薄角膜的近视散光眼行准分子激光原位角膜磨镶术后角膜生物力学状态长期观察  

Long-Term Observation on Corneal Biomechanical Status of Eyes with Thin Corneas after Laser in Situ Keratomileusis (LASIK)

作　　者：宋耀文[1] 贺瑞[2] 周迎霞[2] 

机构地区：[1]山西医科大学,太原市030001 [2]山西省眼科医院准分子激光科

出　　处：《中国激光医学杂志》2017年第2期74-79,116,共7页Chinese Journal of Laser Medicine & Surgery

基　　金：国家自然科学基金青年基金项目(11402161);山西省科技攻关计划项目(20120313025-3);山西省卫生厅科技攻关项目(201201018)

摘　　要：目的探讨薄角膜(<500μm)近视散光眼行准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)后长期(≥60个月)的角膜生物力学状态、手术的安全性、有效性及准确性。方法选取1998年9月至2010年9月,行LASIK手术且资料完整的薄角膜患者89例175只眼,观察术前及术后末次的裸眼视力(uncorrected visual acuity,UCVA)、矫正视力(corrected distance visual acuity,CDVA)、球镜度数、散光度数、等效球镜度数(spherical equivalent,SE),以及术前的中央角膜厚度(central corneal thickness,CCT)及术后末次复查时的CCT、角膜瓣厚度与剩余基质床厚度(residual stromal bed thickness,RSBT)及角膜地形图。计算安全指数、有效指数、准确性以及角膜瓣厚度+切削深度)/术前中央角膜厚度(Percent Tissue Altered,PTA)与剩余基质床厚度/术前中央角膜厚度(Percentage stromal bed thickness,PSBT)结果安全指数为1.09,有效指数为0.99,末次复查的SE在±0.50D、±1.00D范围之内的百分比分别为71.2%、87.7%,PTA为20%~55%(40%±6%),PSBT为51%~85%(61%±9%),无术眼发生继发性圆锥角膜。结论 PSBT达到50%及以上时,薄角膜(459~499μm)近视散光眼行LASIK术后角膜生物力学状态长期稳定,且安全有效。Objective To investigate the long-term （ ≥ 5 years） corneal biomechanical state and the safety, efficacy and accuracy of laser in situ keratomileusis （LASIK） in eyes with thin corneas （central corneal thickness （CCT） 〈 500 μm）. Methods One-hundred and seventy five eyes of 89 patients who had thin corneas and underwent LASIK at least 5 years ago were se- lected. Preoperative parameters recorded include uncorrected visual acuity （UCVA）, corrected distance visual acuity （CDVA）, mani- fest refraction and CCT. At returning visits, in addition to visual acuity and manifest refraction, ultrasound CCT and corneal topography were performed. Optical coherence tomography was used to measure the CCT, LASIK flap thickness and residual stromal bed thickness （RSBT）. Safety index, efficacy index, percentage of eyes within ±0. 5 D and ± 1.0 D of refraction, percent tissue altered （ PTA）, and percentage stromal bed thickness （PSBT） were calculated. Results The safety index was 1.09 and efficacy index 0. 99. The percentages of eyes within ±0. 5 D and ± 1.0 D were 71.2% and 87.7% respectively. The mean PTA was （40% ~6%） （range 20% to 55%） and mean PSBT （61% ~ 9%） （range 51% to 85% ）. No eye developed ectasia. Conclusions When the PSBT was 50% or more, cornea biomechanical state was stable and LASIK was safe at least during 60 months ＂follow-up.

关 键 词：准分子激光原位角膜磨镶术 薄角膜 PTA PSBT 

分 类 号：R779.63[医药卫生—眼科]