去瓣LASEK治疗高度近视的5年疗效观察  

Five- year follow- up of free- flap LASEK for treatment of high myopia

作　　者：陈丽华[1,2] 

机构地区：[1]三峡大学第一临床医学院 [2]宜昌市中心人民医院眼视光学专科,中国湖北省宜昌市443003

出　　处：《国际眼科杂志》2015年第9期1539-1541,共3页International Eye Science

摘　　要：目的：探讨去瓣准分子激光上皮下角膜磨镶术（LASEK）治疗高度近视的远期疗效。方法：随机选择在我院行LASEK治疗、术后随访达5a的高度近视患者209例277眼。将其按屈光度两组：组Ⅰ〈-9.00D（115例145眼）,组Ⅱ≥-9.00D（94例132眼）。术后1、5d,1wk,1、3、6mo,1、2、5a对其症状、裸眼及矫正视力、屈光状态、角膜并发症、眼压等情况进行随诊观察。结果：去瓣LASEK术后5d,所有患者角膜上皮均愈合。96.3%患者术后1-3d以上出现眼磨痛、畏光、流泪、异物感等刺激症状,但都可耐受。术后5a裸眼视力：组Ⅰ≥1.0者为131眼（90.3%）,≥0.8者为145眼（100%）;组Ⅱ≥1.0者为104眼（78.8%）,≥0.8者为119眼（90.2%）,≥0.6者为129眼（97.7%）,〈0.6者3眼（2.3%）。屈光度：术后6mo两组屈光度趋于稳定,术后5a与术后6mo比较差异无统计学意义（P〉0.05）,术后各时间点与术前比较差异均有统计学意义（P〈0.01）。两组术后屈光度有向近视回退的趋势,但两组术中、术后均无严重并发症,其并发症主要为haze、屈光回退和高眼压。结论：去瓣LASEK能安全、有效地矫正高度近视,但对超高度近视患者应持谨慎态度。AIM： To evaluate the long-term outcomes of free-flap laser subepithelial keratomileusis （LASEK） for treatment of high myopia. METHODS： Two hundred and nine patients （277 eyes） with high myopia were treated with free-flap LASEK in our hospital, each patient was followed up for 5a. Patients were divided into two groups including group Ⅰ with high myopia （〈-9.00D, 145 eyes of 115 cases） and group Ⅱ（ ≥ -9.00D, 132 eyes of 94 cases）. All patients were evaluated at 1,5d, lwk, 1,3, 6mo, 1,2 and 5a after surgery. The postoperative irritation, uncorrected and corrected visual acuity, refractive status, corneal complications, intraocular pressure were observed and analyzed. RESULTS： On the fifth day after surgery, all epithelial flaps were nearly transparent and 96. 3% patients had postoperative irritation symptom such as wear eye pain, photophobia, tearing, foreign body sensation but all could tolerate. Five years after operation, 131 eyes （90.3%） had uncorrected visual acuity （UCVA） of ≥1.0, 145 eyes （100%） ≥0. 8 in group Ⅰ ; 104 eyes （78. 8%） had UCVAof ≥1.0, 119 eyes （90.2%） ≥0. 8, 129 eyes （97.7%） ≥0. 6 and 3 eyes （2. 3%） 〈0.6 in group 11. The diopter tended to be stable in both groups after 6mo and there was no statistically significant difference after 6too and 5a （P〉0. 05）, but there was statistical significance difference between each time point of postoperative and preoperative （P〈 0.01 ）. The two groups had refraction regression, but had no serious intraoperative and postoperative complications, the main complications included haze, refractive regression and high intraocular pressure. CONCLUSION： Free-flap LASEK is one of methods to treat eyes with high myopia safely and effectively, but should be cautious for super-high myopia.

关 键 词：角膜 近视 角膜磨镶术 上皮下 激光 

分 类 号：R779.6[医药卫生—眼科]