高度近视患者的视野改变及屈光性角膜手术的效果观察  

Visual field changes and effects of refractive corneal surgery on high myopia

作　　者：张百珂[1] 

机构地区：[1]解放军153医院眼科,郑州450000

出　　处：《临床眼科杂志》2017年第4期322-324,共3页Journal of Clinical Ophthalmology

摘　　要：目的观察高度近视患者的视野改变特点,并对飞秒激光小切口角膜基质透镜取出术(SMILE)和准分子激光原位角膜磨镶术(LASIK)的术后效果进行探讨与评价。方法选取2010年1月至2013年10月于本院接受屈光性角膜手术的高度近视患者120例(共214只眼)为研究对象。视野检查总结视野改变特点。将120例患者随机分为观察组(103只眼)与对照组(111只眼)各60例。观察组采用SMILE术,对照组采用LASIK术。对比两组术后的视力改善情况。结果被检查214只眼中53只眼(24.8%)视野正常。161只眼(75.2%)视野显示不同程度的缺损。视野缺损特征包括:上方缺损59只眼(36.6%),下方缺损28只眼(17.4%),与盲点相连的束状缺损15只眼(9.3%),盲点外露11只眼(6.8%),向心性缩小9只眼(5.6%),旁中心暗点5只眼(3.1%),不规则缺损44只眼(27.3%)。术后3个月时两组的裸眼视力分别为(0.78±0.31)、(0.62±0.24),矫正视力分别为(0.12±0.39)、(0.79±0.33),角膜屈光力分别为(39.74±5.63)、(32.13±5.04),屈光度分别为(-0.23±0.06)、(-0.74±0.23);组间比较观察组的裸眼视力、矫正视力、角膜屈光力及屈光度均高于对照组,差异具有统计学意义(P<0.05)。观察组治愈率为87.4%,对照组为66.7%,组间比较差异具有显著性(P<0.05)。结论高度近视患者的视野变化以颞上方缺损最为多见,同时具有多样性、不规则性等个体差异。SMILE对于患者视力的改善效果要优于LASIK。Objective To investigate changes in visual field of patients with high myopia and to evaluate SMILE and LASIK surgeries in treating high myopia. Methods 120 cases （214 eyes ） of patients with high myopia underwent corneal refractive surgery in our hospital between January 2010 and October 2013 were selected. Visual field changes were observed and analyzed. Patients randomly received SMILE （ n = 111 eyes） or LASIK surgery （ n = 103 eyes）. Visual acu- ity was assessed and compared between the 2 groups. Results 53 eyes in the 214 eyes had normal visual field （ 24.8% ）. 161 eyes （75.2%） showed varied degrees of defect. Visual field defects were in upper field （59 eyes or 36.6% ） , lower field （28 eyes or 17.4% ） , or presented as beam defects connected to the physiological blind spot （ 15 eyes or 9.3% ） , blind spot expanding （ 11 eyes or 6.8% ） , centrally shrinking （ 9 eyes or 5.6% ） , central scotoma （ 5 eyes, 3.1% ） , or ir- regular defects （44 eyes or 27.3% ）. 3 months after surgery, the uncorrected visual acuity of the 2 groups were 0. 78 ± 0. 31 and 0. 62 ±0. 24 respectively. Corrected visual acuity were 0. 12 ±0. 39 and 0. 79 ±0. 33, and cornea refractive pow- er were 39.74 ± 5.63 and 32.13 ± 5.04. Refractive diopter were - 0. 23 ± 0.06 and - 0. 74 ± 0. 23. All these visual function measurements were better in SMILE group （ P 〈 0. 05）. The cure rate was 87.4% in SMILE group and 66.7% in LASIK group （ P 〈 0. 05 ）. Conclusions Patients with high myopia often suffer temporal upper visual field defects. Variation of the defects is also common. SMILE is better than LASIK on the improvement of visual acuity.

关 键 词：高度近视 视野改变 飞秒激光小切口角膜基质透镜取出术 准分子激光原位角膜磨镶术 

分 类 号：R779.6[医药卫生—眼科]