近视未行LASIK手术824例分析

目的:探讨近视行术前检查而未行准分子激光原位角膜磨镶术(laser in situkeratomileusis,LASIK)原因。方法:对2891例近视患者常规进行术前检查,未行手术824例进行原因分析。结果:未行LASIK手术824例中,角膜厚度不足297例(36.0%);存在思想顾虑194例(23.5%);瞳孔过大96例(11.6%);角膜前后表面高度(眼前节全景仪Pentacam基于Scheimpflug成像原理,获得全角膜前、后表面角膜地形图及各点角膜厚度,可应用于圆锥角膜筛查和早期诊断)偏高50例(6.1%),高曲率46例(5.6%),矫正视力不佳43例(5.2%),眼底病变31例(3.8%),干眼31例(3.8%),其它36例(4.4%)。结论:LASIK手术是一种选择性手术,必须进行严格的术前筛查,全面科学评估检查结果,医患之间加强沟通,严格掌握手术的适应证和禁忌证。     

未行LASIK手术239例原因分析

目的:探讨经常规准分子激光原位角膜磨镶术(laserin situ keratomileusis,LASIK)术前检查后未行手术的原因。方法:对行LASIK术前检查的884例屈光不正患者中未行手术的239例患者进行原因分析。结果:未行LASIK手术的239例中,角膜厚度不足76例(31.8%);高眼压33例(13.8%);高角膜曲率27例(11.3%);Diff值(Orbscan-Ⅱ角膜地形图仪测得,为角膜后表面高度图的最高点超出参照面高度,是诊断早期圆锥角膜的客观依据之一)偏高21例(8.8%);视网膜出血、囊变、裂孔17例(7.1%);角膜炎16例(6.7%);干眼9例(3.8%);矫正视力不佳7例(2.9%);瞳孔过大3例(1.3%);全身病3例(1.3%);心理精神因素9例(3.8%);其他18例(7.5%)。结论:LASIK手术是一种选择性手术,必须严格细致地进行术前检查,对患者进行全面的术前评估,掌握其适应证及禁忌证,才能保证手术的安全性,使手术取得满意的效果。     

LASIK手术常见临床禁忌证分析

目的:探讨常见LASIK手术禁忌证的发生情况。方法:对拟行LASIK手术2693例(5304眼)进行详细术前检查,对未行手术的476例906眼进行原因分析。结果:476例906眼未能手术患者的原因包括角膜厚度不够(<450μm)、矫正视力<0.5、超高度近视、眼压高、圆锥角膜、视网膜变性或裂孔、瞳孔偏大、角膜瘢痕、慢性泪囊炎、瘢痕体质、思想顾虑大等。其中最常见的原因为角膜厚度不够298眼(32.89%)、矫正视力<0.5者155眼(17.11%)和思想顾虑大134眼(14.79%)。结论:LASIK术前必须进行严格的检查,除外手术的禁忌证,以保证手术的安全性。     

110例未行准分子激光角膜屈光手术的原因分析

目的研究近视患者未能行准分子激光原位角膜磨镶术(LASIK)的原因。方法分析655例近视患者中110例行常规准分子术前检查后停手术的原因。结果未行手术110例(216只眼),其中:(1)角膜中央厚度不足92只眼(42.59%)。(2)角膜曲率过高22只眼(10.18%)。(3)眼底病变者24只眼(11.11%)。本组24只眼中,格子样变性16只眼,囊样变性8只眼。(4)高眼压12只眼(6.12%),眼压在21~35 mm Hg。确定青光眼2只眼。(5)心理及社会因素影响者46只眼(21.29%)。(6)眼表疾病:20只眼(9.25%),角膜点状着色14只眼,重度结膜炎4只眼,严重干眼2只眼。结论为了保证LASIK手术的安全及有效性,术前仔细的常规检查尤为必要。     

未行LASIK手术189眼原因分析

目的 探讨进行术前检查而未行准分子激光原位磨镶术（LASIK）的原因.方法 对639例（1263眼）逐一进行眼部检查,对未行手术的96例（189眼）进行原因分析.结果 189眼中角膜厚度不适合者有51眼（26.98%）,矫正视力＜0.5者35眼（18.52%）,角膜屈光力偏大25眼（13.23%）,眼压高24眼（12.70%）,思想顾虑大19眼（10.05%）,眼底病变17眼（8.99%）,瞳孔偏大4眼（2.12%）,其他原因如年龄偏小、瘢痕体质等14眼（7.41%）.结论 LASIK是一种选择性手术,必须进行严格的术前检查和医患沟通,严格掌握手术的适应证和禁忌症.     

未行准分子激光原位角膜磨镶术的原因分析

目的:探讨未实施准分子激光原位角膜磨镶术(LASIK)的具体原因。方法:对574例患者经术前系统检查以及术前谈话后未实施手术的原因进行了分析。结果:574例中293例对手术有顾虑(占51.0%);角膜厚度不足61例(占10.6%);眼底病变60例(占10.4%);矫正视力不良50例(占8.7%);角膜屈光力较高40例(占7.0%);圆锥角膜13例(占2.3%);高眼压8例(占1.4%);年龄偏小、近视度数不稳定17例(占3.0%);干眼症12例(占2.1%);其它20例(占3.5%)。结论:LASIK手术有明显的选择性和严格的适应证。     

接受术前检查后未行准分子激光原位角膜磨镶术原因分析

目的分析屈光不正患者已接受准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)术前常规检查后最终未实施手术治疗的原因。方法自2003年1月开展LASIK治疗近视至2005年9月,共检查屈光不正患者1841例,其中185例(10.05%)最终未行LASIK,分析其原因。结果未行LASIK的原因为:角膜厚度不足74例(40.00%),思想顾虑47例(25.41%),社会因素34例(18.38%),视网膜严重病变11例(5.95%),青光眼或可疑青光眼9例(4.86%),矫正视力差7例(3.78%),圆锥角膜或可疑圆锥角膜3例(1.62%)。结论对近视度数相对高、角膜厚度相对薄的病例,LASIK具有明显的局限性。正确引导LASIK,术前认真检查和宣教,严格掌握手术适应证和禁忌证是减少医疗纠纷的关键。同时,应减少社会因素对近视手术选择的影响。     

299例未行准分子激光原位角膜磨镶术的原因分析

目的 :探讨未行准分子激光原位角膜磨镶术病例的原因。方法 :对 15 99例中经检查后未行LASIK手术的 2 99例 (占 18.6 % )患者的原因进行了分析。结果 :2 99例中 15 3例对手术有顾虑 (占 5 1.2 % ) ;角膜厚度不足有 4 4例 (占 14 .7% ) ;角膜屈光力偏大 34例 (占 11.0 % ) ;矫正视力不良 2 9例 (占 9.7% ) ;高眼压 18例 (占 6 .0 % ) ,眼底病变 11例 (占 3.7% ) ;其他原因 10例 (占 3.3% )。结论 :LASIK手术有明显的选择性 ,患者术前存在着明显的心理因素     

LASIK术后角膜瓣移位的临床研究

目的:探讨LASIK术后角膜瓣移位的治疗方法。方法:对我院2002-01/2007-01行LASIK手术共1082例(2040眼),术后发生角膜瓣皱褶或移位13例(15眼)进行分析。结果:LASIK术后1d出现角膜瓣皱褶2例(2眼),13例(14眼)术后1d出现角膜瓣移位并瓣内折7例(9眼),外伤所致4例(4眼)。13例(15眼)均行角膜瓣重新复位,除2例(2眼)术后1mo未达术前矫正视力外,其余均达到。结论:LASIK术中角膜瓣薄、角膜瓣大、蒂部小,易引起角膜瓣皱褶或移位;对角膜瓣皱褶或移位如发现及时、治疗得当,可达到理想的治疗效果。     

近视305例未行LASIK手术的原因

目的 分析近视眼而未行LASIK术的原因。方法 近视1680例（3350眼）经检查后未行LASIK者305例（597眼）,例数占18.15%,眼数占17.82%。对未行LASIK的原因进行了分析。结果 305例（597眼）中角膜厚度不足者109例（218眼）,眼数占597眼的36.52%;92例184眼占30.82%对手术存在顾虑;矫正视力不良者30例56眼（9.38%）;高眼压者23例43眼占7.20%;角膜屈光力偏高或过低21例40眼占6.70%;眼底病变15例26眼占4.36%;角膜中央内皮密度偏低8例16眼占2.68%;其他原因7例14眼占2.34%。结论 LASIK已被大多数近视者所接受;LASIK的医源性选择比例明显高于患者心理因素的选择。     

未能进行准分子激光角膜磨镶术298例原因分析

目的分析拟行准分子激光原位角膜磨镶术（LASIK）矫治近视者经检查后未能手术的原因。方法对我院近3a来1326例（2652眼）中行LASIK术前检查后未能行手术的298例596眼（22．47％）的原因进行了分析。结果准备行LASIK手术并接受术前检查中有298例（596眼）未能接受手术,其中因思想顾虑大、害怕手术失败或期望值过高从而放弃手术者127例（42．62％）;中央角膜度不够者45例（15．10％）;眼底病变26例（8．72％）;角膜屈光力偏大者32例（10．74％）;圆锥角膜8例（2．68％）;矫正视力欠佳者20例（6．71％）;眼压高可疑青光眼者14例（4．70％）;干眼症8例（2．69％）;其他18例（6．04％）。结论LASIK手术有明显的选择性,做好术前宣教,加强医患之间的沟通,认真做好术前检查,把握手术适应证和禁忌症,尽可能减少并发症出现。     

Reasons for not performing LASIK in refractive surgery candidates

PURPOSE: To analyze the reasons for which LASIK was rejected in eyes of patients who requested surgical correction of their refractive errors. METHODS: A retrospective study was performed in which data pertaining to refractive and ocular status of 338 patients who presented for refractive surgery at our LASIK facility between November 2002 and December 2003 were reviewed. The reasons for not performing LASIK in cases that were rejected were also noted. RESULTS: Among the 338 patients who requested refractive surgery, 223 (66%) underwent LASIK; surgery was not performed in 115 (34%) patients. The most common reason for rejecting LASIK was suboptimal central corneal thickness (55.1%). High myopia > -12.00 diopters (18.4%), keratoconus (9.6%), and hyperopia (5.9%) were other significant reasons. CONCLUSIONS: Suboptimal corneal thickness combined with a high amount of refractive error was found to be the leading cause of rejection of patients for LASIK in India.     

未行准分子激光原位角膜磨镶术原因分析

目的分析346例未行准分子激光角膜原位磨镶术（LASIK）的原因，了解手术的适应范围。方法对1998例近视患者进行术前常规检查，对其中未行手术的346例患者的未手术原因进行分析。结果346例中精神心理因素138例（占39．9％），角膜原因（包括角膜曲率过大、厚度偏薄及角膜疾病）89例（占25．7％），术前视力矫正不良59例（占17．0％），眼底病变21例（占6．1％），干眼症19例（占5．5％），高眼压16例（占4．6％），免疫系统疾病2例（占0．6％），睑内翻2例（占0．6％）。结论对于准备行LASIK手术的患者应仔细进行术前检查，严格掌握手术的适应证和禁忌证，加强医患沟通。     

Corneal hydration affects ablation during laser in situ keratomileusis surgery

BACKGROUND: Studies in animal eyes indicate that the level of corneal hydration affects the ablation rate of laser surgery; the greater the hydration is, the less the ablation for a given laser pulse. Our study is an assessment in human eyes comparing the effects on ablation by blotting the corneal stromal surface under a corneal flap created for laser in situ keratomileusis (LASIK) procedures between sets of excimer laser pulses, with ablation depth in eyes not blotted between sets of laser pulses. METHODS: We modified the surgical technique for LASIK procedures to assess the effects of the level of hydration on excimer laser ablation depth per pulse. In group 1, 40 eyes underwent LASIK surgery without any modification. Group 2 was composed of 36 eyes having LASIK procedures, but the corneal surfaces were kept relatively dry by blotting of the stromal surface between sets of laser pulses. RESULTS: Six months after surgery, the mean spherical equivalent refractive change was from -8.38 diopters (D) to -1.44 D in group 1 and from -7.93 D to -0.09 D in group 2. For predictability, the deviation from the target refraction after surgery was assessed. Thirty-three percent (13 of 40) in group 1 and 25% (9 of 36) in group 2 were within +/-0.5 D. Forty-eight percent (19 of 40) in group 1 and 50% (18 of 36) in group 2 were within +/-1 D. Six months after surgery, 80% or more in both groups were within +/-2 D. There was myopic regression in all patients. Three months after surgery, regression averaged -0.71 D in group 1 and -1.15 D in group 2. CONCLUSIONS: Corneal hydration levels affect the efficiency of laser ablation in LASIK procedures. With less hydrated corneas, ablation effects were greater than for corneas not blotted during the procedure, but these patients appear to undergo greater myopic regression.