摘要
目的探讨影响准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)治疗近视眼术后疗效的相关因素。方法对72例(141眼)近视眼患者进行LASIK治疗。根据术前等效球镜屈光度分为3组:Ⅰ组<-6.00D,计55眼;Ⅱ组-6.00^-8.75D,计40眼;Ⅲ组≥-9.00D,计46眼。分别记录术前和术后第1周、第1个月、第3个月的视力、屈光度、眼压、角膜厚度、角膜地形图检查所得的角膜后表面数据,分析术后裸眼视力与诸多因素之间的关系。结果术后第3个月,裸眼视力4.4~5.2,平均4.98±0.12,三组间差异有显著统计学意义(P=0.000),有36眼视力<5.0且近视屈光度高于-1.00D为屈光回退眼,105眼为正常眼。术后各阶段随访时发现,随着术后时间延长,角膜最薄处厚度均有不同程度增加,角膜后表面负性屈光度增大,角膜后表面Diff值增高,屈光回退组各指标不同阶段(术后第1周、第1个月、第3个月)比较,差异均有统计学意义(F分别为30.033、7.739、6.500,均P<0.01);但正常眼组各指标不同阶段比较,除角膜最薄厚度外,余差异均无统计学意义(角膜最薄厚度F=5.485,P<0.01;其余均P>0.05)。设术后第3个月的裸眼视力为因变量(Y),X1为术前近视屈光度,X2为角膜切削比,X3为术后第3个月角膜后表面最高点Diff值,X4为术后第3个月和术后第1周角膜厚度差,X5为术后第3个月和术后第1周角膜后表面屈光度差,进行逐步回归分析,建立的多元回归方程为Y=5.09-0.034X1+1.785X2-2.216X3-0.002X4+0.081X5(F=21.474,P=0.000)。结论LASIK治疗近视是一种安全、有效的方法。但欲取得较好疗效,应考虑不同因素,如术前近视屈光度、角膜切削比、术后角膜增殖和术后角膜后表面改变等因素均有可能对LASIK的疗效造成影响,尤其是对高度或超高度近视,必要时采取部分矫正屈光力,以提高角膜切削比值,减少角膜的前突,将剩余屈光度用日后配戴低度眼镜的方法进行处理,避免出现术后并发症及屈光回退。
Objective To analyse the relative factors that affect postoperative results of laser in situ keratomileusis （LASIK） for myopia. Methods One hundred and forty-one eyes of 72 patients on which LASIK were performed, which were divided into three groups according to diopter of spherical equivalence： group Ⅰ（55 eyes）, diopter〈-6.00 D; group Ⅱ（40 eyes）, diopter：-6.00^-8.75 D; group Ⅲ（ 46 eyes）, diopter 〉-9.00 D. Respectively recorded their visual acuity, diopter, intraocular pressure, corneal thickness and data measured by corneal topography in preoperation at one week, one month and three months after operation. Analysed the relativity between uncorrected visual acuity and relative factors. Results Uncorrected visual acuity of three months after operation was 4.4~5.2, mean was 4.98±0.12. There were significant difference among three groups （P=0.000）. Thirty-six eyes （visual acuity〈5.0, diopter 〉-1.00 D） were refractive regression ones, 105 eyes were normal ones. During postoperative follow-up, we found that the thickness in corneal thinnest place, negative diopter and Diff of corneal posterior surface increased following postoperative time. There was statistical significance among comparison of different stages in refractive regression group （1 week, 1 month and 3 months after operation respectively, F=30.033, 7.739, 6.500; P〈0.01）, but there was no statistical significance among that of normal eye group except for corneal thickness in the thinnest place. We could also set up a multiple regression equation, that is Y=5.09-0.034X1＋1.785X2-2.216X3-0.002X4＋0.081X5 （F=21.474, P=0.000）, Y standed for the uncorrected visual acuity in three months after operation, X1 standed for the preoperative myopia diopter, X2 standed for the ratio of corneal cutting, X3 standed for the Diff in three months after operation, X4 standed for the remainder of corneal thickness in one week after operation, X5 standed for the remainder of corneal posterior surficial diopter. Conclusion LASIK is a safe and effective way to treat myopia. In order to get a better postoperative result, we should consider many factors such as preoperative myopia diopter, the ratio of corneal cutting, postoperative corneal proliferation and changes in postopreative corneal posterior surface and so on. Especially for high myopia or super high myopia, we shoud correct local diopter in need to increase the ratio of corneal cutting, decrease corneal lordosis, reserve diopter and aviod postoperative complications and refractive regression.
出处
《眼视光学杂志》
CAS
2009年第2期141-145,共5页
Chinese Journal of Optometry & Ophthalmology
基金
台州市科技局课题项目(061KY36)
关键词
近视眼
角膜磨镶术
激光原位/方法
屈光回退
多因素分析
myopia； keratomileusis， laser in situ/methods； refractive regression； analysis of the relative factors
