再次准分子激光原位角膜磨镶术后屈光回退的多因素分析  

Multiple factors analysis on myopia regression for the patients with re-treatment by laser in situ keratomileusis

作　　者：张悦[1] 方之家[2] 陈斌[1] 赵振宇[1] 刘治容[1] 谢丽萍[1] 廖世煌[1] 

机构地区：[1]四川省人民医院眼科,成都610072 [2]重庆医科大学影像系

出　　处：《临床眼科杂志》2005年第6期514-517,共4页Journal of Clinical Ophthalmology

摘　　要：目的探讨准分子激光原位角膜磨镶术(LASIK)术后屈光回退导致再次手术的的原因。方法对2002年3月至2003年1月所做的LASIK全部病例中于2004年2月前再次手术的21例(41只眼)(回退组),测量并统计分析其术前屈光度(等效球镜)、角膜曲率、手术前后超声波和角膜地形图测的角膜厚度、术中角膜瓣厚、角膜切削深度、所留角膜基质床厚度、角膜切削有效光区直径。随机选同期手术随访3月以上、术后裸眼视力1.0以上的受术者21例(41只眼)做对照比较。并就上述因素及年龄是否引起屈光回退做Lojistic回归分析。结果再次手术者占其首次手术同期全部受术者的1.6％。回退组与对照组的年龄、性别、术前屈光度数、角膜曲率、角膜厚度、术中角膜瓣厚、角膜切削深度、所留角膜基质床厚度、角膜切削有效光区直径的均数没有统计学差异。回退组预期术后角膜厚度(术前角膜厚度减去手术切削厚度)(468.1μm±24.5)较一次术后实际角膜厚度(496.8μm±25.7),有统计学差异(t=5.600,P=0.008)；如果将一次预期角膜厚度与二次预期角膜厚度(术后角膜厚度减去二次手术切削厚度)(467.5±29.0)相比较,则没有统计学差异(t=1.093,P=0.299)；而对照组的预期角膜厚度(463.2μm±34.8)与术后实际角膜厚度(481.1μm±34.4359)没有统计学差异(t=3.584,P=0.062)。Logistic回归分析9个因素中只有3个因素有统计学意义。为0.9324+0.1100年龄-5.3427切削光区+0.1432瓣厚。结论 LASIK术后回退需再次手术者第一次术后角膜厚度未能达到术后预期角膜厚度,似应考虑因为术后角膜再增生而增厚所致。术后屈光是否出现回退与年龄呈正相关,年龄越大越易回退；与有效切削光区呈负相关,光区越小越易回退；与术中所作角膜瓣厚度成正相关,角膜瓣越厚越易回退。Objective To evaluate the myopia recession relevant reasons of laser in situ keratomileusis （LASIK） for the cases with re - LASIK. Methods Among all cases（ From March 2002 to Jan 2003） ,41 eyes of 21 myopia patients were retreated by LASIK before Feb 2004 （group re - LASIK）, investigate the preoperative refractive diopter, corneal thickness（by B ultrasonic and Topography, corneal flap thickness, the diameter of ablation zone , ablation depth ,thickness of corneal bed and so on. To analyze these figures by Logistic multiple Regression. 41eyes with uncorrected visual acuiry〉1.0 postoperation were contrasted with them （ contrast group. ） Results The ratio of re - LASIK is 1.6%. There are no statistically difference between the two groups in age, sex, preoperative refractive diopter, corneal thickness, corneal curvature, corneal flap thickness , the diameter of ablation zone , ablation depth ,thickness of corneal bed by singly analyzed. The preoperative expected corneal thickness （preoperative corneal thickness subtracts ablation depth） （468. lure ＋ 24. 5 is significantly different compared with the postoperative real one（496.8um ± 25.7） （ t = 5. 600, P = 0. 008） in re - LASIK group. If preoperative corneal thickness subtracts ablation depth and re - ablation depth ）, there are no significantly different from preoperative expected corneal thickness to the postoperative real corneal thickness. While there are no these difference in contrast group. Only 3 factors among 9 ones are related to myopia regression by Logistic multiple Regression： 0. 9324 ＋ 0. 1100age - 5. 3427 the diameter of ablation zone ＋ 0. 1432 corneal flap thickness. Conclusion It is suggests perhaps the corneal proliferation is responsible on the myopia regression that the postoperative real corneal thickness is thinner than the preoperative expected one in re - LASIK patients. 3 factors are related to the myopia regression that are age be older, the diameter of ablation zone be smaller, the corneal flap th

关 键 词：准分子激光原位角膜磨镶术 屈光回退 再次手术 

分 类 号：R779.63[医药卫生—眼科] R778.11[医药卫生—临床医学]