3.59)D,差异均有统计学意义(均为P<0.05);术后6个月(12.52±3.19)D恢复至术前水平,与术前比较,差异无统计学意义(P>0.05)。术后1个月、3个月PRA分别为(-2.13±1.18)D、(-2.36±1.17)D,与术前(-1.88±1.37)D比较,差异均无统计学意义(均为P>0.05);术后6个月(-2.82±1.36)D较术前提高,差异有统计学意义(P<0.05)。NRA及调节滞后两项指标手术前后比较差异均无统计学意义(均为P>0.05);术后不同时间远近距离隐斜度与术前比较差异均无统计学意义(P>0.05);术后不同时间AC/A比率均较术前降低(均为P<0.05)。术后不同时间近立体视锐度与术前比较差异均无统计学意义(均为P>0.05),而术后交叉视差锐度及非交叉视差锐度均高于术前(均为P<0.05)。结论 LASIK对高度近视患者双眼调节、集合及其相互作用协动参数无明显不良影响,同时可提高高度近视患者近立体视范围。

准分子激光双面式切削原位角膜磨镶术后Haze和屈光回退分析

目的:评价准分子激光双面式切削原位角膜磨镶术(both-sidedLASIK,BSL)的安全性和有效性。方法:2004-12/2005-10我院进行BSL手术治疗的高度近视患者38例75眼,回顾性的对临床疗效进行分析。结果:随访9～15mo,38例患者均未出现严重并发症。术前、术后1d和9mo的平均裸眼视力分别为0.07±0.05、0.67±0.29、0.92±0.23,两两之间比较差异均有统计学意义(P<0.01)。1mo时见7眼(9%)有1级Haze形成,较常规LASIK稍多。电脑验光1d和1mo与3mo和6mo之间比较差异均有统计学意义,1mo和3mo与6mo和9mo之间比较差异均无统计学意义。结论:BSL术后能够获得较好的裸眼视力,无严重的并发症出现,屈光回退程度较轻,Haze形成较常规LASIK稍多,对角膜较薄的高度近视患者是一种较为理想、安全、有效的治疗方法。

超高度近视LASIK术后的屈光回退

目的 探讨准分子激光原位角膜磨镶术 (laserinsitukeratomileusis ,LASIK)矫正超高度近视的准确性、预测性、稳定性及有效性。方法 LASIK矫正超高度近视 -10 1～ -2 6 0D ,平均 ( -13 9± 3 4)D 12 4例 193眼 ,按术前预矫等值球镜分别观察术后 1年的屈光度 ,术前最佳矫正视力及术后裸眼视力。结果 术后 1年屈光回退率与性别、年龄、切削方式无关 (P >0 0 5 ) ,而是随着术前预矫度数的增加而增加。术前预矫屈光度越高 ,屈光回退程度越明显。术后平均裸眼视力达 0 6以上。结论 超高度近视LASIK术后准确性、预测性及稳定性均较差 ,但由于其具有有效性 。

准分子激光上皮下角膜磨镶术后并发症的治疗

目的:分析准分子激光上皮下角膜磨镶术(LASEK)治疗近视的并发症,探讨其发生原因及预防措施。方法:近视患者25例46眼行LASEK后,随诊6mo,分析其并发症。结果:术后角膜上皮愈合延迟4眼(8.7%);丝状角膜炎1眼(2.2%);角膜感染2眼(4.3%);角膜雾状混浊(haze)18眼(39.1%),平均0.81±0.48级;术后激素性高眼压8眼(17.4%)。术后6mo屈光回退>-1.00DS者5眼(10.9%);散光度增加>1.00DC者5眼(10.9%),矫正视力较术前下降1行者7眼(15.2%)。结论:LASEK治疗高度近视安全、有效,但存在一定的并发症,尤其是术后早期的角膜上皮愈合延迟和晚期的严重角膜雾状混浊必须引起重视。术后随访的完善、合理的用药、有效护理措施有助于减少术后并发症的发生和提高手术的预测性和准确性。