CAJ | 학술논문

目的评价准分子激光角膜上皮瓣下磨镶术(LASEK)治疗超高度近视的临床效果和安全性.方法回顾性系列病例研究.33例超高度近视患者(56只眼)接受LASEK手术.术前平均等效球镜度为(-11.70±1.59)D,手术切削光区平均为(5.3 ±0.51)mm.手术设计量:球镜度数较术前球镜度数平均减少2.95%±0.29%,柱镜度数不变.切削深度平均为(146.1±29.3)μm.乙醇浸润时间平均为(29.2±2.8)s.术后1、3、6和12个月随访,分别检测最佳矫正视力(BCVA)、裸眼视力(UCVA)、屈光状态、角膜上皮下雾状混浊、眼压等情况,对数据采用方差分析法进行统计学分析.结果术后6个月UCVA≥1.0者占50.0%,≥0.6者占78.6%;术后1年UCVA≥1.0者占41.1%,≥0.6者占73.2%.术后1、3、6个月和1年UCVA平均分别为0.85±0.20、0.88±0.28、0.84±0.26、0.83±0.28,转化成lgMAR视力进行统计学处理,术后不同时间裸眼视力之间比较差别无统计学意义(F=0.749,P=0.518).术后6和12个月UCVA与术前BCVA相比较,不变或提高和下降分别为71.4%和28.6%、64.3%和35.7%;有效指数术后6和12个月分别为0.994和0.992.术后BCVA与术前比较,不变或提高与下降在术后6和12个月均分别为85.3%和14.7%、84.8%和15.2%.术后1、3、6和12个月BCVA平均分别为0.90 ±0.17、0.94±0.24、0.95 ±0.16、0.96±0.16,转化成lgMAR视力进行统计学处理,术后不同时间BCVA比较,差异无统计学意义(F=1.567,P=0.229).术后6和12个月安全指数均为1.009,1.010.术后3、6和12个月屈光回退发生率分别为19.6%、28.6%和30.3%,发生屈光回退眼的平均屈光度数分别为(-1.20±1.08)、(-1.23±0.75)、(-1.49±1.04)D.角膜上皮下雾状浑浊情况:术后3个月角膜上皮下雾状浑浊0.5级者12只眼(21.4%),术后6个月,0.5级和1级分别为8.9%和5.4%,术后12个月,角膜上皮下雾状浑浊0.5级为12.5%,无1级以上者.术后用糖皮质激素所致高眼压发生率为8.9%.结论 LASEK治疗超高度近视安全有效. 目的評價準分子激光角膜上皮瓣下磨鑲術(LASEK)治療超高度近視的臨床效果和安全性.方法迴顧性繫列病例研究.33例超高度近視患者(56隻眼)接受LASEK手術.術前平均等效毬鏡度為(-11.70±1.59)D,手術切削光區平均為(5.3 ±0.51)mm.手術設計量:毬鏡度數較術前毬鏡度數平均減少2.95%±0.29%,柱鏡度數不變.切削深度平均為(146.1±29.3)μm.乙醇浸潤時間平均為(29.2±2.8)s.術後1、3、6和12箇月隨訪,分彆檢測最佳矯正視力(BCVA)、裸眼視力(UCVA)、屈光狀態、角膜上皮下霧狀混濁、眼壓等情況,對數據採用方差分析法進行統計學分析.結果術後6箇月UCVA≥1.0者佔50.0%,≥0.6者佔78.6%;術後1年UCVA≥1.0者佔41.1%,≥0.6者佔73.2%.術後1、3、6箇月和1年UCVA平均分彆為0.85±0.20、0.88±0.28、0.84±0.26、0.83±0.28,轉化成lgMAR視力進行統計學處理,術後不同時間裸眼視力之間比較差彆無統計學意義(F=0.749,P=0.518).術後6和12箇月UCVA與術前BCVA相比較,不變或提高和下降分彆為71.4%和28.6%、64.3%和35.7%;有效指數術後6和12箇月分彆為0.994和0.992.術後BCVA與術前比較,不變或提高與下降在術後6和12箇月均分彆為85.3%和14.7%、84.8%和15.2%.術後1、3、6和12箇月BCVA平均分彆為0.90 ±0.17、0.94±0.24、0.95 ±0.16、0.96±0.16,轉化成lgMAR視力進行統計學處理,術後不同時間BCVA比較,差異無統計學意義(F=1.567,P=0.229).術後6和12箇月安全指數均為1.009,1.010.術後3、6和12箇月屈光迴退髮生率分彆為19.6%、28.6%和30.3%,髮生屈光迴退眼的平均屈光度數分彆為(-1.20±1.08)、(-1.23±0.75)、(-1.49±1.04)D.角膜上皮下霧狀渾濁情況:術後3箇月角膜上皮下霧狀渾濁0.5級者12隻眼(21.4%),術後6箇月,0.5級和1級分彆為8.9%和5.4%,術後12箇月,角膜上皮下霧狀渾濁0.5級為12.5%,無1級以上者.術後用糖皮質激素所緻高眼壓髮生率為8.9%.結論 LASEK治療超高度近視安全有效.
목적 평개준분자격광각막상피판하마양술(LASEK)치료초고도근시적림상효과화안전성.방법 회고성계렬병례연구.33례초고도근시환자(56지안)접수LASEK수술.술전평균등효구경도위(-11.70±1.59)D,수술절삭광구평균위(5.3 ±0.51)mm.수술설계량:구경도수교술전구경도수평균감소2.95%±0.29%,주경도수불변.절삭심도평균위(146.1±29.3)μm.을순침윤시간평균위(29.2±2.8)s.술후1、3、6화12개월수방,분별검측최가교정시력(BCVA)、라안시력(UCVA)、굴광상태、각막상피하무상혼탁、안압등정황,대수거채용방차분석법진행통계학분석.결과 술후6개월UCVA≥1.0자점50.0%,≥0.6자점78.6%;술후1년UCVA≥1.0자점41.1%,≥0.6자점73.2%.술후1、3、6개월화1년UCVA평균분별위0.85±0.20、0.88±0.28、0.84±0.26、0.83±0.28,전화성lgMAR시력진행통계학처리,술후불동시간라안시력지간비교차별무통계학의의(F=0.749,P=0.518).술후6화12개월UCVA여술전BCVA상비교,불변혹제고화하강분별위71.4%화28.6%、64.3%화35.7%;유효지수술후6화12개월분별위0.994화0.992.술후BCVA여술전비교,불변혹제고여하강재술후6화12개월균분별위85.3%화14.7%、84.8%화15.2%.술후1、3、6화12개월BCVA평균분별위0.90 ±0.17、0.94±0.24、0.95 ±0.16、0.96±0.16,전화성lgMAR시력진행통계학처리,술후불동시간BCVA비교,차이무통계학의의(F=1.567,P=0.229).술후6화12개월안전지수균위1.009,1.010.술후3、6화12개월굴광회퇴발생솔분별위19.6%、28.6%화30.3%,발생굴광회퇴안적평균굴광도수분별위(-1.20±1.08)、(-1.23±0.75)、(-1.49±1.04)D.각막상피하무상혼탁정황:술후3개월각막상피하무상혼탁0.5급자12지안(21.4%),술후6개월,0.5급화1급분별위8.9%화5.4%,술후12개월,각막상피하무상혼탁0.5급위12.5%,무1급이상자.술후용당피질격소소치고안압발생솔위8.9%.결론 LASEK치료초고도근시안전유효.
Objective To assess the clinical efficacy and safety of LASEK in the treatment of super high myopia.Methods It was a retrospective case series study.Fifty-six eyes of 33 cases with super high myopia were treated with LASEK.Mean spherical equivalent preoperative was(-11.70±1.59)D(range from-10.0 D to-15.13 D),mean ablation zone was(5.3±0.51)mm(range from 4.3 mm to 6.0 mm),mean ablation depth was(146.1±29.3)μm.The mean time of alcohol used treatment was (29.2±2.8)seconds.Postoperative follow-up assessments were performed at 1,3,6 and 12 months after surgery.Postoperative measurements included slit-lamp microscopy,manifest refraction,un-corrected visual acuity(UCVA),best corrected visual acuity(BCVA),intraocular pressure and haze,etc.The time of follow-up was more than one year.The results were analyzed with ANOVA by SPSS software.Results Fifty percent of eyes obtained UCVA of ≥1.0,and 78.6% of eyes obtained UCVA ≥0.6,at six months after operation.Forty-one percent eyes obtained UCVA of ≥11.0,and 73.2% eyes obtained UCVA ≥0.6 at one year postoperatively.The mean UCVA in Snellen chart was 0.85±0.20,0.88±0.28,0.84±0.26 and 0.83±0.28 at 1,3,6 and 12 months after operation,respectively.These data were transformed into lgMAR visual acuity and analyzed statistically.There was no significant statistically difference between UCVA at different follow-up periods(F=0.749,P=0.518).The postoperative UCVA compared to preoperative BCVA being the same/or improved in 71.4% eyes and decreased in 28.6% eyes at six months after operation;and was 64.3%,and 35.7% at one year after operation,respectively.The effective index was 0.994 and 0.992 at six and twelve months after operation,respectively.The postoperative BCVA compared to preoperative being the same(or improved)and decreased at six and twelve months after operation was 85.3%vs.14.7%,and 84.8% vs.15.2%,respectively.The mean BCVA in Snellen chart was 0.90±0.17,0.94±0.24,0.95±0.16 and 0.96±0.16 at 1,3,6 and 12 months after operation,respectively.These data were transformed into lgMAR visual acuity and analyzed statistically.There was no significant statistically difference between lgMAR BCVA at difference different follow-up periods(F=1.567,P=0.229).The safe index at 6 and 12 months were 1.009 and 1.010.The incidence of refraction regression at 3,6 and 12 months after operation was 19.6%,28.6% and 30.3%,respectively.Mean regressive diopter in regressed eyes at 3,6 and 12 months after operation was(-1.20±1.08)D,(-1.23±0.75)D,(-1.49±1.04)D,respectively.Haze grade 0.5 was 21.4% at 3 months after operation;grade 0.5 and 1 were 8.9% and 5.4% at 6 months after operation,respectively,at 6 months after operation.Haze grade 0.5 was 12.5% at one year after operation.The incidence of high intraocular pressure induced by topical use of corticosteroid eye drop was 8.9%.Conclusions LASEK is a safe and effective procedure for correction of super high myopia,though there is still some regression happened after operation and the intraocular pressure should be observed during the follow-up periods.