硬性透气性角膜接触镜矫正圆锥角膜疗效分析

目的 探讨硬性透气性角膜接触镜(RGP)矫正圆锥角膜的临床疗效及安全性.方法 对2004～2010年视光门诊应用RGP矫正的63例圆锥角膜患者,男41例,女22例.年龄16-35岁,平均年龄(24.6±7.81)岁.双眼57例,单眼6例.对散光度明显增大,框架眼镜矫正视力下降的患者应用电脑验光仪、角膜地形图仪、角膜内皮镜检测,筛查圆锥角膜病.对确诊及疑似圆锥角膜患者根据角膜圆锥程度采用普通RGP镜或特殊设计圆锥角膜镜进行矫正.测量RGP矫正视力及戴镜验光.应用SPSS13.0统计软件对框架眼镜矫正视力、RGP矫正视力、及配戴RGP前后球镜度、散光度进行统计学分析,P＜0.05为有统计学意义.结果 (1)本组病例框架眼镜矫正视力均值:0.56±0.29,RGP矫正视力均值:0.93±0.20,(t=-14.627,P=0.000),RGP矫正视力明显优于框架矫正视力.(2)配戴RGP前散光均值:(-4.16±2.19)DC,配戴RGP后散光均值:(-0.77±1.2)DC,(t=-14.585,P=0.000),配戴RGP散光度明显降低与配镜前比较差异显著有统计学意义.(3)其中22只眼平均观察3.5年,其中1只眼角膜混浊加重,施板层角膜移植术.其余21只眼角膜散光度降低,有统计学意义.角膜厚度、角膜曲率变化差异无统计学意义.结论 RGP矫正圆锥角膜不规则散光明显提高矫正视力,改善视觉质量,在一定程度上延缓圆锥角膜病的进展.     

RGP对早期圆锥角膜患者屈光状态改变的分析

目的：分析RGP与框架镜对圆锥角膜患者屈光系统的影响及RGP对不同类别(性别、年龄不同)患者的影响,进而探讨RGP的作用。

方法：确诊为早期圆锥角膜患者46例,其中27例为双眼,19例为单眼,共73眼。对患者配戴框架镜及RGP时,视力矫正幅度的差异进行比较; 对配戴RGP前、后分别进行的2次验光的差值进行比较,并针对RGP对不同性别、年龄人群矫正视力的改变值进行统计学分析,对其中44例患者69眼的角膜厚度与正常人进行比较。

结果：配戴框架镜与配戴RGP的患者视力矫正幅度的差异有统计学意义(P<0.05)。患者配戴RGP前2次验光结果的差值与配戴RGP时2次验光结果的差值相比较,差异有统计学意义(P<0.05)。男性与女性矫正视力幅度差异有统计学意义(P<0.05)。25岁以下与大于等于25岁患者矫正视力幅度差异无统计学意义(P>0.05)。确诊患者角膜厚490μm。

结论：(1)配戴RGP患者矫正视力优于配戴框架镜患者。(2)配戴RGP时验光误差小于不戴镜验光。(3)RGP矫正视力男性优于女性。(4)RGP矫正视力与年龄差异无关。(5)圆锥角膜患者角膜中央区厚度变薄。     

非球面高透氧性硬性透气性角膜接触镜矫正特殊类型屈光不正的临床评价

目的:评价非球面高透氧性硬性透气性角膜接触镜(rig idgas-permeable contactlens,RGPCL)矫正特殊类型屈光不正的临床疗效及安全性。方法:收集2009-03/2009-12验配非球面高透氧性RGPCL的特殊屈光不正的患者53例99眼,分为:(1)高度近视组6眼;(2)高度散光8眼;(3)屈光参差组15眼;(4)高度近视+高度散光组(近视≥-6.00D或散光≥-2.00D)10眼;(5)高度近视+高度散光+屈光参差组8眼;(6)圆锥角膜组(确诊为圆锥角膜的患者)48眼;(7)混合散光2眼;(8)特殊类型屈光不正组(角膜屈光手术后)2眼。观察验配RGPCL后的矫正视力,并与框架镜的矫正视力比较。定期复诊,记录矫正视力、镜片配适及配戴情况。结果:本组病例戴框架镜(试镜架)的等效球镜度数为(-8.10±5.38)D,而RGP度数为(-6.50±4.13)D,两者差异有显著性(t=-7.499,P<0.01)。戴RGPCL后的视力矫正视力(LOGMAR)为(0.02±0.09),低于戴框架镜的最佳矫正视力(0.14±0.20)。两者具有统计学差异(t=7.03,P<0.01);戴镜3~6mo后,出现10眼角膜上皮擦伤,3眼镜片丢失。结论:应用非球面RGP可矫正高度近视散光、圆锥角膜及各种原因引起的高度屈光不正,其矫正视力明显优于框架眼镜,并有较高的舒适度和安全性,无明显的并发症发生。     

OCULUS角膜地形图引导下的硬性透氧性角膜接触镜矫治圆锥角膜的验配

目的观察OCULUS角膜地形图相关参数引导下的圆锥角膜患者硬性透氧性角膜接触镜(rigid gas permeable contactlens,RGPCL)的验配。方法 收集2008年6月至2009年12月来我院验配RGPCL的26例(40眼)圆锥角膜患者,根据角膜地形图测得的曲率值选择试戴片并配戴评估确定处方。圆锥角膜患者平均近视度数和散光度数分别为(-7.12±6.12)D和(-3.28±1.57)D。定期复查最佳矫正视力、角膜地形图、眼部健康和主觉症状。所有患者随访6~29个月。结果 所有患者RGPCL平均基弧为(7.40±0.45)mm,平均直径为(9.12±0.24)mm,平均屈光度为(-7.10±3.30)D。最佳矫正视力≤4.5,戴框架眼镜者15眼,戴RGPCL者3眼;最佳矫正视力为4.6~4.9,戴框架眼镜者17眼,戴RGPCL者10眼;矫正视力≥5.0,戴框架镜者为4眼,戴RGPCL者为27眼。平均最佳矫正视力戴RGPCL好于戴框架眼镜,差异有统计学意义(P<0.05)。随访中角膜地形图陡峭曲率值未变者32眼,增加者3眼,减少者5眼。随访中6眼因镜片丢失、2眼因镜片破损而重新定片。所有眼未发现明显并发症发生。结论 利用OCULUS角膜地形图提供的相关参数对圆锥角膜患者进行RGPCL验配,明显提高验配效率;配戴RGPCL后患者的矫正视力改善显著,并有较高的舒适性和镜片稳定性,无明显的并发症发生。     

低度近视性屈光参差不同矫正方式的调节功能研究

目的:研究分别采用单焦框架眼镜与角膜塑形镜矫正低度近视性屈光参差的儿童单眼及双眼调节的差异。方法:回顾性研究。收集2019-11/2020-04于我院眼科门诊就诊的低度近视性屈光参差(1.0D≤双眼等效球镜差<2.5D)儿童47例94眼,其中配戴框架眼镜者27例54眼作为A组,配戴角膜塑形镜者20例40眼作为B组。分别记录并比较两组患儿矫正1mo后的矫正视力及调节参数[调节反应(AR)、调节灵活度(AF)、调节幅度(AMP)]的差异。结果:两组患儿AR测量值均为正值,表现为调节滞后,A组患儿屈光高度眼调节滞后量显著高于屈光低度眼(0.63±0.21D vs 0.25±0.34D,P<0.001),但B组患儿双眼调节滞后量无差异(P=0.104),且两组患儿屈光高度眼与屈光低度眼单眼矫正视力和单眼AMP均无差异(P>0.05)。A组患儿双眼AR差值高于B组(0.38±0.36D vs 0.10±0.26D,P=0.005),双眼AF低于B组(8.22±1.15c/min vs 9.95±0.89c/min,P<0.001),但两组患儿双眼AMP无明显差异(P=0.280)。结论:低度近视性屈光参差儿童配戴角膜塑形镜比单焦框架眼镜矫正可获得更高的双眼调节灵活度,降低双眼调节反应差值,从而维持更协调的双眼调节功能。     

激光角膜屈光术后继发圆锥角膜的临床特征及治疗预后分析

目的 分析激光角膜屈光术后继发圆锥角膜的发病特征和临床表现,并评估其治疗预后。方法 回顾性病例研究。收集2013年1月至2021年12月于山东第一医科大学附属眼科医院(山东省眼科医院)就诊的激光角膜屈光术后继发圆锥角膜的患者27例(54只眼),其中男性患者22例,女性患者5例,4例单眼发病,23例双眼发病,患者年龄为19～48岁,平均(28.6±5.9)岁。分析其发病特征、临床分期、角膜地形图的参数资料、治疗方法和疗效。结果 27例继发圆锥角膜患者术前的屈光手术方式为：准分子激光原位角膜磨镶术(LASIK)24例,准分子激光角膜上皮瓣下磨镶术(LASEK)1例,经上皮准分子激光屈光性角膜切削术(Trans PRK)1例,飞秒激光基质透镜切除术(FLEx)1例。患者接受角膜屈光手术的年龄为15～34岁,平均(19.4±3.6)岁。27例(54只眼)患者中,潜伏期4只眼,初发期16只眼,完成期34只眼。完成期患者均表现出角膜前突变薄,8只眼(24%)可见Fleischer环、7只眼(21%)可见Vogt线。角膜地形图中角膜后表面形态表现为：初发期患者以桥型递增型(38%)和桥型递减型(25...     

常规戴镜和遮盖治疗对单、双眼弱视儿童屈光状态的影响

目的 探讨单眼及双眼弱视患儿通过常规戴镜和遮盖治疗,弱视达基本治愈后屈光状态的变化规律,以探讨弱视眼的正视化特征.方法 回顾性连续观察远视性屈光不正性弱视治愈病例1～10 a共56例(112眼)患者,初诊年龄(5.71±1.67)岁,观察终点年龄(8.77±2.28)岁,平均观察(3.07±1.79)a.选择等效球镜≥+3.00 D的弱视患儿.单眼弱视组弱视眼(38眼)给予所谓健眼遮盖、戴镜联合精细目力训练治疗;双眼弱视组(36眼)给予戴镜及精细目力训练治疗,所谓健眼组38眼未做任何处理.随访观察各组病例屈光度(球镜、柱镜)变化及初诊年龄、治愈年龄、治疗周期分布特点等.结果 单眼弱视组:基本治愈年龄(8.34±2.15)岁,球镜度数平均每年减少(0.46±0.42)DS,柱镜度数减少(0.016±0.143)DC;所谓健眼组每年球镜度数减少(0.28±0.62)DS,柱镜度数减少(0.003±0.067)DC.双眼弱视组:基本治愈年龄(9.67±2.34)岁,球镜度数平均每年减少(0.40±0.32)DS,柱镜度数减少(-0.056±0.237)DC.3组球镜度数及柱镜度数平均每年变化值组间比较,差异均无统计学意义(P＞0.05);所谓健眼组等效球镜数平均每年减少度数与其他2组比较,差异均有统计学意义(均为P＜0.05).单眼弱视组的球镜度数与疗程呈负相关(r=0.428,P＜0.01).结论 常规戴镜和遮盖治疗可减慢单眼弱视所谓健眼的正视化进程,但对弱视眼无显著影响;常规戴镜治疗对双眼弱视眼正视化进程也无明显影响.     

AstraMax角膜地形图在准分子激光手术前筛查圆锥角膜的应用价值

目的评价AstraMax角膜地形图在准分子激光手术前筛查圆锥角膜的应用价值。设计病例系列研究。研究对象拟行准分子激光近视矫正手术患者2202例(4382眼),年龄18～45岁,平均(27.0±0.5)岁。方法患者术前行AstraMax角膜地形图检查,以筛选亚临床期圆锥角膜及可疑圆锥角膜。主要指标角膜地形图,角膜中央屈光力、IS值及角膜厚度。结果共筛选出2例(4眼)亚临床期圆锥角膜,占总体的0.09%;发现可疑圆锥角膜5例(8眼),占总体的0.23%。结论AstraMax角膜地形图检查在圆锥角膜的早期诊断中具有简便、快速、准确的优点,是准分子激光术前筛查的重要检查手段。     

圆锥角膜基质环植入手术前后人工晶状体度数的比较

目的:评估圆锥角膜基质环(keraring 355°)(ICRS)植入术前术后3mo人工晶状体(IOL)度数的计算和生物学特征.方法:队列研究.收集18例(19眼)圆锥角膜接受角膜基质环植入术患者术前及术后3mo数据.分析裸眼视力(UCVA), 最佳矫正视力(BCVA),屈光度,人工晶体度数计算公式,眼轴长度(AL)和角膜曲率.结果:患者平均年龄为29.58±0.6y.裸眼视力由0.84(0.35) LogMAR 显著提高到0.43 (0.31) LogMAR (P<0.001).3mo后,最佳矫正视力和眼轴长度无明显变化.球镜度数,柱镜度数和等效球镜(SE)均显著提高 (P<0.001).另一方面,角膜曲率1(K1)和角膜曲率2(K2)显著下降.3mo后, SRK/II (P<0.001), Hoffer Q (P<0.001) and Holladay I (P<0.001)发生显著变化.结论:角膜基质环植入术后,视力,屈光率和角膜曲率均有所提高,此外,人工晶状体计算公式度数明显改变.然而,角膜基质环植入术过程没有过度干预眼轴长,但降低角膜曲率值使得人工晶状体度数计算更加精确,所有公式得出同一晶状体度数.     

角膜胶原交联技术的临床应用

目的观察角膜胶原交联技术(CXL)的临床应用及治疗效果。方法回顾性分析郑州市第二人民医院2019年1至6月行CXL或屈光手术联合CXL者62例(84只眼)的临床资料。其中圆锥角膜42例(46只眼),采用核黄素及紫外线诱导的快速去上皮CXL;薄角膜及高度近视20例(38只眼),进行角膜屈光手术联合CXL。术后随访12个月,观察并发症并进行对症治疗。结果随访期末,裸眼视力和最佳矫正视力(logMAR)分别由术前的0.95±0.36和0.43±0.21,提高至0.82±0.33和0.31±0.22(t=8.668,8.471;均P<0.05),角膜前表面最大曲率值下降(2.65±2.49)D,手术前后差异有统计学意义(t=7.178,P<0.05)。安全性指数(术后最佳矫正视力/术前最佳矫正视力)为1.05±0.03、有效性指数(术后裸眼视力/术前最佳矫正视力)为1.01±0.02。术后并发症:圆锥角膜46只眼中,术后发生高眼压4只眼、角膜上皮延迟愈合2只眼、边缘性角膜浸润1只眼、角膜内皮细胞密度减少1只眼;联合手术38只眼中术后发生边缘免疫性角膜炎1只眼、短期类圆锥角膜改变1只眼。各种并发症经对症治疗后均治愈或减轻。结论临床上CXL首选治疗进展期圆锥角膜,联合角膜屈光手术治疗薄角膜以及高度近视效果良好。     

准分子激光角膜表层切削术矫治疑似圆锥角膜的长期临床观察

目的 探讨准分子激光上皮瓣下角膜磨镶术（LASEK）及机械法准分子激光上皮瓣下角膜磨镶术（Epi-LASIK）矫治疑似圆锥角膜引起的近视及散光的长期安全性、有效性和稳定性.方法 回顾性病例系列研究.疑似圆锥角膜患者38例（55眼）,年龄19～44岁,男7例,女31例.近视度-3.25～-7.75 D,平均（-5.54±2.18）D;散光度0～3 D,平均（0.80±0.75）D;中央角膜厚度479～605μm,平均（541.8±30.0）μm.角膜地形图均提示1期圆锥角膜,近视及散光度、角膜地形图形态稳定至少2年.55眼均成功接受了LASEK（38眼）或Epi-LASIK（17眼）.术后6个月及2年以上（2～5年）随访,检查患者的视力、屈光度及角膜地形图.对手术前后的数据进行配对t检验（正态分布）或Wilcoxon Signed Ranks检验（非正态分布）.结果 术后2年以上,48眼（87.3%）的裸眼视力≥1.0,有效指数为1.002;51眼（92.7%）的最佳矫正视力较术前不变或提高,仅4眼（7.3%）下降1行,安全指数为1.053;等效球镜度为（-0.11±0.45）D,在±0.50 D范围内为49眼（89.1%）,在±1.00 D范围内为53眼（96.4%）;近视度和散光度分别为（-0.01±0.45）D和（0.25±0.33）D.术后2年以上的近视及散光度与术后6个月比较,差异均无统计学意义（P＞0.05）.术后2年以上的角膜地形图圆锥角膜指数KI值为1.02±0.04,较术前（1.08±0.01）降低,差异有统计学意义（Z=-6.098,P＜0.01）.随访期间未见明显haze及圆锥角膜进展.结论 疑似圆锥角膜患者的年龄、近视屈光度、角膜厚度及屈光度和角膜地形图的稳定性是其能否接受LASEK或Epi-LASIK治疗的关键.LASEK和Epi-LASIK对于矫治屈光及角膜地形图形态稳定的疑似圆锥角膜的近视及散光,可能是一种安全、有效的方法,但更长期的安全性有待于进一步的观察.     

因视力下降误诊为视神经病变的圆锥角膜患者的临床特征

 Objective To study the clinical characteristics of patients with keratoconus who were misdiagnosed as optic neuropathy due to short-term vision loss. Design Retrospective case series. Participants 26 patients (33 eyes) were initially misdiagnosed as optic neuropathy, but finally diagnosed as keratoconus after relevant examinations from 2010 to 2020 in Beijing Tongren Eye Center. Methods The patients' medical records and auxiliary ophthalmic examination results, including corneal topography, visual evoked potentials (VEP), visual field and etc were reviewed. Main Outcome Measures Visual acuity, refraction, corneal curvature, ocular signs. Results Among all 26 cases, 20 patients were male (76.9%), and mean age was (27.8±8.2) years. 19 patients (73.1%) were affected unilaterally, and 7 patients (26.9%) were affected bilaterally. The corrected visual acuity was from 0.02 to 1.0 when diagnosed as neuropathy. The average sphere refraction of affected eyes was (-7.18 ± 3.63) D, cylinder refraction was (-2.09±1.86) D. The corneal curvature K1 and K2 was (52.83±3.89) D and (47.55±3.64) D respectively in affected eyes. Among 19 monocular patients, the sphere and cylinder refraction was (-6.51±2.99) D and (-2.27±1.60) D in affected eyes, significantly higher than the lateral eyes (-3.06±2.09) D and (-1.11±1.03) D (P<0.001 and P=0.048). The color fundus images of 28/33 eyes (84.8%) were slightly blurred. The corneal morphology with slit lamp microscopy was normal in 18/33 eyes (54.6%), and only 15/33 eyes (45.4%) were found slight corneal cone-like protrusion and mild stromal opacity. The relative afferent pupillary defect (RAPD) of all patients were negative. No abnormalities were observed in the posterior fundus, VEP and electroretinogram. Conclusion Keratoconus patients misdiagnosed as optic neuropathy due to decreased vision often have a short-term increased myopia and astigmatism, ignoring the signs of optic neuropathy. Corneal topography examination is beneficial to the diagnosis of keratoconus. （Ophthalmol CHN, 2022, 31: 94-98）     

Keratoconus in Asians: demographics, clinical characteristics and visual function in a hospital-based population

Background: To describe the demographics, clinical characteristics and visual function of Asian patients with keratoconus managed in a tertiary eye centre. Design: Prospective cross‐sectional study. Participants: 116 patients with clinically evident or suspected keratoconus (on videokeratography) recruited over 11 months. Methods: A standardised interview, full ophthalmic examination, refraction and corneal topography were performed. Visual function was assessed with the VF‐14 questionnaire. Main Outcome Measures: Demographics, clinical characteristics and visual function. Results: Mean age of our patients was 29.5 ± 9.40 years on enrolment, 62.9% were male, and the ethnic distribution was 60.3% Chinese, 13.8% Malays and 9.5% Indians. Clinically evident keratoconus was present bilaterally in 65 patients (56.0%) and unilateral keratoconus in five patients (4.3%). Five patients (4.3%) had a family history of keratoconus. The majority of patients were managed with contact lenses (60.8%) or glasses (24.5%). Eye rubbing was common (68%) as were asthma (26.3%) and eczema (18.4%). Conical protrusion was the commonest sign (75.3%). The mean cylinder was higher in keratoconus eyes compared with keratoconus suspect eyes (?4.01 vs. ?1.27, P < 0.001), and best‐corrected visual acuity was poorer (0.19 vs. 0.05, P < 0.001). Unaided visual acuity was significantly worse with increasing age (P = 0.016). On the VF‐14, 32% scored 90 or less (out of 100), reflecting difficulties with vision‐related daily activities. Conclusions: Our Asian patients with keratoconus had similar demographic and clinical characteristics to patients in Western populations. Even with apparently good visual acuity, some patients still experience substantial impairment in vision‐related activities.     

硬性透气性隐形眼镜(RGP)矫正圆锥角膜的疗效分析

目的: 评价硬性透气性隐形眼镜( RGP) 矫正圆锥角膜屈光异常的疗效。方法: 选择我院 2004- 05/2005- 12 收治的 25 例( 43 眼) 圆锥角膜患者配戴 RGP, 观察视力、角膜曲率、配适状况、舒适度及并发症。结果: RGP矫正视力均好于或等于框架球柱面联合镜。其中优于框架球柱面联合镜片者 37 眼( 86.0%) , 二者视力相等者 6 眼( 14.0 %) , 矫正视力低于框架球柱面联合镜者 0眼, 经统计学处理, 两者有显著性差异( P< 0.01) 。配戴RGP 6mo 时角膜曲率值没有明显变化。本组病例配适良好, 合并症少而轻。结论: 经 6mo 随访观察, RGP 对圆锥角膜的视力矫正明显优于框架眼镜, 是目前矫正圆锥角膜的非手术治疗的有效方法。     

Can true monocular keratoconus occur?

Evidence increasingly supports keratoconus as an inherited, genetic disorder. If this is the case, it would be expected to express itself as a binocular condition even though variable expression of the gene may show differing levels in the two eyes. It is a common occurrence in specialist contact lens practices to see pseudo‐monocular keratoconus, that is, an overt clinical level of the condition in one eye and forme fruste keratoconus in the other. The advent of videokeratoscopy has shown almost every case of apparent monocular keratoconus to be different expressions of the condition in the two eyes. Nevertheless, rare cases of the condition are seen that appear to be truly monocular. Such a case is presented in which the condition has been present for more than 23 years. The age of the subject makes the future onset of keratoconus highly unlikely and videokeratoscopy does not show the presence of forme fruste in the ‘good’ eye. There is no history of monocular eye rubbing. Pachymetry shows the normal eye to be well within the range of normal corneal thickness, while the keratoconus in the other eye is sufficiently advanced to warrant corneal grafting. Thus, it is a case of true monocular keratoconus and represents an extreme example of variable gene expression.     

Measure of keratoconus progression using Orbscan II

PURPOSE: To observe the progression of keratoconus over 3 years using Orbscan II, and to estimate risk correlations with rapid progressive changes. METHODS: Fifty-six eyes of 35 patients (mean age: 25.9+/-5.7 years, range: 18 to 35 years) with keratoconus were reviewed whose sex, age, visual acuity, refractive error, atopy, eye rubbing habits, family history of keratoconus, hard contact lens wear, intraocular pressure, keratometric reading, corneal shape, corneal thickness index, and corneal asphericity had been determined. The keratometric change over 3 years was evaluated using Orbscan II, with 6-month intervals between each examination. All patients selected had less than moderate keratoconus on initial examination. RESULTS: The rate of keratometric change was 0.78+/-0.99 diopters (D)/half-year. In 30 eyes, the apparent progression was evident with a rate of keratometric change of 1.37+/-1.08 D/half-year, whereas the rate of change was 0.15+/-0.15 D/half-year in eyes exhibiting no apparent progression (P=.001). Logistic regression analysis showed that eye rubbing (odds ratio [OR] = 3.810; 95% confidence interval [Cl] = 1.194-12.158) and inferior steepening compared to superior steepening (OR = 5.465; 95% CI = 1.667-17.857) were associated with progression after diagnosis (P<.05). CONCLUSIONS: Careful attention must be paid to the presence of eye rubbing and corneal shape with inferior steepening at the time of diagnosis, as these factors may help in predicting the rapid progressive change in keratoconus.     

Intacs implantation using a femtosecond laser for management of keratoconus: Comparison of 306 cases in different stages

PURPOSE: To evaluate the efficacy of intrastromal ring segment (Intacs, Addition Technology, Inc.) implantation and analyze outcomes according to different keratoconus stages. SETTING: Kudret Eye Hospital, Ankara, Turkey. METHOD: In this retrospective noncomparative case series, 306 keratoconic eyes of 255 patients who had Intacs segment implantation were reviewed. Patients were grouped according to the Amsler-Krumeich keratoconus classification (stage II, 155 eyes; stage III, 83 eyes; stage IV, 68 eyes). The uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), central corneal curvature, spherical and cylindrical manifest refractions, and central corneal thickness were analyzed and compared according to keratoconus stage. RESULTS: At a mean follow-up of 10.39 months +/- 5.04 (SD), the BCVA improved in 71.6% of eyes and the UCVA improved in 75.7% of eyes. The mean keratometry (K) decreased from 50.7 diopters (D) to 47.9 D (P<.05); the mean manifest spherical refraction, from -6.04 D to -3.09 D (P<.05); and the mean manifest cylindrical refraction, from -4.11 D to -3.82 D (P>.05). The changes in BCVA and manifest spherical and cylindrical refractions were not statistically different between the different keratoconus stages (P >.05). There was less change in UCVA and more improvement in the mean K value after Intacs treatment in stage IV than in the other stages (P<.05, analysis of variance). CONCLUSIONS: Intacs treatment with a femtosecond laser was effective for management of keratoconus of all stages. Improvement in UCVA may be less in severe keratoconus than in moderate keratoconus.     

OrbscanⅡ在准分子激光角膜屈光手术中应用的研究

目的评价OrbscanⅡ存准分子激光角膜屈光手术中的应用价值。方法对拟行准分子激光手术的600例（1196眼）,术前行OrbscanⅡ检查,以排除圆锥角膜、可疑圆锥角膜及中央角膜厚度过薄不适宜行LASIK手术者;术后检查200例（400眼）,了解有无偏心切削、中央岛等情况。结果术前查出网锥角膜（5例）10眼,占0．84％;角膜偏薄56眼,占4．68％。术后查出偏心切削9眼,占2．25％,未发现中央岛。结论OrbscanⅡ是角膜屈光手术前重要的检查手段,对手术方案的设计及术后效果的评价提供了重要依据。[1]