准分子激光角膜前弹力层磨镶术矫正近视的临床效果

目的探讨准分子激光角膜前弹力层磨镶术（SBK）矫正近视的临床效果。方法选取2012年6月至2013年2月在我院就诊的要求矫正近视的患者120例（240只眼）,随机分为SBK组和LASIK（准分子激光原位角膜磨镶术）组,每组60例（120只眼）。SBK组和LASIK组患者分别使用准分子激光前弹力层下角膜磨镶术和准分子激光原位角膜磨镶术进行视力矫正。所有患者随访1年,记录患者的裸眼视力、屈光度和并发症。结果SBK组和LASIK组患者各时间段裸眼视力与各自组的术前水平相比,P〈0．05,差异具有统计学意义;SBK组屈光度回退率和LASIK组比较,P〈0．05,差异具有统计学意义。结论SBK矫正近视安全有效,屈光度回退率低。     

准分子激光角膜切削术随访十年结果分析

目的评价准分子激光角膜切削术（PRK）远期疗效。方法收集在我院施行PRK手术随访10年近视156例（308眼）。根据术前屈光度（等值球镜）分为A、B两组，A组屈光度-1．50D～-6．00D者224眼，B组-6．12D--10．00D者84眼。术后随访视力、屈光度、眼前段及眼底表现，眼压、角膜地形图等。6个月后每年复查1次，以1、5、10年检查情况为准。结果PRK术后随访10年，裸眼视力达预期矫正视力A组为91．96％、B组为76．19％，屈光度±0．75D正视范围内比率A组为90．18％，B组为75．00％。近视屈光回退-1．00D以上在5年和10年时A组为7．14％和6．70％，B组为22．62％和23．81％，屈光回退率相比，相同时间两组间P〈0．01，同一组5年和10年相比P〉0．05。随时间延长haze逐渐吸收，无角膜感染、角膜扩张及变性样角膜病变等发生。结论PRK矫正近视远期效果稳定，预测性、安全性好，中低度近视优于高度近视。随时间延长haze逐渐吸收，回退的屈光度稳定。     

准分子激光屈光性角膜切削术后屈光回退的多因素分析

目的：探讨准分子激光屈光性角膜切削术后屈光回退的主要因素。方法：采用VISX20／20型准分子激光仪对121例214眼近视患者行准分子激光角膜切削术,术后随访2年。分二组进行比较,Ⅰ组为低中度近视（－1．00D－－6．00D）124眼,Ⅱ组为高度近视（－6．25D－－16．00D）90眼。结果：术后2年低中度近视回退率9．7％,高度近视回退率27．8％（P＜0．005）,高度近视中高龄组较低龄组回退率高（P＜0．005）,较严重的角膜上皮下雾状混浊与回退伴行。结论：准分子激光角膜切削术后屈光回退的主要因素有预期矫正屈光度,角膜Haze及年龄。     

准分子激光屈光性角膜切削术治疗近视及近视散光临床分析

目的评价准分子激光屈光性角膜切削术治疗近视及近视散光的临床效果。方法应用准分子激光（NIDEKEC—5000型）治疗24D以下．伴或不件5D以内散光的近视眼。214只治疗眼随诊6个月以上。结果随诊1年以上的病例显示术后3个月屈光度及视力基本稳定。术后6个月时，在等值球镜度低于6D的治疗眼中，裸眼视力≥1．0者占92．04％，≥0．5为100％，80．53％的裸眼视力≥术前最佳矫正视力，99．12％的眼屈光度在预定矫正度数的±1．00D以内。低于10D的高度近视眼也有近似的疗效。214只治疗眼中操眼视力≥1．0者占78．97％，≥0．5为90．65％，72．43％的裸眼视力≥术前最佳矫正视力，88．32％的眼屈光度在预定矫正度数的±1．00D以内。6只眼（2．80％）最佳矫正视力减少2行以上，有Ⅱ级以上Haze的有7眼间（3．27％）。结论准分子激光屈光性角膜切削术治疗近视及近视散光具有很高程度的精确性和安全性，在＜10D的近视眼中更显示了良好的预测性和稳定性。     

非球面切削准分子激光角膜屈光手术的早期临床观察

目的前瞻性研究非球面切削引导准分子激光角膜屈光手术的临床疗效。方法将球镜-6.00D以下,柱镜0.00～2.00D的近视患者随机分成2组,Q调整组32例64眼行非球面切削引导准分子激光角膜屈光手术,对照组32例64眼行传统准分子激光原位角膜磨镶术（LASIK）。观察术后裸眼视力,残余屈光度,高阶像差中的慧差、球差、总高阶像差均方根增加值和满意度等指标。结果术后裸眼视力和残余屈光度两组比较差异无统计学意义,但Q调整组高阶像差的增加较对照组小,差异有统计学意义（P〈0.05）。术后Q调整组患者的满意度情况比较,两组差异有统计学意义（P〈0.05）。结论非球面切削引导准分子激光角膜屈光手术可以减少术后角膜波面像差的增加,尤其是减少球差增加,明显改善视觉质量。     

小光斑飞点扫描准分子激光治疗近视的疗效评价

目的　探讨小光斑飞点扫描主动眼球跟踪准分子激光行LASIK术治疗近视的优点所在。方法　 2 0 0 1 12— 2 0 0 2 12采用鹰式ALLEGRETTOWAVELIGHT准分子激光扫描仪及法国MO RIA -2 ( 13 0 )角膜切削刀对 464例 ( 92 8眼 )近视患者行LASIK治疗。结果　术前屈光度低于 -6 0D的患者术后一个月 ,裸眼视力 (UCVA) 96 4%达到 1 0 ,86 0 %达到 1 2以上 ;术后 3个月 ,裸眼视力 (UCVA) 98 5 %达到 1 0 ,94 6%达到 1 2以上术前屈光度高于 -6 0D的患者术后一个月 ,裸眼视力 (UCVA) 93 3 %达到 1 0 ,78 1%达到 1 2以上 ;术后 3个月 ,裸眼视力 (UCVA )90 8%达到 1 0 ,89 7%达到 1 2以上。术后随访 1～ 6个月单区切削中 ,屈光度低于 -6 0D的患者有 0 6%患者出现屈光回退 ( >-1 0D) ,屈光度介于 -6 0D～ -9 0D的患者 2 3 2 %出现屈光回退 ;屈光度介于 -9 2 5D～ -14 0D的患者 12 2 %出现屈光回退。主要的并发症为 :不完全角膜瓣 1例 ( 1眼 ) ;术后上皮剥脱 6例 ( 11眼 ) ;术后弥散性层间角膜炎 1例 ( 2眼 ) ;角膜皱折 1例 ( 1眼 )。无术后夜间视力下降、眩光、光晕及其它严重并发症的发生。结论　小光斑飞点扫描联合眼球跟踪系统准分子激光行LASIK术治疗近视 ,安全可靠 ,因其光斑小 ,频率快 ,大大减少了术后角膜皱     

准分子激光角膜切削术矫正RK术后近视22例

目的:探讨准分子激光角膜切削术(PRK)矫正角膜放射状切开术(RK)后残留近视及近视散光的有效性和安全性。方法:应用波长193nm的ArF准分子激光对22例39眼RK术后残留的近视及近视散光进行准分子激光屈光手术治疗。结果:随访5a,平均屈光度由术前-4.21±1.42D下降至术后的-0.41±0.31D,34眼≥术前最佳矫正视力,术前裸眼视力≥1.0者32眼,术后裸眼视力≥1.0者30眼,回退4眼(10%),回退度数<-1.25D。术前矫正视力≤0.9者,术后5a时仅2眼裸眼视力≥1.0。结论:PRK是一种有效和安全的矫正RK术后残留近视的方法。     

准分子激光角膜原位磨镶术治疗高度近视

应用准分子激光角膜原位磨镶术（Ｌａｓｉｋ）治疗高度近视５０例９１眼。术前屈光度为－８．００—－２５．０Ｄ（ｘ±ｓ：－１０．７３±４．４８Ｄ），其中散光度最高达－４．Ｄ。术后第１天，９１眼视力均有明显提高，１周后逐渐有下降趋势，３个月趋于稳定。术前屈光度≤－１２Ｄ的Ⅰ组，术后３个月屈光度为－０．２５±０．６５Ｄ，９７．９％的患眼术后裸眼视力达到术前矫正视力。术前屈光度＞－１２Ｄ的Ⅱ组，术后３个月屈光度－１．５９±２．２７Ｄ，７４．４％患眼术后裸眼视力达到术前矫正视力。存在的主要问题为术后屈光度欠矫，术后３个月Ⅰ组２０．８％欠矫，欠矫屈光度在－０．５—－２．０Ｄ，Ⅱ组３２．６％欠矫，欠矫屈光度在－１．０—－８．０Ｄ，（ｘ±Ｓ：－２．０９±１．８５Ｄ）。结论：准分子激光角膜原位磨镶术治疗高度近视早期效果令人满意。但如何减少术后屈光度回退，改进计算机切削程序，熟练手术技巧及Ｌａｓｉｋ术远期效果尚待更深入的研究。     

治疗性准分子激光原位角膜磨镶术手术疗效分析

目的分析准分子激光原位角膜磨镶术（LASIK）治疗超高度近视、近视性屈光参差及混合性散光的临床疗效。方法2002年8月～2007年8月在我科接受LASIK治疗的非单纯近视患者532例（972眼），根据屈光状态不同分为3组：A组超高度近视336例（672眼）；B组近视性屈光参差107例（170眼）；C组混合性散光89例（130眼），并对其进行回顾性分析。结果术后第一天裸眼视力即有明显提高；术后1周达到或接近术前最佳矫正视力；术后3个月时视力趋向稳定，裸眼视力与预期矫正视力符合率A组为632眼（94．05％），B组为164眼（96．47％），C组为121眼（93．08％）。术后3个月时，实际矫正屈光度与预期矫正屈光度差值在0．75D左右范围内者，三组分别为94．2％、96．47％及91．54％，屈光回退者三组分别为16眼（2．53％）、6眼（3．66％）及4眼（3．36％）。结论LASIK在治疗超高度近视、近视性屈光参差及混合性散光中是安全、有效和可预测的。疗效的提高有赖于设备与方法的改进、手术技巧的熟练及经验的积累。     

激光屈光性角膜切削术联合丝裂霉素C矫治近视的临床观察

目的评价准分子激光屈光性角膜切削术（PRK）术中预防性使用丝裂霉素C（MMC）矫治角膜较薄的近视的作用。方法角膜较薄的近视（-2．00D--0．00D）128例（243眼）采用PRK＋MMC治疗。术后随访6个月。结果128例（243眼）均未出现2级或2级以上角膜上皮下雾状浑浊（haze）,术后1周裸眼视力≥0．8者206眼（84．77％）,术后6个月裸眼视力≥0．8者216眼（88．89％）,术后6个月裸眼视力达到或超过术前最佳矫正视力233眼（95．88％）。术后6个月与术后1周屈光状态相比无回退。使用MMC未见明显毒副作用。结论角膜较薄的近视治疗采用PRK＋MMC,在术后减少haze、预防屈光回退及改善视力方面安全有效。     

准分子激光角膜原位磨镶术矫治高度近视准分子激光屈光性角膜切削术后屈光回退的临床观察

目的评价准分子激光角膜原位磨镶术（LASIK）矫治高度近视准分子激光屈光性角膜切削术（PRK）后屈光回退的疗效。方法回顾性临床研究。对PRK术后2年以上、屈光回退且屈光度稳定的患者8例14眼行LASIK,对LASIK术后术眼进行评价。患眼PRK术前屈光度为-6.25～-12.50 D,PRK术后屈光度为-1.50～-6.25 D。随访观察LASIK矫正1年后术眼的裸眼视力、最佳矫正视力、屈光度、上皮下雾状混浊（haze）形成和角膜厚度的变化。结果所有患眼术后主观症状较轻。LASIK术后1年平均球镜度数为（-0.62±0.94）D。LASIK术后0.5≤裸眼视力〈0.8者4眼,≥0.8者9眼,1眼（7.1%）最佳矫正视力下降2行。4眼术后出现不同程度的haze,包括2级haze 3眼、3级haze 1眼。应用氟米龙滴眼液1个月后,haze及屈光回退减轻;术后1年,1级haze 2眼,2级haze 2眼,3级haze 1眼。LASIK术前角膜厚度为（467±38）μm,术后为（422±21）μm。结论高度近视PRK术后屈光回退行LASIK矫治是一种可行的方法,但少数患者术后可出现haze,仍需治疗。     

准分子激光原位角膜磨镶术后屈光度数回退的原因分析

目的　探讨准分子激光原位角膜磨镶术 (laserinsitukeratomileusis,LASIK)后屈光度数回退的原因。方法　将 2 5 0例 (40 8只眼 )近视患者 (- 6 0 0～ - 15 0 0D)按屈光度数分为A组 194只眼 (- 6 2 5～ - 10 0 0D)和B组 2 14只眼 (- 10 2 5～ - 15 0 0D)行LASIK ,记录术后视力、屈光度数、角膜厚度和角膜激光切削区直径 ,并进行统计学分析。术后平均随访时间 1年。结果　 (1)A组 :正常术眼 (术后屈光度数 <- 1 0 0D) 173只眼 (89 2 % ) ,术前平均角膜厚度为 (5 4 9 5± 31 5 ) μm ,术中平均激光切削直径为 (4 96± 0 35 )mm ,术后屈光度数为 +0 5 0～ - 0 75D ;回退术眼 (术后屈光度数≥ - 1 0 0D) 2 1只眼 (10 8% ) ,术前平均角膜厚度为 (5 4 7 5± 37 0 ) μm ,与正常术眼比较差异无显著意义 (P >0 0 5 ) ;术中平均激光切削直径为 (4 6 4± 0 4 1)mm ,与正常术眼比较差异有非常显著意义(P <0 0 1) ;术后平均屈光度数为 (- 1 33± 0 5 8)D。 (2 )B组 :正常术眼 136只眼 (6 3 5 % ) ,术前平均角膜厚度为 (5 6 0 9± 30 9) μm ,术中平均激光切削直径为 (4 5 1± 0 2 8)mm ,术后屈光度数为 +0 5 0～- 0 75D ;回退术眼 78只眼 (36 5 % ) ,术前平均角膜厚度为 (5 38 0± 31 0 ) μm ,     

超高度近视准分子激光原位角膜磨镶术术后视力及屈光状态的改变

目的:探讨超高度近视准分子激光原位角膜磨镶术(LASIK)术后视力及屈光状态的改变。方法:选择行LASIK手术的超高度近视患者31例54眼,术前屈光度介于-10.00～-17.00D之间,分别测量术前、术后1d,1wk;1,3及6mo的视力、球镜度数、柱镜度数及其轴向并对所得结果进行回顾性分析。结果:超高度近视LASIK术后平均视力较术前增加,球镜度数随时间推移呈下降趋势,至术后6mo尚未达到稳定,术后散光随时间推移逐渐减少,术后散光的轴向可发生一定的变化。结论:认真分析术前资料,科学的设计切削参数,LASIK矫治超高度近视是安全有效的。     

Comparison of two procedures: photorefractive keratectomy versus laser in situ keratomileusis for low to moderate myopia

PURPOSE: A prospective study was conducted to compare the effectiveness, safety, and stability of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) for correction of low to moderate myopia. METHODS: Forty-five patients with a manifest refraction (PRK, -4.54 +/- 0.80; LASIK, -4.82 +/- 1.10) from -1.50 to -6.00 diopters (D) were treated and followed-up for 6 months. In each case, 1 eye received PRK and the other LASIK. The first eye treated, and the surgical method used in the first eye, were randomized. Uncorrected and corrected visual acuity, manifest refraction, corneal haze, and topographic analysis of ablation decentration were examined. RESULTS: The uncorrected visual acuity was 20/20 or better in 35 PRK eyes (77.8%) and 28 LASIK eyes (62.2%) at 6 months (P =.107). At 6 months, 28 eyes (62.2%) that received PRK showed a spherical equivalent of within +/-0.5 D as compared with 24 eyes (53.4%) that received LASIK (P =.393). The amount of ablation decentration was 0.37 +/- 0.25 mm in PRK eyes and 0.49 +/- 0.38 mm in LASIK eyes at 3 months (P =.36). CONCLUSIONS: In our study, PRK and LASIK were found to be similarly effective and predictive of correction in low to moderate myopia. PRK has the advantage of less ablation decentration and is safer than LASIK, so we recommend PRK for eyes with low to moderate myopia.     

近视眼LASIK术后屈光回退的相关因素分析

目的 探讨影响准分子激光原位角膜磨镶术(LASIK)治疗近视术后疗效的相关因素.方法 采用LASIK对72例(141只眼)近视眼患者进行治疗.分别记录术前、术后第1周、第1个月、第3个月、第6个月和第12个月视力、屈光度、眼压、角膜厚度、角膜地形图检查所得的角膜后表面数据.根据术后第12个月裸眼视力和等效球镜屈光度分2组,Ⅰ组屈光回退组视力＜5.0且术后近视等效球镜屈光度＞1.00I),计35只眼;Ⅱ组视力正常组视力≥5.0,计106只眼.分析术后裸眼视力与i者多因素关系.结果 术后第12个月裸眼视力4.4～5.1,平均4.97±0.13,以术后第12个月裸眼视力为因变量(Y)与术前近视屈光度(X1)、角膜切削比(X2),术后第12个月角膜后表面最高点Diff值(X3),术后第12个月和术后第1周角膜厚度差(X4),术后第12个月和术后第1周角膜后表面屈光度差(X5)等进行逐步回归分析建立多元同归方程Y=5.09-0.034X1+1.785X2-2.216X3-0.002X4+0.081X5(F=21.474,19＜0.01).术后随访角膜厚度有不同程度增加,角膜后表面屈光度降低,角膜后表面Diff值增高,屈光回退组各指标不同阶段比较差异有统计学意义(分别F=8.56、4.68、2.49;均P＜0.05),变化尤以术后3个月内明显;正常眼组各指标不同阶段比较除角膜最薄处厚度有差异外,余均无统计学意义(角膜最薄厚度F=7.27,P＜0.01;其余均P＞0.05).结论 LASIK治疗近视是一种安全、有效的方法,但欲取得较好疗效,应考虑不同因素如术前近视屈光度、角膜切削比、术后角膜增殖、术后角膜后表面改变等因素的影响.     

Intacs after laser in situ keratomileusis and photorefractive keratectomy

PURPOSE: To evaluate the efficacy of intrastromal corneal ring segments (Intacs, Addition Technology) for the correction of residual myopia after laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). METHODS: In this prospective noncomparative case series, Intacs were implanted in 5 eyes (4 patients) that developed myopic regression after LASIK or PRK. Intacs were implanted a minimum of 11 months after the laser procedure. The technique was identical to the standard procedure for myopic unoperated eyes. The Intacs thickness was based on the amount of residual myopia. RESULTS: Postoperative results revealed a reduction in the residual myopia and the mean K-reading. No eye lost best corrected Snellen visual acuity. No intraoperative or postoperative complications occurred. CONCLUSIONS: Implantation of Intacs in eyes with myopic regression after LASIK and PRK resulted in a good refractive outcome and an improvement in uncorrected visual acuity.     

Ablation centration after active eye-tracker-assisted photorefractive keratectomy and laser in situ keratomileusis

PURPOSE: To evaluate the ablation centration after active eye-tracker-assisted photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) and to investigate the effect of surgery, patient, and surgeon on the centration. SETTING: Department of Ophthalmology, China Medical College Hospital, Taichung, Taiwan, Republic of China. METHODS: This retrospective study comprised 177 eyes of 101 patients: 16 eyes had PRK and 161, LASIK. All laser treatments were performed with the aid of an eye tracker. The amount of decentration was analyzed by corneal topography. The factors influencing centration were divided into surgery related (PRK/LASIK), patient related (low/high myopia and effect of learning), and surgeon related (learning curve). RESULTS: The mean decentration was 0.33 mm in PRK eyes and 0.35 mm in LASIK eyes. For the surgery-related factor, there was no significant difference between the PRK and LASIK eyes. For the patient-related factors, centration was better in the second eye (effect of learning) and decentration was more severe in eyes with high myopia (low/high myopia). For the surgeon-related factor, there was no significant difference between eyes that had the first 50 LASIK procedures and those that had the last 50 procedures. CONCLUSIONS: An eye tracker, which makes the laser beam follow the eye's movements, helps to avoid severe decentration. This study showed, however, that an active eye-tracking system alone cannot ensure good centration. Patient cooperation and fixation are important.     

Randomized bilateral comparison of excimer laser in situ keratomileusis and photorefractive keratectomy for 2.50 to 8.00 diopters of myopia

OBJECTIVE: To compare effectiveness, safety, and stability of excimer laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) for low-to-moderate myopia. DESIGN: Prospective, randomized, bilateral study. PARTICIPANTS: Thirty-three patients with a manifest refraction of -2.50 to -8.00 diopters (D) participated. INTERVENTION: For each patient, one eye received LASIK and the other received PRK. The first eye treated, and surgical method in the first eye, were randomized. Both eyes were treated by the same surgeon during the same operative session with a Summit Omnimed I laser (6-mm-diameter ablation) and a Chiron Automated Corneal Shaper. Follow-up was 90% at 1 and 2 years. RESULTS: At baseline, mean (+/-standard deviation) spherical equivalent manifest refraction was -4.80 +/- 1.60 D in LASIK-treated eyes and -4.70 +/- 1.50 D in PRK-treated eyes. At 1 day after surgery, 81% of patients (21 eyes) reported no pain in the LASIK-treated eye, whereas no patient (0%) reported being pain-free in the PRK-treated eye. At 3 to 4 days after surgery, 18 (80%) LASIK-treated eyes either improved or remained within 1 line of baseline spectacle-corrected visual acuity; only 10 (45%) PRK-treated eyes achieved this result. At 2 years after surgery, 18 (61%) LASIK- and 10 (36%) PRK-treated eyes achieved an uncorrected visual acuity of 20/20 or better, with no statistically significant difference in refractive outcome between the two techniques. Quantitative videokeratography showed more regularity after LASIK. Complications were similar in the two groups. Patients preferred LASIK by a margin of 2 to 1 at 1 year but showed no preference at 2 years. CONCLUSIONS: Using a 6-mm-diameter single-pass, large area ablation and an automated microkeratome to treat myopia of -2.50 to -8.00 D with 1.00 D or less astigmatism in 1994, the authors used LASIK to produce a higher percentage of eyes with an uncorrected visual acuity of 20/20 or better, more regular postoperative corneal topography, less postoperative pain, and more rapid recovery of baseline spectacle-corrected visual acuity than PRK. Both LASIK and PRK achieved successful correction of low-to-moderate myopia at 1 and 2 years after surgery.     

One-year results of photorefractive keratectomy and laser in situ keratomileusis for myopia using a 213 nm wavelength solid-state laser

PURPOSE: To study the long-term results of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) in low to moderate myopic corrections using the Pulzar Z1 system (CustomVis), a 213 nm wavelength solid-state laser. SETTING: University refractive surgery center. METHODS: This prospective noncomparative case series comprised 20 patients (40 eyes) who had refractive surgery using the Pulzar Z1 laser system. Manifest refraction, uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), safety, predictability, stability, and confocal microscopy images were evaluated. RESULTS: Ten patients (20 eyes) had PRK and 10 patients (20 eyes) had LASIK. The mean follow-up was 13.9 months +/- 1.1 (SD) (range 12 to 17 months) and 14.6 +/- 1.2 months (range 12 to 18 months) in the PRK group and LASIK group, respectively. No eye lost a line of Snellen BSCVA during the follow-up period; 2 eyes (10%) gained 2 Snellen lines. There was a statistically significant decrease in spherical equivalent manifest refraction postoperatively in both groups (P<.05). Refractive stability was obtained during the first postoperative month and remained stable during the follow-up period, with no significant changes between any interval in both groups (P>.05). At the last follow-up, 95% of all eyes were within +/-1.00 diopter of emmetropia. No late postoperative complications were observed. CONCLUSION: Refractive surgery using the Pulzar Z1 213 nm wavelength solid-state laser was a safe, effective procedure in the treatment of low to moderate myopia.