治疗性准分子激光原位角膜磨镶术手术疗效分析(1)

                  作者：郑卫国，刘登忠，刘兴洪

【关键词】  角膜磨镶术手术

    Curative effect analysis on therapeutic excimer laser-in-situ keratomilusis

      ［Abstract］  Objective  To analyze the curative effect of excimer laser-in-situ keratomilusis（LASIK） for superhigh myopia,myopical anisometropia and mixed astigmatism.Methods  The retrospective study involved 532 patients（972 eyes） with non-simple myopia who received LASIK treatment from Auguest 2002 to August 2007 in our department.They were divided into three groups according to preoperative diopters:Group A was 336 cases （672 eyes）with superhigh myopia.Group B was 107 cases （170 eyes） with myopical anisometropia and Group C was 89 cases （130 eyes） with mixed astigmatism.Results  Naked visual acuity had been improved clearly in the second day after surgery and arrived or approached the best corrected visual acuity of preoperation.After three months the visual acuity tended to stablize.The coincidence rate between naked visual acuity and anticipated corrected visual acuity were 632 eyes in Group A （94.05%）,164 eyes in Group B （96.47%） and 121 eyes in Group C （93.08%）.The difference within range 0.75D between actual corrected diopters and anticipated corrected diopters were 94.2%,96.47% and 91.54% in the above three groups accordingly.Regressive eyes were 16 （2.53%）,6 （3.66%） and 4 （3.36%） in three groups accordingly.Conclusion  It is safe,effective and predictable for excimer laser-in-situ keratomilusis（LASIK） to treat superhigh myopia,myopical anisometropia and mixed astigmatism.The improvement of effect depends on improvements of apparatus and methods,proficiency of surgical technique and experience accumulation.

    ［Key words］  LASIK；therapeutic；curative effect

    准分子激光原位角膜磨镶术（LASIK）是目前矫正屈光不正的普及手术之一，已为广大患者所接受，手术适应证也逐步扩大。自2002年8月～2007年8月，我科已对532例非单纯近视患者（972眼）实行LASIK手术，取得了较好的效果，现报告如下。

    1  资料与方法

    1.1  一般资料

    1.1.1  病例选择  非单纯近视患者共532例（972眼），其中左眼468例，右眼504例，男260例，女272例，年龄16～44岁，平均21岁。病例分组：A组超高度近视（屈光度>-10D）336例（672眼）;B组近视性屈光参差（双眼屈光度相差2D以上）107例（170眼）;C组混合性散光89例（130眼）。纳入条件:（1）佩戴隐形眼镜者脱镜2周以上;（2）角膜厚度>450 μm;（3）眼部无活动性病变;（4）最佳矫正视力大于或等于0.5;（5）无其他系统性疾病或瘢痕体质者;（6）未服用影响角膜代谢药物;（7）视网膜周边变性,眼底激光治疗1个月后;（8）无圆锥角膜倾向者。

    1.1.2  术前检查项目  电脑验光（NIDEK AR-600A）,非接触式眼压测量（TOPCON CT-60）,角膜地形图（KERA TRON）,散瞳验光,插片验光,眼轴A超测量（TOMEY AL-1000）,角膜测厚（DGH 1000）,裂隙灯及检眼镜检查。

    1.2  手术方法  结膜囊冲洗,倍诺喜表面麻醉,术眼常规消毒铺巾,开睑器开睑,确定角膜光学中心,安放负压吸引环,抽吸测眼压达8.67 kPa后用微型角膜瓣切开刀（MORIA KN-5000A）制作鼻侧带蒂直径约7.5 mm角膜瓣,瓣厚约130～180 μm,翻转角膜瓣,吸除角膜基质床水分,用进口准分子激光仪进行角膜板层切削，之后用BBS液冲洗残留物,复位角膜瓣,点抗生素眼液,戴透明有孔硬质眼罩24 h。

    1.3  术后用药  典必殊、氟米龙、爱丽滴眼液,并逐步减量,用药时间约1个月。

    1.4  术后复查  术后第1、3、7天及1、3、6、12、24个月定期复查，复查内容:主诉、视力、屈光状态、地形图、眼压、角膜情况等。

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