准分子激光原位角膜磨镶术后的二次手术  

Second operation after laser in situ keratomileusis

作　　者：刘怡[1] 赵宏伟[1] 李飞[1] 

机构地区：[1]解放军三0六医院眼科,北京100101

出　　处：《中华眼科杂志》2010年第8期714-718,共5页Chinese Journal of Ophthalmology

摘　　要：目的 探讨准分子激光原位角膜磨镶术（LASIK）后行二次LASIK手术和准分子激光上皮下角膜磨镶术（LASEK）的临床效果.方法 回顾性病历对照研究.对31例（62只眼）LASIK术后欠矫或屈光回退的患者行二次手术.其中A组（30眼）的病例行LASIK手术,B组（32眼）行LASEK手术,随访观察1年.主要观察指标有：视力、屈光度、角膜曲率、总高阶像差值.对数据采用非配对t检验进行统计学分析.结果 二次手术后1周,A、B组裸眼视力分别为（0.79±0.21）及（0.57±0.11）,差异有统计学意义（t=5.21,P＜0.05）.术后1个月和1年两组视力差异均无统计学意义（t=0.59,-0.60;P＞0.05）.术后1年A、B两组裸眼视力分别为0.84±0.15和0.82±0.11、等效球镜屈光度分别为（-0.34±1.15）和（-0.32±1.13）D,平均角膜曲率分别为37.87±1.95和38.47±2.15,总高阶像差值分别为0.45±0.11和0.48±0.13,差异均无统计学意义（t=0.60,-0.07,-1.15,-0.98,P＞0.05）.LASIK组发生1例角膜上皮内生,LASEK组有1例2＋级haze.结论 LASIK术后二次手术采用LASEK和LASIK均可获得满意的临床效果.但从患者的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方式作为候补方式也能取得较满意的临床效果.但用LASEK方式是否可以补矫更高的屈光度仍有待观察.Objective To compare clinical results between the laser in situ keratomileusis （ LASIK） surgery and the laser subepithelial keratomileusis （LASEK） surgery as the second operation after an unsuccessful LASIK surgery. Methods Thirty one patients （62 eyes） with refractive regression or under-correction after LASIK operation received the second surgery. Thirty eyes received LASIK surgery （group A） and 32 eyes received LASEK surgery （group B）. The follow-up period was one year. The main parameters included visual acuity, refraction, corneal curvature, and the total value of high-aberration. Results The difference in visual acuity in one week postoperation between both group was statistically significant（t=5.21, P〈0.01） , the acuity of LASEK group（0.57 ±0. 11） was obviously lower LASIK group（0.79 ±0.21）. There is no difference in acuity between both group in 1 month and lyear postop. The difference in uncorrected visual acuity, average spherical equivalent refractive degree, average corneal curvature, and the total value of high - aberration between both group 1 year after operation was statistically not significant. Uncorrected visual acuity （ A group 0.84 ± 0. 15, Bgroup 0. 82 ± 0. 11, t = 0. 60 ） , average spherical equivalent refractive degree（A group -0.34 ±1.15,B group -0.32 ±1.13,t= -0.07）,average corneal curvature（A group 37. 87 ±1. 95, B group 38. 47 ±2. 15,t = - 1. 15） ,the total value of high -aberration （A group 0. 45 ±0. 11, B group 0. 48 ± 0. 13, t = - 0. 98）. One patient developed epithelium ingrowth after LASIK surgery. One patient suffered from 2 ＋ haze after LASEK surgery. Conclusion Both LASIK and LASEK surgery can obtain satisfactory therapeutic results after an unsuccessful LASIK surgery.

关 键 词：角膜磨镶术 激光原位 角膜切削术 上皮下 激光 像差 再手术 

分 类 号：R779.63[医药卫生—眼科]