准分子激光原位角膜磨镶术后二次手术方式探讨  

Second operation after laser in situ keratomileusis

作　　者：刘怡[1] 赵宏伟[1] 李飞[1] 

机构地区：[1]解放军306医院眼科,北京100101

出　　处：《总装备部医学学报》2010年第2期73-76,共4页Medical Journal of General Equipment Headquarters

摘　　要：目的探讨准分子激光原位角膜磨镶术(Lasik术)后二次手术方式及其临床效果。方法对31例(62眼)Lasik术后欠矫或屈光回退行二次手术的病例进行回顾性对照研究。其中A组15例(30眼)行Lasik手术,B组16例(32眼)行准分子激光上皮下角膜磨镶术(Lasek术),随访观察1年。其主要观察指标有:视力、屈光度、角膜曲率、总高阶像差值。结果二次手术采用Lasek与Lasik术后1周视力比较具有显著性差异(t=5.2140,P<0.01),B组视力明显低于A组;术后1个月、1年两组视力比较均无显著性差异(分别为t=0.5854、t=-0.5954,P>0.05);术后1年两组间裸眼视力、平均等效球镜屈光度、平均角膜曲率、总高阶像差值比较均无显著性差异(分别为t=0.6014、t=-0.0691、t=-1.1485、t=-0.9776,P>0.05)。A组发生角膜上皮内生1例,B组发生2+级角膜上皮下雾状浑浊(Haze)1例。结论 Lasik术后二次手术采用Lasek和Lasik术均可获得满意的临床效果。但从术后愈合时间、早期反应及最终结果来看,Lasik术后二次手术采用Lasik术式应该是比较恰当的选择,对于角膜基质床比较薄的患者采用Lasek手术作为候补方式也能取得较满意的临床效果。Lasek手术方式是否可以补矫更高的屈光度仍有待观察。Objective To compare clinical effects between the laser in situ keratomileusis (Lasik) and the laser subepithelial keratomileusis (Lasek) after Lasik surgery. Methods 31 patients (62 eyes) with refractive regression or less-correction after Lasik received the second surgery. 30 eyes received Lasik surgery (group A),and 32 eyes received Lasek surgery(group B). During one year following-up,the main indexes,including visual acuity,refraction,corneal curvature,and the total value of high-aberration,were observed. Results There was statistical significance(P<0.01)between the two groups after 1 year observation,as compared with the preoperative indexes including uncorrected visual acuity,average spherical equivalent refractive degree,average corneal curvature,and the total value of high-aberration. There was no statistical significance (P>0.05)in uncorrected visual acuity,average spherical equivalent refractive degree,average corneal curvature,and the total value of high-aberration between the two groups 1 year after treatment. There was also no statistical significance (P>0.05)in visual acuity after 1 year as compared with the preoperative in uncorrected visual acuity between the two groups. There was one case of epithelial ingrowth in Lasik group,and one case with Haze II in Lasek group. Conclusion No matter which type of surgery has been used for retreatment after laser in situ keratomileusis,the outcomes of visual acuity are satisfied.

关 键 词：准分子激光原位角膜磨镶术 准分子激光上皮下角膜磨镶术 高阶像差 二次手术 

分 类 号：R779.63[医药卫生—眼科]