准分子激光原位角膜磨镶术后屈光度数欠矫及回退再手术探讨  

Excimer retreatment for undercorrection or regression after laser in situ keratomileusis

作　　者：齐虹[1] 夏英杰[1] 陈跃国[1] 朱秀安[1] 

机构地区：[1]北京大学第三医院眼科,100083

出　　处：《中华眼科杂志》2002年第2期72-75,共4页Chinese Journal of Ophthalmology

摘　　要：目的　探讨再次手术治疗准分子激光原位角膜磨镶术 (laserinsitukeratomileusis,LASIK)后屈光度数欠矫和回退的疗效。方法　将 1996年 3月至 1999年 7月在我院近视激光治疗中心行再次LASIK(re LASIK ,RLASIK)矫治残余近视度数患者 6 3例 (88只眼 ) ,按首次LASIK(firstLASIK ,FLASIK)术前等值球镜屈光度数分为Ⅰ组 4 1只眼 (≤ 10 0 0D)和Ⅱ组 4 7只眼 (>10 0 0D) ,分析导致再手术的因素 ;观察RLASIK术后屈光度数、裸眼视力、最佳矫正视力及手术并发症情况 ,统计术后屈光度数 <± 1 0 0D的发生率。术后随访时间 >1年。结果　在行RLASIK者中 ,FLASIK术前屈光度数>10 0 0D者超过 5 0 0 % ,同时行散光矫正术者占 73 9%。RLASIK术后Ⅰ组无屈光度数欠矫和回退现象 ,Ⅱ组存在屈光度数欠矫现象。RLASIK术后 1年 ,屈光度数 <± 1 0 0D者Ⅰ组为 6 8 3% ,Ⅱ组为5 1 1% ;全部病例RLASIK术后不同时间裸眼视力≥ 0 5者均超过 90 0 % ,最佳矫正视力较RLASIK术前下降 >2行者 8只眼 (9 0 % )。RLASIK术后Ⅱ组 3只眼 (3 4 % )发生圆锥角膜。结论　导致LASIK术后再手术的危险因素为高度近视、合并散光、个体反应差别。对于FLASIK术前屈光度数≤ 10 0 0D者 ,RLASIK的安全性、有效性、预测性及准确性均较为理想 ;Objective To evaluate the results of excimer retreatment for undercorrection or regression after laser in situ keratomileusis (LASIK). Methods Eight eight eyes received retreatment for undercorrection or regression after first LASIK (FLASIK) in 2 149 eyes in our photorefractive keratotectomy (PRK)/LASIK center from March, 1996 to July, 1999. They were divided into 2 groups according to their degrees of pre FLASIK myopia spherical equivalents. Group Ⅰ was ≤10 00 diopters (D) (41 eyes); group Ⅱ was >10 00 D (47 eyes). We analyzed the factors of FLASIK which led to the re LASIK(RLASIK), and observed the mean spherical equivalents (MSE), the ratio within ±1 00 D of emmetropia, the uncorrected visual acuity (UCVA), the best corrected visual acuity (BCVA) and the complication after RLASIK for at least 1 year follow up study. Results The retreatment ratio was 4 1% among the 2 149 eyes. In group Ⅱ, the ratio was 2 3 times that of the group Ⅰ. In the comparison with other eyes, the eyes received RLAISK had no difference in sex, laterality and age ( P >0 05). Over 50 0% had pre FLASIK diopters ≥10 00 D, and 73 9% had astigmatism correction in FLASIK. After RLASIK, no undercorrection or regression occurred in group Ⅰ, but there was undercorrection in group Ⅱ. The ratio within ±1 00 D of emmetropia after 1 year was 68 3% in group Ⅰ and 51 1% in group Ⅱ. The UCVA above 0 5 was over 90 0% in all eyes. Eight eyes (9 0%) lost two or more lines of BCVA. The serious complication after RLASIK was keratoconus of 3 eyes in group Ⅱ. Conclusions The risk factors which lead to retreatment after FLASIK are high myopia with astigmatism before FLKSIK and the reaction to the operation. In this study, RLKSIK is safe, effective, predictable and accurate for ≤-10 00 D correction in FLASIK. But, to prevent the occurrence of serious complication such as keratoconus, it is better not to perform RLASIK for >-10 00 D in FLASIK.

关 键 词：准分子激光原位角膜磨镶术 再手术 屈光度数欠矫 屈光度数回退 

分 类 号：R779.63[医药卫生—眼科]