Zyoptix XP与Hansatome角膜板层刀制作角膜瓣特点比较

目的比较Zyoptix XP与Hansatome角膜板层刀制作角膜瓣的特点,为临床使用提供参考。方法50例(100眼)近视眼患者随机分成两组,每组25例(50眼),分别用Zyoptix XP120刀头、8.5mm负压环与Hansatome角膜板层刀160刀头、8.5mm负压环制作角膜瓣。制瓣前后分别用超声角膜测厚仪测量角膜厚度,计算实际角膜瓣厚度。制瓣后分别测量角膜瓣横径、纵径和蒂的长度,进行成组的两两比较t检验以及相关性分析,评价两种角膜板层刀制瓣特点。结果Zyoptix XP与Hansatome两组患者手术前角膜曲率、直径以及厚度差异均无统计学意义(P>0.05)。Zyoptix XP120刀头与Hansatome角膜板层刀160刀头制作的角膜瓣厚度分别为(124.04±15.29)μm和(115.38±11.86)μm,两者差异有统计学意义(t=2.938,P=0.005);XP板层刀制作的角膜瓣的厚度与手术前角膜曲率、直径以及厚度均无相关性(P>0.05);Hansatome板层刀制作的角膜瓣的厚度与手术前角膜曲率和直径无相关性(P>0.05),但与角膜厚度呈正相关(r=0.280,P=0.049)。XP板层刀制作的角膜瓣的横径、纵径和蒂长度分别为(9.05±0.14)mm、(8.22±0.29)mm和(4.63±0.46)mm,Hansatome板层刀制作的角膜瓣的横径、纵径和蒂长度分别为(8.70±0.37)mm、(8.07±0.25)mm和(4.69±0.42)mm;两组横径和纵径分别相比,差异均有统计学意义(P<0.05);蒂长度的差异无统计学意义(t=-0.694,P=0.490)。Zyoptix XP板层刀制作的角膜瓣横径、纵径与手术前角膜曲率、直径以及角膜厚度均无相关性(P>0.05),角膜瓣蒂的长度与角膜曲率呈正相关(r=0.456,P=0.001),与角膜直径呈负相关(r=-0.356,P=0.011),与角膜厚度无相关性(P>0.05)。Hansatome板层刀制作的角膜瓣的大小与角膜曲率呈正相关(r=0.561,P=0.000),与角膜直径和角膜厚度无相关性(P>0.05)。结论使用Zyoptix XP120刀头、8.5mm负压环制作的角膜瓣较使用Hansatome角膜板层刀160刀头、8.5mm负压环制作的角膜瓣厚,角膜瓣也较大,且Zyoptix XP板层刀制瓣厚度与大小不受术眼角膜曲率、直径和厚度的影响,但两种角膜板层刀均有良好的安全性和稳定性。

基于Zyoptix模式的个体化联合瓣膜面准分子激光切削术治疗高度近视的临床观察

目的观察基于Zyoptix模式的个体化联合瓣膜面准分子激光切削术治疗高度近视的疗效。方法收集于我院拟行Zyoptix波前像差引导的个体化手术,合成OTE文件时角膜基质床剩余≤250μm患者86例(156眼),改行波前引导的个体化联合瓣膜面切削手术,OTE文件合成80%PPR值,剩余球镜度数做瓣膜面切削。术后随访6个月以上,观察视力、屈光度、角膜曲率、角膜厚度。结果术后1天、1个月、3个月、6个月裸眼视力超过术前最佳矫正视力,差异具有非常显著性意义(P<0.01);角膜厚度1个月(402±25)μm、3个月(415±26)μm、6个月(414±25)μm。结论对于近视度数较高、角膜偏薄的患者,做像差引导的个体化联合瓣膜面准分子激光切削术,能更好地保留基质床厚度,具有良好的安全性、有效性和可预测性,与其他手术相比在安全性方面具有更明显的优势,是一种值得推荐的治疗高度近视的手术方法。

采用Zyoptix3.1系统的波前导LASIK术对近视及复合近视性散光矫正的1年随访研究:临床预后及高阶像差的改变

To assess safety, efficacy, predictability, stability, and change in aberratio ns after wavefront-guided LASIK for myopia and myopic astigmatism. Prospective, nonrandomized, self-controlled trial. Wavefront-guided LASIK was performed in 97 eyes in a 1-year trial. Treated eyes had a mean subjective manifest spheric al equivalent (SE) of -5.22±2.07 diopters (D), with a range of -0.25 to -9.0 0 D of myopia and 0 to -3.25 D of astigmatism. After a microkeratome cut, a wav efront-based excimer ablation (Zyoptix 3.1) was performed. The full treatment t o achieve emmetropia of an early nomogram provided by the system manufacturer wa s used in all procedures. Safety, efficacy, predictability, and stability were e valuated at 1, 3, and 12 months postoperatively. Wavefront changes of higher ord er aberrations (HOAs) at 1 year were determined for pupil sizes of 3.5 and 6 mm. At 1 year postoperatively, uncorrected visual acuity (VA) was 20/20 or better i n 83%of the eyes, and 20/40 or better in 98%. The mean subjective manifest SE at 1 year was -0.25±0.43 D; it was within 0.50 D in 77%and within 1.0 D in 95 %. No eye lost < 2 lines of best spectacle corrected VA (BSCVA) at 1 year post operatively; 40 eyes gained 1 line of BSCVA, and 5 eyes gained 2 lines. The tota l HOA root meansquare (RMS) increased on average by a factor of 1.23±0.57 with a 3.5-mm pupil; for the 6 mm pupil, the increase factor was 1.52±0.36. No chan ge or reduction in the total HOA RMS was observed in 45.5%of the eyes for a 3.5 -mm pupil and in 20.6%for a 6-mm pupil. There was a significant increase of p rimary spherical aberration (Z 4,0) by a factor of 4.11±10.17 for 3.5-mm pupil s and 4.31±6.76 for 6-mm pupils. Wavefront-guided LASIK using Zyoptix 3.1 is an effective and safe procedure for the treatment of myopia and myopic astigmati sm. Although in close to half of the eyes HOAs could be reduced, there was still undercorrection and induction of HOAs with the algorithm employed.

LASEK联合Zyoptix Tissue Saving治疗屈光不正

目的:观察准分子激光角膜上皮下磨镶术(laser-assisted subepithelial keratomileusis,LASEK)联合Zyoptix Tissue Saving(简称T.S,节约角膜个体化切削)治疗近视的安全性和效果。方法:4例8眼高度近视合并薄角膜患者采用LASEK联合T.S治疗,记录切削深度等数据,随访并记录检查结果。结果:术后1mo8眼均达到或超过术前最佳矫正视力;haze均<Ⅰ级;术中经计算角膜基床厚度均>280μm。结论:LASEK联合T.S治疗高度近视合并薄角膜能保留更多角膜组织,提高了安全性,且效果良好。

Zyoptix波前引导准分子激光原位角膜磨镶术治疗近视眼的临床疗效分析

目的 观察波前引导准分子激光原位角膜磨镶术 (LASIK)治疗近视眼的疗效。方法接受Zyoptix波前引导LASIK手术的近视患者 63例 (113只眼 )作为试验组 ,同期接受常规LASIK手术(Planoscan)的 3 3 5只眼作为对照组 ,对 2组的疗效进行比较。结果 2组术后屈光度数差异无显著意义 (t检验 ,P >0 .0 5)。试验组 3 3 .6%患眼 (3 8只眼 )术后裸眼视力优于其术前戴镜矫正视力 ,而对照组此比例为 17 0 % (57只眼 )。当瞳孔直径为 6mm时 ,对照组术后高阶像差RMS平均增加 10 0 % ,而试验组平均增加 3 5%。术后 6个月对照组对比敏感度接近术前水平 ,而试验组则略优于术前。结论 Zyoptix波前引导LASIK的术后视觉质量优于传统LASIK。 (中华眼科杂志 ,2 0 0 4,40 :9 12 )

波前技术引导与标准LASIK矫正残留屈光不正效果的比较

Objective: To assess efficacy,safety,predictability,stability,and changes in higher-order aberrations (HOAs) and contrast sensitivity (CS) after wavefront-guided and standard LASIK enhancement for the correction of residual refractive errors. Design: Prospective,randomized,comparative clinical study. Participants: Twenty eyes of 20 consecutive patients (spherical equivalent SE,-2.01± 1.36 diopters D) treated with wavefront-guided Zyoptix Ablation Refinement software (ZAR) LASIK and 20 eyes of 20 consecutive patients (SE,-1.81± 1.21D) treated with standard Planoscan LASIK,both for residual refractive error enhancement. Main Outcome Measures: Efficacy,safety,predictability,stability,HOAs,and CS were evaluated before and after enhancement at 6 months’ follow-up. Methods: Uncorrected visual acuity (UCVA),bestcorrected visual acuity (BCVA),manifest refraction,CS by means of the Functional Acuity Contrast Test,and HOAs by means of Zywave aberrometry were evaluated preoperatively and 6 months after retreatment. Results: At 6 months postoperatively,UCVA was 20/25 or better in 100% of the eyes. Efficacy indexes were 1.09 for ZAR patients and 0.95 for Planoscan patients. No eyes lost <1 line of BCVA; in the ZAR group,2 eyes gained 1 line and 6 eyes gained < 2 lines; in the Planoscan group,3 eyes gained 1 line. The ZAR group showed a percentage of eyes (94.4% ) within the 0.5-D range in SE higher than that shown by the Planoscan group (88.8% ). After 6 months,the HOA root mean square (RMS) increased on average by a factor of 1.44 for the Planoscan group (P= 0.003). No change or reduction in HOA RMS was found in the ZAR group (factor of 0.96; P >0.01). Contrast sensitivity was reduced in the Planoscan group only at the highest spatial frequency (18 cycles per degree; P< 0.01). There was a significant reduction of CS as a function of HOA increase for the Planoscan group (P< 0.0001). No changes were observed for the ZAR group at any spatial frequency (1.5-18 cycles per degree; P >0.01). Conclusions: Wavefront-guided LASIK using the ZAR algorithm is an effective and safe procedure for treatment of residual refractive errors. Wavefront-guided LASIKdoes not increase HOAs and does not modify CS compared with preoperative values. Wavefront-guided LASIK seems to be better than standard LASIK for retreatments.

博士伦新产品发布会在成都举行

博士伦新产品发布会于2007年11月11日在成都举行。在本次会议上，美国博士伦眼科手术产品公司力推经采纳全球手术专家长达2年的临床经验和诸多建议、以Hansatome为设计平台而研发的Zyoptix XP角膜板层刀，着重强调其“超凡精确、超级可靠、超值实用”的特点。陆文秀、王铮、Arthur Cheng（中国香港）等知名专家与来自全国的眼科医师探讨了使用Zyoptix XP角膜板层刀的临床体会与经验。现场样机的演示给各位与会嘉宾带来了全新的操作体验。

节约角膜的个体化LASIK治疗近视短期疗效分析

目的探讨节约角膜的个体化准分子激光原位角膜磨镶术治疗近视的短期临床疗效。方法 2008年6月至12月在我院行节约角膜的准分子激光个体化切削的大度数、薄角膜近视患者40例(80眼),分别于术后1d、1周、1个月行裸眼视力、眼压、电脑验光等检查,术后1个月调查患者满意度。并与同期行标准LASIK治疗的120例(240眼)进行对比。结果节约角膜的准分子激光个体化切削组术后1d复查裸眼视力与标准LASIK组(对照组)比较差异无统计学意义,术后1周与1个月均优于标准LASIK组,差异有统计学意义;术后1个月主观满意度显示节约角膜的准分子激光个体化切削组高于标准LASIK组。结论节约角膜的准分子激光个体化切削治疗大度数、薄角膜近视眼具有良好的短期疗效,减轻术后的度数残留。