LASIK矫治儿童重度远视屈光参差性弱视的远期疗效观察  

Long-term efficacy of laser-assisted in situ keratomileusis for high hyperopic anisometropia in children

作　　者：汪辉[1] 阴正勤[1] 胡春明[1] 罗启惠[1] 周青青[1] 

机构地区：[1]第三军医大学西南医院全军眼科中心,重庆400038

出　　处：《第三军医大学学报》2013年第17期1848-1852,共5页Journal of Third Military Medical University

基　　金：重庆市科技攻关计划项目(CSTC2011AC5030)~~

摘　　要：目的通过远期临床观察评价准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)矫治儿童高度远视性屈光参差的安全性、有效性、可预测性和稳定性,并探讨其对术后长期弱视治疗效果的影响。方法采用回顾性研究方法观察自2000年9月开始接受LASIK手术矫治的61例61眼高度远视屈光参差性弱视儿童病例,年龄6~14岁。使用SVS Apex plus准分子激光系统及科医人公司鹰视世纪波及鹰视酷眼准分子激光系统,在局麻或基础麻醉下对患儿重度远视眼施行LASIK手术,矫治屈光度范围:(+3.00^+7.50)D。术后根据患儿年龄、弱视类型及弱视严重程度制定后期弱视治疗方案。22例随访时间60个月以上。结果术前患儿裸眼远视力为(0.12±0.07),裸眼近视力为(0.25±0.14),矫正远视力为(0.23±0.14),矫正近视力为(0.35±0.23)。双眼扩瞳等值球镜屈光参差度为(+6.41±1.24)D,小瞳等值球镜屈光参差度为(+5.52±1.16)D。中心同时视47.5%,中心融合16.4%,立体视3.3%,≤3%不等像14.8%。术后60个月:裸眼远视力为(0.35±0.13),裸眼近视力为(0.70±0.19),矫正远视力为(0.48±0.18),矫正近视力为(0.81±0.18),与术前比较,差异均有统计学意义(P<0.05)。双眼扩瞳等值球镜屈光参差度为(+0.61±1.43)D,小瞳等值球镜屈光参差度为(+0.59±1.37)D,与术前比较,差异均有统计学意义(P<0.05)。中心同时视91.7%,中心融合75.0%,立体视33.3%,≤3%不等像66.7%,与术前比较,差异均有统计学意义(P<0.05)。术后60个月所随访的22眼均没有发现最佳矫正远、近视力丢失。结论 LASIK手术可显著降低儿童高度远视性屈光参差,长期随访结果表明其具有较好的安全性、有效性、可预测性和稳定性,术后可显著提高弱视治愈率。Objective To assess the safety, efficacy, predictability and stability of laser-assisted in situ keratomileusis （LASIK） in pediatric patients with high hyperopic anisometropia, and to study its effect on long-term amblyopia efficacy after operation. Methods This clinical data of 61 children of 6-14 years old with high hyperopic anisometropic amblyopia who underwent LASIK from September, 2 000 were retrospectively analyzed. LASIK was performed in the seriously hyperopic eyes under topical or general anesthesia using the Summit’s SVS Apex plus and the Lumenis’s Allegretto Wave. The postoperative visual acuity and refraction and the binocular vision outcomes were analyzed. The minimum duration of follow-up was 12 months, and 22 children had a 60-month follow-up. Results Compared with those before operation, the uncorrected distance visual acuity （0.35±0.13）, the uncorrected reading visual acuity （0.70±0.19）, the best spectacle-corrected distance visual acuity （0.48±0.18）, and the best spectacle-corrected reading visual acuity （0.81±0.18） were significantly improved at 60 months after operation （P〈0.05）. Cycloplegic equivalent refraction changed from （＋6.41±1.24） D preoperatively to （＋0.61±1.43） D postoperatively （P〈0.05）. Compared with those before operation, the proportions of patients who gained central simultaneous vision （91.7%）, central fusion （75%）, stereopsis （33.3%） and heterophoria （≤3%） significantly increased at 5 years after operation （P〈0.05）. The loss of best spectacle-corrected distance visual acuity and reading visual acuity was not observed after 60-month follow-up. Conclusion LASIK is safe and effective in correcting high hyperopic anisometropia in children who are intolerant to contact lenses, and offers good safety, efficacy, predictability and stability in a long term. The curative effect of amblyopia is improved after operation.

关 键 词：LASIK 儿童 远视 屈光参差 弱视 

分 类 号：R778.1[医药卫生—眼科] R779.63[医药卫生—临床医学]