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中华眼科医学杂志(电子版) ›› 2018, Vol. 08 ›› Issue (01) : 15 -22. doi: 10.3877/cma.j.issn.2095-2007.2018.01.003

所属专题： 青少年近视防控； 文献；

论著

高度近视眼行准分子激光原位角膜磨镶术后长期稳定性的研究
宋耀文1, 贺瑞2,†(), 马秋霞2   
  1. 1. 030002　山西医科大学第一临床医学院眼科
    2. 030002　太原，山西省眼科医院准分子激光科
  • 收稿日期:2018-03-07 出版日期:2018-02-28
  • 通信作者: 贺瑞
  • 基金资助:
    国家自然科学基金青年基金(11402161); 山西省科技攻关计划项目(20120313025－3); 山西省卫计委科技攻关项目(201201018)

Long term stability of high myopia after excimer laser in situ keratomileusis

Yaowen Song1, Rui He2,†(), Qiuxia Ma2   

  1. 1. Department of Ophthalmology, the First Clinical Medical College of Shanxi Medical University, Taiyuan 030002, China
    2. Excimer Laser Department, Shanxi Eye Hospital, Taiyuan 030002, China
  • Received:2018-03-07 Published:2018-02-28
  • Corresponding author: Rui He
  • About author:
    Corresponding author: He Rui, Email:
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宋耀文, 贺瑞, 马秋霞. 高度近视眼行准分子激光原位角膜磨镶术后长期稳定性的研究[J]. 中华眼科医学杂志(电子版), 2018, 08(01): 15-22.

Yaowen Song, Rui He, Qiuxia Ma. Long term stability of high myopia after excimer laser in situ keratomileusis[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2018, 08(01): 15-22.

目的

探讨高度近视眼准分子激光原位角膜磨镶术(LASIK)术后长期的安全性和有效性。

方法

纳入2003年8月至2011年7月在山西省眼科医院准分子激光科接受LASIK、(角膜瓣厚度＋切削深度)/术前中央角膜厚度的百分比(PTA)≥40%且资料完整的高度近视眼患者112例(221只眼)的临床资料。其中，男性54例(105只眼)，女性58例(116只眼)；年龄18～35岁，平均年龄(25.6±5.4)岁。患者术前的等效球镜度(SE)均≥－6.00 D。术前及术后末次复查时均进行裸眼视力(UCVA)、矫正视力(CDVA)、球镜度数、散光度数、SE、中央角膜厚度(CCT)及角膜地形图等检查。分析患者术后的屈光状态、稳定性、安全性及有效性。术后还需测量患者的剩余基质床厚度(RSBT)，计算PTA及术后RSBT占术前CCT的百分比(PSBT)。患者术前及末次复查的各项数据采用均数±标准差(±s)表示。术前与术后患者的视力和SE采用独立样本t检验进行比较，不同的CCT检查方法采用配对t检验进行比较。

结果

患者术前的UCVA为0.08±0.30，术后末次复查时的UCVA为0.8±0.2。两者比较，差异有统计学意义(t＝29.99，P<0.05)。末次复查时的屈光检查结果显示，患者的球镜度数为(－0.87±0.97) D，散光度数为(0.40±0.41)D，SE为(－0.75±1.03)D。末次检查时的SE与术前SE比较，差异有统计学意义(t＝36.33，P<0.05)。手术的安全指数为1.10，有效指数为0.90。术后患者的PTA为44%±3%。术后患者的PSBT为58%±5%。患者未出现继发性圆锥角膜。

结论

PTA≥40%但PSBT达到50%及以上时，高度近视眼患者在LASIK术后长期稳定，未发现继发性圆锥角膜。

关键词: 准分子激光原位角膜磨镶术, 高度近视眼, 角膜形态
Objective

Discussion on (the corneal flap thickness and cutting depth) for the safety and efficacy of preoperative central corneal thickness and the percentage of more than 40% patients with high myopia after LASIK long-term corneal biomechanics and operation state.

Methods

In July 2011 August 2003 to accept LASIK, PTA ≥ 40% and the complete data of 112 cases with high myopia after excimer laser, Eye Hospital of Shanxi province (221 eyes) of clinical data. Among them, there were 54 males (105 eyes), 58 women (116 eyes), 18~35 years old, and the average age (25.6±5.4) years. Preoperative spherical equivalent (SE) were more than -6.00 D. Preoperative and postoperative final review were performed to examine the patients′ naked eye (UCVA), corrected visual acuity (CDVA), spherical degree, astigmatism, SE, central corneal thickness (CCT) and corneal topography. The diopter status, stability, safety and effectiveness of postoperative patients were analyzed. Residual matrix bed thickness (RSBT) was also required after operation to calculate the percentage of PTA and the percentage of RSBT before the operation (PSBT). The data of the patients before and after the final reexamination were expressed by mean standard deviation(±s). The visual acuity of the patients before and after the operation was examined by independent sample t-test, and the patients were paired with the t-test before and after the operation of the CCT.

Results

The preoperative UCVA was 0.01 to 0.20, and the average UCVA was 0.08±0.30. The UCVA at the last postoperative reexamination was 0.8±0.2. There was a significant difference between the two groups (t=29.99, P < 0.05). The refraction results at the last review showed that the spherical mirror degree of the patients was (-0.87±0.97) D, the astigmatism was(0.40 ± 0.41) D, the SE was(-0.75±1.03). The difference between the SE and the preoperative SE was statistically significant (t=36.33, P < 0.05). The safety index of the operation was 1.10 and the effective index was 0.90. The PTA of the patients after operation was 40% ~ 55%, and the average PTA was 44%±3%. The PSBT of the patients after operation was 51% ~ 85%, and the average PSBT was 58%±5%. There was no secondary keratoconus in the patient.

Conclusion

In this cohort with the PTA≥40% and PSBT reached 50% and above, long-term stability in patients with high myopia after LASIK, no secondary keratoconus found.

Key words: Laser in situ keratomlleusis, High myopia, Corneal pattern
图1 LASIK患者术前CDVA、术后UCVA及术后CDVA的示意图
图2 LASIK术后患者的SE在不同范围的分布图
图3 LASIK患者术后CDVA的变化示意图
图4 术前CDVA、术后UCVA的累积百分比示意图
图5 LASIK术后患眼的中央角膜厚度在不同范围内的分布图(采用眼前节OCT测量)
图6 LASIK术后患眼的剩余基质床厚度在不同范围内的分布图
图7 LASIK术后患眼的(角膜瓣厚度＋切削深度)/术前中央角膜厚度百分比在不同范围内的分布
图8 LASIK术后患眼的剩余基质床厚度/术前中央角膜厚度百分比在不同范围的分布图
图9 术前屈光度为－15.00 D的术眼在术后第119个月时的角膜地形图及眼前节OCT图像　未发现类似圆锥角膜的形态改变
图10 RSBT＝240 μm的术眼在术后104个月时的角膜地形图及眼前节OCT图像　未发现类似圆锥角膜的形态改变
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