中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2013年
8期
711-715
,共5页
散光%角膜磨镶术,激光原位%激光,准分子%激光,飞秒%眼球运动
散光%角膜磨鑲術,激光原位%激光,準分子%激光,飛秒%眼毬運動
산광%각막마양술,격광원위%격광,준분자%격광,비초%안구운동
Astigmatism%Keratomileusis,laser in situ%Lasers,excimer%Laser,femtosecond%Eye movements
目的 探讨实时虹膜识别引导的飞秒激光制瓣准分子激光原位角膜磨镶术(LASIK)治疗近视性散光的准确性、稳定性、安全性.方法 回顾性系列病例研究.接受实时虹膜识别引导飞秒激光制瓣LASIK的近视性散光患者136例(249只眼),按术前柱镜度数分为3个组:低度组106只眼(-0.75～-1.25 D),中度组89只眼(-1.50～-2.25 D),高度组54只眼(-2.50～-5.00 D);同时按术前柱镜轴向分为3个组,柱镜轴向在180°±22.5°之间的近视性散光为顺规组(156只眼)；轴向在90°±22.5°之间的近视性散光为逆规组(64只眼)；轴向在45°±22.5°之间的近视性散光为斜轴组(29只眼).手术前应用波阵面像差仪进行小瞳孔下虹膜摄像,将数据导人准分子激光仪,掀瓣前进行静态虹膜识别,掀瓣后激光切削时以25 Hz眼球旋转跟踪频率进行动态虹膜识别,观察患者术后1、3、6个月的裸眼视力、最佳矫正视力、散光度、散光轴向的变化.配对设计均数采用配对t检验,多组均数比较采用单因素方差分析,计数资料采用卡方检验,多个构成比比较采用R×C表卡方检验.结果 静态虹膜识别检测出眼球旋转偏移角度为2.37°±2.16°,动态虹膜识别检测出眼球旋转变化范围为0～4.3°,术中对其加以补偿.术后6个月时,裸眼视力均≥0.5,术后最佳矫正视力均未丢失,术中术后均未产生严重并发症；裸眼视力≥术前最佳矫正视力的患者227只眼(91.16％),裸眼视力≥术前最佳矫正视力l行以上的患者87只眼(34.94％)；散光度数由术前(-1.72±0.77)D减少为术后(-0.29±0.25)D(F=2.16,P＞0.05).低、中、高度组术后1个月散光度数分别为(-0.23±0.21)、(-0.31±0.27)、(-0.37 ±0.34)D,均较术前明显降低(t=7.35,7.74,6.52；P＜0.01).术后6个月时,顺规散光下降为43只眼(17.27％),逆规散光下降为28只眼(11.25％),斜轴散光上升为34只眼(13.65％),144只眼(57.83％)成为无散光眼,与术后1个月相比,差异无统计学意义(x2 =1.28,P＞0.05).结论 实时虹膜识别引导的飞秒激光制瓣LASIK能够有效校正患者平卧后和手术中眼球的旋转偏差,使散光度数和轴向的治疗更加精确,同时能够减少术后散光的产生.
目的 探討實時虹膜識彆引導的飛秒激光製瓣準分子激光原位角膜磨鑲術(LASIK)治療近視性散光的準確性、穩定性、安全性.方法 迴顧性繫列病例研究.接受實時虹膜識彆引導飛秒激光製瓣LASIK的近視性散光患者136例(249隻眼),按術前柱鏡度數分為3箇組:低度組106隻眼(-0.75～-1.25 D),中度組89隻眼(-1.50～-2.25 D),高度組54隻眼(-2.50～-5.00 D);同時按術前柱鏡軸嚮分為3箇組,柱鏡軸嚮在180°±22.5°之間的近視性散光為順規組(156隻眼)；軸嚮在90°±22.5°之間的近視性散光為逆規組(64隻眼)；軸嚮在45°±22.5°之間的近視性散光為斜軸組(29隻眼).手術前應用波陣麵像差儀進行小瞳孔下虹膜攝像,將數據導人準分子激光儀,掀瓣前進行靜態虹膜識彆,掀瓣後激光切削時以25 Hz眼毬鏇轉跟蹤頻率進行動態虹膜識彆,觀察患者術後1、3、6箇月的裸眼視力、最佳矯正視力、散光度、散光軸嚮的變化.配對設計均數採用配對t檢驗,多組均數比較採用單因素方差分析,計數資料採用卡方檢驗,多箇構成比比較採用R×C錶卡方檢驗.結果 靜態虹膜識彆檢測齣眼毬鏇轉偏移角度為2.37°±2.16°,動態虹膜識彆檢測齣眼毬鏇轉變化範圍為0～4.3°,術中對其加以補償.術後6箇月時,裸眼視力均≥0.5,術後最佳矯正視力均未丟失,術中術後均未產生嚴重併髮癥；裸眼視力≥術前最佳矯正視力的患者227隻眼(91.16％),裸眼視力≥術前最佳矯正視力l行以上的患者87隻眼(34.94％)；散光度數由術前(-1.72±0.77)D減少為術後(-0.29±0.25)D(F=2.16,P＞0.05).低、中、高度組術後1箇月散光度數分彆為(-0.23±0.21)、(-0.31±0.27)、(-0.37 ±0.34)D,均較術前明顯降低(t=7.35,7.74,6.52；P＜0.01).術後6箇月時,順規散光下降為43隻眼(17.27％),逆規散光下降為28隻眼(11.25％),斜軸散光上升為34隻眼(13.65％),144隻眼(57.83％)成為無散光眼,與術後1箇月相比,差異無統計學意義(x2 =1.28,P＞0.05).結論 實時虹膜識彆引導的飛秒激光製瓣LASIK能夠有效校正患者平臥後和手術中眼毬的鏇轉偏差,使散光度數和軸嚮的治療更加精確,同時能夠減少術後散光的產生.
목적 탐토실시홍막식별인도적비초격광제판준분자격광원위각막마양술(LASIK)치료근시성산광적준학성、은정성、안전성.방법 회고성계렬병례연구.접수실시홍막식별인도비초격광제판LASIK적근시성산광환자136례(249지안),안술전주경도수분위3개조:저도조106지안(-0.75～-1.25 D),중도조89지안(-1.50～-2.25 D),고도조54지안(-2.50～-5.00 D);동시안술전주경축향분위3개조,주경축향재180°±22.5°지간적근시성산광위순규조(156지안)；축향재90°±22.5°지간적근시성산광위역규조(64지안)；축향재45°±22.5°지간적근시성산광위사축조(29지안).수술전응용파진면상차의진행소동공하홍막섭상,장수거도인준분자격광의,흔판전진행정태홍막식별,흔판후격광절삭시이25 Hz안구선전근종빈솔진행동태홍막식별,관찰환자술후1、3、6개월적라안시력、최가교정시력、산광도、산광축향적변화.배대설계균수채용배대t검험,다조균수비교채용단인소방차분석,계수자료채용잡방검험,다개구성비비교채용R×C표잡방검험.결과 정태홍막식별검측출안구선전편이각도위2.37°±2.16°,동태홍막식별검측출안구선전변화범위위0～4.3°,술중대기가이보상.술후6개월시,라안시력균≥0.5,술후최가교정시력균미주실,술중술후균미산생엄중병발증；라안시력≥술전최가교정시력적환자227지안(91.16％),라안시력≥술전최가교정시력l행이상적환자87지안(34.94％)；산광도수유술전(-1.72±0.77)D감소위술후(-0.29±0.25)D(F=2.16,P＞0.05).저、중、고도조술후1개월산광도수분별위(-0.23±0.21)、(-0.31±0.27)、(-0.37 ±0.34)D,균교술전명현강저(t=7.35,7.74,6.52；P＜0.01).술후6개월시,순규산광하강위43지안(17.27％),역규산광하강위28지안(11.25％),사축산광상승위34지안(13.65％),144지안(57.83％)성위무산광안,여술후1개월상비,차이무통계학의의(x2 =1.28,P＞0.05).결론 실시홍막식별인도적비초격광제판LASIK능구유효교정환자평와후화수술중안구적선전편차,사산광도수화축향적치료경가정학,동시능구감소술후산광적산생.
Objective To assess the safety,efficacy,stability and changes in cylindrical degree and axis after real-time iris recognition guided LASIK with femtosecond laser flap creation for the correction of myopic astigmatism.Methods Retrospective case series.This observational case study comprised 136 patients (249 eyes) with myopic astigmatism in a 6-month trial.Patients were divided into 3 groups according to the pre-operative cylindrical degree:Group 1,-0.75 to-1.25 D,106 eyes;Group 2,-1.50 to-2.25 D,89 eyes and Group 3,-2.50 to-5.00 D,54 eyes.They were also grouped by pre-operative astigmatism axis:Group A,with the rule astigmatism (WTRA),156 eyes; Group B,against the rule astigmatism (ATRA),64 eyes;Group C,oblique axis astigmatism,29 eyes.After femtosecond laser flap created,real-time iris recognized excimer ablation was performed.The naked visual acuity,the bestcorrected visual acuity,the degree and axis of astigmatism were analyzed and compared at 1,3 and 6 months postoperatively.Results Static iris recognition detected that eye cyclotorsional misalignment was 2.37° ± 2.16°,dynamic iris recognition detected that the intraoperative cyclotorsional misalignment range was 0-4.3°.Six months after operation,the naked visual acuity was 0.5 or better in 100％ cases.No eye lost ≥ 1 line of best spectacle-corrected visual acuity (BSCVA).Six months after operation,the naked vision of 227 eyes surpassed the BSCVA,and 87 eyes gained 1 line of BSCVA.The degree of astigmatism decreased from (-1.72 ± 0.77) D (pre-operation) to (-0.29 ± 0.25) D (post-operation).Six months after operation,WTRA from 157 eyes (pre-operation) decreased to 43 eyes (post-operation),ATRA from 63 eyes (pre-operation) decreased to 28 eyes (post-operation),oblique astigmatism increased from 29 eyes to 34 eyes and 144 eyes became non-astigmatism.Conclusions The real-time iris recognition guided LASIK with femtosecond laser flap creation can compensate deviation from eye cyclotorsion,decrease iatrogenic astigmatism,and provides more precise treatment for the degree and axis of astigmatism.It is an effective and safe procedure for the treatment of myopic astigmatism.
