CAJ | 학술논문

目的探讨机械刀完成的薄瓣准分子激光原位角膜磨镶术(LASIK)矫正放射状角膜切开术(RK)后屈光不正的安全性、有效性与可预测性.方法回顾性系列病例研究.RK近视矫正术后视功能下降要求再次手术矫正的病例27例(38眼),近视20眼,远视18眼,其中22眼合并不规则散光.RK术后11～24年,年龄38～53岁,等效球镜度-9.50～+4.25 D,放射状角膜切口8～32条,角膜厚度512～557 μm.应用OUP-SBK角膜板层刀制作角膜瓣,采用Allegretto准分子激光治疗系统进行基质切削.合并不规则散光病例应用角膜地形图引导的个性化切削,其他的采用优化模式进行切削.数据采用配对t检验和单因素方差分析进行比较.结果术中未发生角膜瓣游离、纽扣瓣、不全瓣以及角膜瓣碎裂,未发生眼球破裂.角膜瓣厚度( 102.0±7.7) μm.角膜基质平滑,9眼角膜上皮边缘缺损,7眼角膜边缘出血.术后第1天角膜瓣透明,上皮完整,术后1d、1周、1个月、6个月裸眼视力大于或等于术前最佳矫正视力(BCVA)的比例分别为63％、82％、88％、87％.38眼术后的BCVA均大于或等于术前BCVA.进行角膜地形图引导的个体化切削的22眼,术后治疗区偏移及治疗光学区过小等情况得到了不同程度的矫正,手术前后彗差、总高阶像差明显减小(t=-3.70、4.10,P＜0.01),3.0 c/d及18.0 c/d频率上的对比敏感度差异有统计学意义(t=-2.45、-3.24,P＜0.01).结论放射状角膜切开术后出现的视功能下降采用机械刀薄瓣LASIK再次手术矫正安全、有效,同时可明显地改善部分患者的视觉质量.
목적 탐토궤계도완성적박판준분자격광원위각막마양술(LASIK)교정방사상각막절개술(RK)후굴광불정적안전성、유효성여가예측성.방법 회고성계렬병례연구.RK근시교정술후시공능하강요구재차수술교정적병례27례(38안),근시20안,원시18안,기중22안합병불규칙산광.RK술후11～24년,년령38～53세,등효구경도-9.50～+4.25 D,방사상각막절구8～32조,각막후도512～557 μm.응용OUP-SBK각막판층도제작각막판,채용Allegretto준분자격광치료계통진행기질절삭.합병불규칙산광병례응용각막지형도인도적개성화절삭,기타적채용우화모식진행절삭.수거채용배대t검험화단인소방차분석진행비교.결과 술중미발생각막판유리、뉴구판、불전판이급각막판쇄렬,미발생안구파렬.각막판후도( 102.0±7.7) μm.각막기질평활,9안각막상피변연결손,7안각막변연출혈.술후제1천각막판투명,상피완정,술후1d、1주、1개월、6개월라안시력대우혹등우술전최가교정시력(BCVA)적비례분별위63％、82％、88％、87％.38안술후적BCVA균대우혹등우술전BCVA.진행각막지형도인도적개체화절삭적22안,술후치료구편이급치료광학구과소등정황득도료불동정도적교정,수술전후혜차、총고계상차명현감소(t=-3.70、4.10,P＜0.01),3.0 c/d급18.0 c/d빈솔상적대비민감도차이유통계학의의(t=-2.45、-3.24,P＜0.01).결론 방사상각막절개술후출현적시공능하강채용궤계도박판LASIK재차수술교정안전、유효,동시가명현지개선부분환자적시각질량.
Objective To evaluate the safety,efficacy,and predictability of mechanical automated microkeratome laser in situ keratomileusis (LASIK) in eyes underwent radial keratotomy (RK).Methods In this retrospective case-series study,38 eyes of 27 patients who had undergone RK were performed automated microkeratome One Use-Plus LASIK,including 20 myopic eyes and 18 hyperopic eyes,among them 22 eyes with irregular astigmatism.The patients were 11-24 years after RK,38-53 years old,The mean spherical equivalent was -9.50-+4.25 D,the number of RK incisions was 8-32,the cornea thickness was 512-557 μm.An Allegretto system was used. Data were analyzed using a paired samples t test and a one-way ANOVA. Results No free flap,incomplete flap and flap or eye ball broken happened during the surgeries.The flap thickness was (102.0±7.7)μm.The stromal bed was smooth,9 eyes with corneal epithelial border defect was found and 7 eyes with cornea bleeding.The percentage of uncorrected visual acuity equal to or better than preoperative best corrected visual acuity (BCVA) at 1 day,1 week,1 month and 6 months after surgery was 63％,82％,88％ and 87％.Postoperative BCVA post surgery of all the 38 eyes were equal to or better than BCVA before surgery.Excursion or undersize of the operation field in 22 eyes which received corneal topography guided individual surgery was corrected in varying degree.The coma,total higher-order aberration were reduced obviously after surgery (t=-3.70,4.10,P＜0.01).The significant difference of contrast sensitivity was found in the frequency of 3.0 c/d and 18.0 c/d (t=-2.45,-3.24,P＜0.01).Conclusion Automated microkeratome One Use-Plus LASIK is an effective and safe method to treat post-RK poor visual outcomes.