传导性角膜成形术治疗老视的二年临床观察  

Conductive keratoplasty for presbyopia and two years follow-up

作　　者：徐雯[1] 吴炜[1] 姚克[1] 李兆春[1] 叶盼盼[1] 徐鹤升[1] 倪海龙[1] 许素惠[1] 

机构地区：[1]浙江大学附属第二医院眼科中心,杭州310009

出　　处：《中华眼科杂志》2011年第7期611-617,共7页Chinese Journal of Ophthalmology

摘　　要：目的评估传导性角膜成形术治疗老视2年的临床疗效。方法前瞻性研究传导性角膜成形术治疗老视患者34例，其中26例远视伴老视症状患者接受双眼手术，8例正视伴老视症状患者接受单眼手术。随访24个月。样本间统计学检验采用t检验和单因素方差分析。结果术后24个月时，远视眼组和正视眼组的双眼裸眼近视力（UNVA）（33cm，5-10gMAR值）（4．63±0．12；4．68±0．16）均比术前（4．06±0．15；4．13±0．18）提高（t=9．237，0．413；P〈0．001）；远视眼组双眼裸眼远视力（UDVA）（4．99±0．02）比术前（4．82±0．21）改善（t=6．718，P〈0．05），正视眼组双眼裸眼远视力与术前相同；所有术眼等效球镜度数比术前[（＋0．97±0．63）D]降低（t=14．704，P〈0．001），术后1周时达到峰值[（-1．21±1．00）D]，并随时间推移缓慢回退，术后24个月[（～0．40±0．70）D]时渐趋平稳；回退速度由术后1个月的（＋0．35±0．44）D／月逐渐减慢至24个月的（＋0．01±0．01）D／月；对比敏感度和眩光敏感度，眼压、泪膜破裂时间、角膜内皮细胞数目、中央角膜厚度，双眼立体视功能和最佳矫正视力无明显变化。结论传导性角膜成形术治疗老视安全有效，具有较好的屈光状态预测性和控制性，术后以逐渐减缓的速度回退并于术后24个月时相对渐趋平稳，更远期效果尚待进一步观察。Objective To investigate the effect of conductive keratoplasty （CK） for presbyopia and 2 years follow-up. Methods This study is prospective clinical trial. CK was performed on 34 patients for presbyopia, in which 26 hyperopic patients underwent binocular operations and 8 emmetropic patients underwent monocular operation. The following-up time was 24 months. Results At 24 months postoperatively, for the hyperopia group, binocular uncorrected near visual acuity （33 cm） （5-logMAR） （4. 63±0. 12 ） was increased significantly （ t = 9. 237, P 〈 0. 001 ） compared pre-operatively （ 4. 06 ± 0. 15） ; binocular uncorrected distance visual acuity （4. 99 ± 0. 02） was significantly increased （ t = 6. 718, P 〈 0. 05 ） compared pre-operatively （4. 82 ±0. 21 ） ; for the emmetropia group, binocular uncorrected near visual acuity （33 cm） （5-1ogMAR） （4. 68 ±0. 16） was increased significantly （t = 10. 413, P 〈 0. 001 ） compared pre-operatively （4. 13 ± 0. 18 ） ; binocular uncorrected distance visual acuity was same as preoperative one; compared pre-operatively （ ＋ 0. 97 ± 0. 63 D）, manifest refractive spherical equivalent was decreased significantly （P 〈0. 001 ） to peak value （ -1.21 ±1.00）D at 1 week, and then regressed to a relative plateau（ -0. 40±0. 70）D at 24 months; the regressive rate was decreased from （ ＋0. 35 ±0.44） D/month at 1 month postoperatively to （ ＋ 0. 01 ± 0. 01 ） D/months at 24 months postoperatively. Contrast sensitivity and glare sensitivity, intraocular pressure, tear break-up time, endothelial cell count, central corneal thickness, stereopsis function and best corrected visual acuity were not significantly changed. Conclusions For treatment of presbyopia, CK appeared to be safe, effective, refractive-predictable and controllable, and relatively stable at 24 months post-operatively. More long-time follow-up is necessary for further evaluation.

关 键 词：老视 屈光外科手术 视敏度 

分 类 号：R779.6[医药卫生—眼科]