准分子激光原位角膜磨镶术治疗超高度近视的理论参数计算与临床疗效分析  

The study on mathematic relationship with Gullstrand exact model eye(No.1)′s parameters of refraction in situ keratomileusis and middleterm evaluation of outcome for rectifying extremely high myopia

作　　者：曾祥云[1] 文道源[1] 彭文轩[1] 郭慧[1] 刘觅[1] 胡萍[1] 卢琴[1] 

机构地区：[1]赣南医学院附属医院准分子激光近视治疗中心,江西赣州341000

出　　处：《赣南医学院学报》2005年第6期743-748,共6页JOURNAL OF GANNAN MEDICAL UNIVERSITY

摘　　要：目的:以Gullstrand(1号)精密模型眼视光参数为设计基础,探讨准分子激光原位角膜磨镶术(LASIK)理论参数的精确计算,并以此筛查、分析、探讨LASIK治疗超高度(等效球镜度数>-10.00 D)近视的中远期效果和安全性。方法:以Gullstrand(1号)精密模型眼的生理光学参数为基础,推导出LASIK手术理论参数,并以之为超高度近视LASIK术前筛查指标,结合我院德国SCHWIND ESIRIS准分子激光屈光不正矫治系统治疗超高度近视的实际手术矫正值,对48例(83只眼)超高度近视行LASIK矫正,患者术前屈光度数-10.00^-21.50 D,平均(-12.48±3.12)D(等效球镜),其中-15.00 D以上9只眼。常规行裂隙灯显微镜、三面镜眼底检查、角膜地形图ORK分析系统、眼压、A超、角膜测厚、电脑验光、散瞳检影、主观验光等检查。术后随访12个月以上。结果:LASIK单光学区切削矫正屈光不正度(R)、切削半径(r)、切削厚度(T)、切削光学区弦长(L)的理论参数及数理关系是:r=0.346/(R+44.928)=L2/[8(C-T)]+[(C-T)/2];LASIK术后12个月时裸眼视力≥0.5者72只眼(86.75%),最佳矫正视力高于或等于术前最佳矫正视力者69只眼(83.13%),未见术后最佳矫正视力较术前最佳矫正视力低于2行以上的眼;屈光度数稳定在±1.00 D以下者59只眼(71.08%),角膜上皮瓣微皱褶1只眼,诉暗视力下降、眩光3例(6只眼)。结论:LASIK治疗超高度近视有效安全。对于屈光度数太高而角膜厚度偏薄者行LASIK应慎重,可考虑应用Epi-LASIK、眼内屈光手术或联合手术矫治。Objective：To study on mathematic relationship with Gullstrand,exact model eye （No. 1）＇s parameters of refraction in situ keratomileusis and evaluate the middle- term efficacy and safety of laser in situ keratomileusis（LASIK） for extremely high myopia （witha preoperative refraction more than - 10. 00 diopters）. Methods Based on Gullstrand exact model eye （No. 1 ）, we deduced the mathematic relationship with rectifying refractive error＇s degree （R）, radius （r）, thickness （T）, mono- optical chord （L） of Laser in situ keratomileusis. 83 eyes of 48 patients with mean spheric equivalent of （ - 12.48 ± 3.12） D （range - 10.00～21.50 D）. ineluding 9 eyes more than - 15.00 D were treated with LASIK and foilowed up for more than 12 months. The examinations included slitlamp microscopy, fundus examination, ORK- link corneal topography system, tonometry, pachymetry, cycloplegic and subjectfraction. Results：The mathematic relationship with Gullstrand exact model eye （No. 1）＇s parameters of refraction in situ keratomileusis is： r=0.346/（R＋ 44.928） = L^2/[8（C-T）] ＋ [（C-T）/2]. At 12 months postoperatively,the uncorrected visual acuity（UCVA）was 0.5 or better in 72 eyes（86.75% ） ,and the best spectacle- corrected visual acuity（BSCVA）remained the same or increased in 69 eyes（83.13% ）. No eye lost more than two lines of BSCVA. 59 eyes （71.08%） were within ＋ 1.00 D of emmetropia. At final follow- up,corneal flap folds were found in 1 eyes, and 3 patients（6 eyes）complained of glare or decreased scotopic vision. Conclusion Guide by the mathematic relationship with Gullstrand exact model eye （No. 1 ）＇s parameters of refraction in situ keratomileusis, LASIK appeared to be an effective and safe treatment for correction of extremely high myopia. Meanwhile the candidates should be carefully screened.

关 键 词：准分子激光原位角膜磨镶术 治疗 超高度近视 理论参数 参数计算 临床疗效 

分 类 号：R778.11[医药卫生—眼科] R779.6[医药卫生—临床医学]