改良单眼视LASIK手术矫正老视的疗效

目的 评价Custom-Q引导的改良单眼视准分子激光角膜磨镶术(LASIK)治疗患有近视、散光的老视患者的疗效.方法 前瞻性系列病例研究.收集2009年6月至2010年2月在华西医院近视中心实施改良单眼视LASIK手术的老视患者10例,主视眼屈光度全矫,实施传统LASIK切削;非主视眼保留-1.50 D球镜度数,实施“Custom-Q”引导的非球面性切削,实现改良的单眼视,分别于术后1周、1个月、3个月、6个月及1年进行随访,观察非主视眼和双眼的远、近视力,通过问卷调查,评估患者手术前后用眼舒适度、眼镜的依赖程度及术后满意度.分别对结果进行单因索方差分析、配对t检验和Wilcoxon秩和检验.结果 ①视力:与术前相比,术后非主视眼单眼的裸眼远、近视力差异均有统计学意义(P＜0.01),双眼同时视的裸眼远、近视力差异均有统计学意义(P均＜0.01).②稳定性:非主视眼的单眼和双眼裸眼视力在术后各时间点,差异均无统计学意义.③安全性:术中、术后无严重并发症发生,非主视眼最佳矫正视力术后较术前差异无统计学意义.④满意度:术后主观评分8.40±0.88,问卷调查显示用眼舒适度和眼镜依赖度评分术前和术后差异具有统计学意义(Z=-2.527、-2.609,P＜0.05).结论 运用Custom-Q改良的高级单眼视可用于矫正患有近视、散光的老视人群,可同时获得较好的远、近视力,患者满意度较高.     

单眼视LASIK治疗伴有老视的屈光不正临床观察

目的:探讨单眼视准分子激光原位角膜磨镶术(单眼视LASIK)治疗伴有老视的屈光不正对患者视觉质量、生活质量的影响。方法:屈光不正伴老视的患者172例中124例施行单眼视LASIK(主视眼按最佳矫正远视力完全矫正,非主视眼近视者低矫-0.75~-2.00D,远视者过矫0.75~2.00D),35例放弃手术,13例患者双眼全部矫正。观察术后1d;1wk;3mo时的检查结果。结果:术后3mo单眼视LASIK组124例患者双眼远视力0.7~1.2,双眼近视力J1~J3。无因为难以耐受的不适而需要戴镜补充矫正或再次手术者。双眼完全矫正组术后双眼远视力0.7~1.2,双眼近视力J3~J6,8例(62%)视近困难,需配近用眼镜。结论:单眼视LASIK治疗伴有老视的屈光不正安全有效。单眼视治疗在设计手术方案时需根据患者年龄及调节能力、近附加度数、阅读距离、工作性质等综合考虑。     

大龄近视患者行LASIK的体会

目的:探讨大龄近视伴调节力下降患者行准分子激光原位角膜磨镶术(LASIK)的手术设计对视力的影响。方法:屈光不正伴老视的患者32例63眼中27例53眼行单眼LASIK主视眼按最佳矫正远视力完全矫正,非主视眼近视欠矫-0.5～-2.00D,5例10眼双眼远视力全部矫正。观察术后3mo视力。结果:术后3mo,27例53眼远视力主视眼1.0～1.2,非主视眼0.3～0.6;近视力主视眼0.6,非主视眼1.0。5例10眼双眼远视力完全矫正。结论:LASIK矫正大龄调节力下降患者,在设计手术方案时需按患者要求、年龄等综合考虑。     

多焦点准分子激光原位角膜磨镶术治疗老视前近视的对比研究

目的 探讨多焦点准分子激光原位角膜磨镶术(LASIK)治疗老视前近视的可行性.方法 前瞻性对照研究.共32例(64只眼)近视眼患者,平均年龄(38.5 ±2.7)岁;主视眼行常规LASIK,非主视眼行多焦点LASIK.检测项目:远近视力、屈光度、角膜地形图、眼压、超声角膜厚度、对比敏感度、调节幅度、焦深、波阵面像差等.对计量资料计算均数和标准差,检验水准α为0.05,对数据进行双侧检验.将调节增幅和术后角膜多焦点指数、手术前后球差改变进行相关分析.结果 随访6～11个月,平均(7±3)个月.非主视眼术前近视力为(LogMAR-0.082±0.220),术后6个月为(LogMAR-0.004±0.213),术后较术前提高(t=4.108,P=0.009);主视眼术前近视力(LogMAR-0.055±0.218),术后6个月为(LogMAR-0.034±0.187),差异无统计学意义(t=1.051.P=0.334).术后6个月6 mm拟合球面Q值,非主视眼平均为(0.08±0.27),主视眼平均为(0.46±0.27),两组差异有统计学意义(t=4.301,P=0.000).非主视眼术后角膜中央区出现高屈光力范围(手术预期视近区域),平均为(5.64±3.05)mm2;术后6个月,非主视眼4只眼(12.5%)出现正球差,平均均方根值为(-0.204±0.195)μm,与术前比较差异无统计学意义(t=0.532,P=0.600);主视眼无正球差出现,均方根值为-0.791～-0.083μm,平均(-0.470±0.208)μm,和术前相比负球差明显增加,差异有统计学意义(t=12.622,P=0.000),术后两组的差异有统计学意义(t=9.214,P=0.000).非主视眼术后6个月调节幅度较术前增加(0.84±0.61)D,主视眼较术前降低(0.10±0.67)D.非主视眼手术后调节力增幅和术后角膜多焦点指数、球差改变具有相关关系.结论 多焦点准分子激光原位角膜磨镶术治疗老视前近视安全、有效.多焦点准分子激光原位角膜磨镶术后能够得到一定程度的伪调节,角膜多焦点性质和非球面性是手术后伪调节产生的根源,伪调节和术后负球差的减少有关.     

Q值调整联合单眼视LASIK治疗近视伴老视的疗效

目的：评价Q值调整联合单眼视LASIK治疗近视伴老视的效果。方法：回顾性病例对照研究。纳 入2017年2月至2018年12月在上海爱尔眼科医院国际屈光中心实施老视手术患者。34例非主视眼采用Q值调整联合单眼视LASIK治疗老视,非主视眼设定目标Q值比术前Q值向更负的方向变化 0.3～0.5,保留的屈光度在-1.00～-0.25 D范围。对照组43例匹配年龄和非主视眼屈光度,保留的屈光度在-1.00～-0.25 D范围,不做Q值调整;2组主视眼均全矫。记录非主视眼的裸眼远、中、近 视力,角膜中央3 mm屈光度,前表面Q值,总像差,低阶像差,高阶像差,球差,角膜球差,离焦和彗差。记录双眼裸眼远、中、近视力。组间连续型变量比较采用独立样本t检验,使用Spearman相关检验近视力与离焦、术后Q值及瞳孔变化幅度的相关性。结果：术后3个月,Q值调整联合单眼视组 非主视眼近视力较对照组好（t=0.597,P=0.021）,远视力和中视力与对照组相比差异无统计学意义。 Q值调整联合单眼视组93%的患者双眼近视力（LogMAR）在0或以上,比对照组的86%高（χ2 =27.127, P<0.001）。与对照组相比,Q值调整组总像差、低阶像差、角膜球差、离焦较对照组大（t=-2.210, P=0.032;t=-2.135,P=0.038;t=-2.108,P=0.038,t=-2.190,P=0.034）。77例患者近视力与术后自然 光线瞳孔下的离焦、术后Q值及调节引起的瞳孔变化均呈负相关（r1=-0.251,P1=0.028;r2=-0.543, P2<0.001;r3=-0.417,P3<0.001）。结论：采用Q值调整联合单眼视LASIK治疗老视在提高近视力的同 时,不影响远视力。Q值向负向调整,增加了中央角膜的屈光度、离焦和球差,在视近时通过瞳孔直径的变化,提高近视力,同时不会明显影响远视力。     

非球面优化单眼视准分子激光手术治疗近视合并老视的短期临床观察

目的探讨非球面优化单眼视准分子激光治疗近视合并老视的安全性和有效性。方法选择2017年3~11月在我院视光中心行非球面优化单眼视准分子激光治疗的患者30例(60只眼)。主视眼实施常规模式的准分子激光原位角膜磨镶术(LASIK)矫正全部屈光度,非主视眼实施Q值调整的非球面切削的LASIK。术后随访观察患者术后1 d、1个月、3个月的裸眼远近视力、对比敏感度、角膜地形图变化情况。结果所有患者手术均顺利,无角膜瓣有关的并发症;术后所有患者均没有角膜水肿、Haze反应、高眼压等术后并发症。术后1 d、1个月、3个月,主视眼远视力分别为1.02±0.28、1.10±0.15及1.07±0.20;非主视眼远视力分别为0.8±0.17、1.03±0.26及1.09±0.18。术后1个月至3个月患者远视力趋于稳定。非主视眼术后1 d为0.37±0.10,术后1个月时达到0.51±0.19,3个月时基本稳定。术后3个月时非主视眼中有90%(27/30)≥0.33,70%(21/30)≥0.5。主视眼术后1、3个月的Q值向正值方向发展,分别为0.44±0.20、0.40±0.26,与术前比较差异有统计学意义(P<0.05)。非主视眼术后1、3个月的Q值分别为-0.55±0.26、-0.48±0.29。患者术后1、3个月患者的对比敏感度逐步达到术前水平。结论非球面优化单眼视准分子激光治疗近视合并老视是安全性和有效性的。     

传导性角膜成形术治疗老视眼的临床观察

目的评价传导性角膜成型术(CK)治疗老视眼的有效性、安全性、预测性。方法对有老视症状的33例54眼行CK治疗,应用射频能量通过探针在周边角膜基质刺8～32个点。患者手术前屈光度 0.75～ 3D,散光<0.75D,手术后主视眼目标屈光度为0,非主视眼目标屈光度为-0.75～-2.25D。结果术后1年,30例(93%)患者双眼远视力为0.8,近视力为J4或以上。54眼(100%)等值球镜和目标屈光度的差值在±1.0D以内;手术眼屈光度和目标屈光度的差值为(0.53±0.34)D,平均每月变化0.10D。术后1个月33例(96%)患者比较满意或者特别满意。结论CK手术治疗老视眼具有安全性高,预测性好,并发症少的特点。     

准分子激光原位角膜磨镶术和钬激光热角膜成形术治疗原发性远视眼

目的　评价准分子激光原位角膜磨镶术 (LASIK)和钬激光热角膜成形术 (LTK)治疗原发性远视眼的有效性、预测性和安全性。方法　对 3 0例原发性远视眼患者 ( 1 0 0～ 8 5 0 0D) ,分别采用LASIK( 19眼 )和LTK( 11眼 )进行治疗 ,术后平均随访 12个月。结果　至术后 12个月时 ,LASIK组裸眼视力达到 0 5～ 0 9和 1 0以上者分别为 42 1%和47 4% ;LIK组裸眼视力达到 0 5～ 0 9和 1 0以上者分别为 2 7 3 %和 45 5 %。LASIK组屈光度在≤± 0 5D和 >± 0 5～± 1 0D者分别为 5 2 6%和 3 1 6% ;LIK组屈光度在≤± 0 5D和 >± 0 5～± 1 0D者分别为 45 5 %和 2 7 3 %。结论　LASIK可有效地治疗低中度远视眼且具有较好的预测性和安全性 ;LTK治疗低度远视眼简便、安全 ,但术后有屈光回退。对手术技术和激光治疗的不断改进将进一步提高预测性和稳定性。     

CK和LASIK治疗老视的临床效果对比研究

目的:比较分析传导性角膜成形术(conductive keratoplas-ty,CK)和准分子激光原位角膜磨镶术(laser in situ kera-tomileusis,LASIK)应用单眼视治疗老视的临床效果和视觉质量。方法:21例(26眼)及24例(41眼)老视患者分别接受CK和LASIK治疗,术前患者屈光度球镜+0.75~+2.0D,散光≤+0.75D,术后预期目标屈光度主导眼矫正为0~-0.5D,非主导眼矫正为-1.5~-2.5D近视状态且近视力≥0.5(J3),术后随访1a。结果:术后1aCK组和LASIK组双眼裸眼视力≥0.8且近视力≥J3者分别为52.4%、66.7%,近视力≥0.33(J4)者分别为81.0%、87.5%,两组与术前相比均有显著性差异(P<0.01),两组间相比较无显著性差异(P>0.05);术眼等效球镜屈光度与预期目标相差±0.5D以内者分别为42.3%、70.7%,两组相比较差异有显著性(P<0.05);术眼散光度在±0.75D以内者分别为57.7%、92.7%,两组相比较差异有显著性(P<0.05);术眼角膜光学视功能区CK组和LASIK组相比较无显著性差异;两组患者术眼对比敏感度较术前均无明显下降;术后1a患者术眼有干眼症状者CK组为3眼(11.5%),LASIK组为8眼(19.5%),两组相比较无显著性差异(P>0.05)。结论:应用单眼视原理采用CK和LASIK治疗老视均取得了较满意的疗效,两种手术方式的远期疗效和稳定性有待进一步观察。     

准分子激光角膜瓣背面磨镶术治疗LASIK术后屈光欠矫和回退

目的 探讨准分子激光角膜瓣背面磨镶术(LASUK)治疗准分子激光原位角膜磨镶术(LASIK)术后屈光欠矫和回退的疗效.方法 对LASIK后屈光欠矫和回退的14例(24眼)施行LASUK,观察术后视力、屈光度、角膜后表面及haze情况.结果 术后3个月视力和屈光度趋于稳定,术后无角膜浑浊,无继发性圆锥角膜.术后6个月,裸眼视力≥0.6和≥1.0者分别为24眼(100.00%)和18眼(75.00%).屈光度介于±1.00D者22眼(91.67%),19眼屈光度介于±0.50D之间,最佳矫正视力无下降者.结论 LASUK治疗LASIK术后屈光欠矫是安伞有效的.     

传导性角膜成形术治疗老视眼的临床效果观察

目的:探讨应用单眼视原理采用传导性角膜成形术(Conductive keratoplasty,CK)治疗老视的临床效果、安全性及可预测性。方法:选择31例(40眼)有明显老视症状的患者,术前屈光度球镜+0.50~+2.50D,散光≤+0.75D,采用CK进行治疗,术后预期目标屈光度主导眼矫正为0.00~-0.50D,非主导眼术后目标屈光度为-1.50~-2.50D,且近视力≥0.5(J3),术后随访1a以上。结果:术后1a双眼裸眼远视力≥0.8且近视力≥0.5(J3)或近视力≥0.33(J4)者分别为61.3%,74.2%;与术前相比均有显著性差异(P<0.01);术后1a等效球镜屈光度与预期目标差值在±0.50D、±1.00D以内者分别为45.0%,82.5%;术后1a术眼散光度在±1.00D以内者为87.5%;术后双眼各空间频率对比敏感度与术前相比较差异无统计学意义(P>0.05);术后1a无最佳矫正视力下降,无严重干眼症的发生;术后1a90.3%的患者表示满意。结论:应用单眼视原理采用CK治疗老视取得了较好的临床疗效,但其远期疗效和稳定性有待进一步观察。     

大龄近视患者LASIK疗效分析

目的：探讨大龄近视患者LASIK特点及采用Monovision矫正方法设计的LASIK术后疗效。

方法：对104例186眼大龄近视患者(年龄≥40岁)采用Monovision矫正方法设计并进行LASIK手术,并对术前后视力、屈光度、手术疗效等进行统计分析。

结果：术后1mo,所有术眼的裸眼视力均明显提高(P<0.01),达到1.0的百分率分别为非主导眼83.7%(87/104),主导眼91.5%(75/82); 术后裸眼视力与术前最佳矫正视力比较,非主导眼差异不显著(P>0.05),而主导眼提高明显(P<0.01); 术后屈光度非主导眼为-0.70±0.12D,与术前欠矫设计量基本一致(P>0.05),主导眼为-0.04±0.28D,两组差异显著(P<0.01); 患者对远视力满意度100%、近视力满意度82.7%。

结论：大龄近视患者行LASIK治疗以高度、超高度近视患者为主,大屈光参差(>2.50D)患者占比例较高; 采用Monovision矫正方法设计的LASIK术对改善大龄患者术后视近功能、缓解视疲劳以及提高其视觉满意度是切实有效的,将这一临床经验用于个体化手术方案的设计可以使其更为完善。     

Q值优化Micro-Monovision矫正近视合并老视的短期临床效果

探讨Q值优化Micro-monovision准分子激光手术矫正近视合并老视的安全性、有效性及预测性。方法：前瞻性临床研究。收集2017 年8 月至2018 年5 月在青岛大学附属医院行Q值优化Micro-monovision准分子激光手术的近视合并老视患者35例（70眼）。术后3个月观察单眼和双眼的远、近视力（logMAR视力）、屈光状态、对比敏感度（CS）及立体视，并进行近距离工作视觉疲劳问卷及满意度调查。采用配对t检验对手术前后数据进行分析。结果：35例患者术前双眼视远最佳矫正视力（BCVA）为0.01±0.06，术后3个月为-0.04±0.21，且术后无一眼BCVA下降1行及以上。术后主视眼裸眼视力（UCVA）为-0.04±0.19，非主视眼UCVA为0.04±0.13。所有患者主视眼视近UCVA 均达20/25及以上，非主视眼均达20/20。所有术眼实际获得等效球镜度（SE）与预期切削SE的差值均在±1.00 D以内，而差值在±0.50 D以内为60眼（86%）。术后3个月CS在昼+周边眩光条件下18.0 c/d频段较术前显著提高（t=-2.504，P=0.017）；在昼1.5、6.0、18.0 c/d频段，昼+周边眩光6 c/d频段，夜1.5 c/d频段，夜+周边眩光18.0 c/d频段CS均较术前显著下降（P<0.05），其他各条件频段CS均恢复至术前水平。立体视术后3个月与术前比较差异均无统计学意义。所有患者术后均未出现近距离工作后头痛、恶心、阅读模糊及视近困难。所有患者对手术效果均表示满意，满意度为100%。结论：Q值优化Micro-monovision准分子激光手术矫正近视合并老视，可同时获得较好的双眼远、近视力及双眼视功能，是一种安全、有效且预测性好的手术方法。     

Conductive keratoplasty for presbyopia: 1-year results

PURPOSE: To assess the safety, efficacy, and stability of conductive keratoplasty (CK) in the treatment of presbyopia. METHODS: Ten near plano presbyopic patients (6 women and 4 men) underwent unilateral CK in the non-dominant eye to improve their near vision. Mean age was 51 +/- 3.1 years (range: 46 to 56 years). The surgeries were the author's first 10 CK procedures performed. The postoperative target for these eyes ranged from -1.25 to -1.75 diopters (D). RESULTS: Preoperative mean manifest refraction spherical equivalent (MRSE) was -0.18 +/- 0.27 D (range: -0.75 to -0.25 D), yielding a mean near uncorrected visual acuity (UCVA) of J10 (range: J12 to J5). Twelve months after CK, the mean near UCVA was J1 (range: J3 to J1) with 90% (9/10) eyes J1 and 100% (10/10) eyes J3 or better. The mean MRSE was -1.31 +/- 0.53 D (range: -2.25 to -0.75 D). Treated eyes lost an average of 2.2 +/- 2 lines (range: 0 to 5) of distance UCVA but gained an average of 8.7 +/- 2 lines (range: 4 to 11) of near UCVA. No eye lost best spectacle-corrected visual acuity or had induced cylinder > or = 0.75 D. Nine (90%) of 10 patients had binocular distance UCVA < or = 20/20 and near UCVA < or = J1 and all 10 (100%) patients had binocular distance UCVA < or = 20/25 and near UCVA < or = J3. CONCLUSIONS: Conductive keratoplasty for the treatment of presbyopia provided safe and effective results 1 year following the initial surgery. Longer follow-up will be needed to describe refractive stability. The mean near and distance UCVA results were better than expected for the amount of refractive change observed during this study.     

Results of laser in situ keratomileusis for myopia of -10 to -19 diopters with a Technolas 217 laser

PURPOSE: To evaluate the effectiveness, predictability, and safety of laser in situ keratomileusis (LASIK) for correcting myopia greater than -10.00 D. METHODS: Sixty-five eyes of 37 patients with myopia greater than -10.00 D underwent LASIK. Patients were evaluated on day 1, 1 week, 1, 3, and 6 months after surgery. Parameters evaluated were uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA), residual refractive error, regression of correction, and presence of any complication. RESULTS: Mean preoperative BSCVA was 0.745 +/- 0.234, which improved to 0.8070 +/- 0.237 postoperatively. The average preoperative UCVA was 0.022 +/- 0.02; postoperative UCVA at 6 months was 0.536 +/- 0.255. UCVA of 20/40 or better was achieved in 58% (38 eyes) and 20/20 or better in 26% (17 eyes). The average refractive error before LASIK was -12.64 +/- 2.16 D (range -10.00 to -19.00 D). Mean residual refractive error 1 week following LASIK was -0.63 +/- 1.36 D, which regressed to a mean -1.78 +/- 2.08 D at the end of 6 months. Nineteen eyes (29%) were within +/-0.50 D of intended refractive correction. CONCLUSION: LASIK was partially effective in the correction of high myopia. An initial overcorrection may be programmed to offset the effect of refractive regression.     

Nomogram adjustment of laser in situ keratomileusis for myopia and myopic astigmatism with the Alcon LADARVision system

PURPOSE: To evaluate the visual and refractive results of conventional (non-wavefront) laser in situ keratomileusis (LASIK) for treatment of myopia and myopic astigmatism using the Alcon LADARVision 4000 excimer laser system and nomogram adjustment techniques. METHODS: A retrospective analysis of 499 eyes that had LASIK for myopia and myopic astigmatism was performed. Preoperative manifest spherical equivalent refraction ranged from -0.43 to -6.00 D and preoperative astigmatism ranged from 0 to -4.75 D. Patients were evaluated during 3 months following surgery. RESULTS: One month after surgery, 72% of eyes examined (298/415 eyes) had uncorrected visual acuity (UCVA) of 20/20 or better. Three months after surgery, 83% of eyes examined (216/261 eyes) had UCVA of 20/20 or better. One and three months after surgery, 82% and 83% of eyes, respectively, were within +/-0.50 D of attempted correction; 97% of eyes were within +/-1.00 D at both 1 and 3 months. No eye lost more than 1 line of best spectacle-corrected visual acuity (BSCVA) at 3 months after surgery. At the 3-month examination, 83% of eyes had UCVA better than or equal to preoperative BSCVA. CONCLUSIONS: Conventional LASIK to correct myopia and myopic astigmatism was safe and effective using the Alcon LADARVision 4000 excimer laser system. Outcomes were substantially improved throughout development of an accurate nomogram, derived from continually updated regression analysis of previous refractive results.     

Treatment of presbyopia with conductive keratoplasty: six-month results of the 1-year United States FDA clinical trial

PURPOSE: To provide 6-month results of a 1-year clinical trial evaluating conductive keratoplasty (CK) for the treatment of presbyopic symptoms in emmetropic and hyperopic eyes. METHODS: A total of 143 patients with presbyopic symptoms were enrolled in this 1-year United States FDA clinical trial and treated to improve near vision in 1 eye (unilateral treatment). In addition, 33 fellow eyes were treated to improve distance vision (bilateral treatment). For near vision correction, the target refraction was up to -2.0 D in the nondominant eye, and for distance vision correction, 0.0 D. Enrolled patients had a preoperative spherical equivalent of plano to +2.00 D, no more than 0.75 D of refractive astigmatism, and were 40 years of age or older. No retreatments were performed. RESULTS: Of the eyes treated for near, 77% had uncorrected near vision of J3 or better at 6 months postoperatively. A total of 85% of all patients had binocular distance UCVA of 20/25 or better along with J3 or better near, a combination that represents functional acuity for a presbyope. Sixty-six percent of eyes treated for near had a manifest refractive spherical equivalent (MRSE) within +/- 0.50 D of intended at 6 months. In 89% of eyes, the MRSE changed 0.05 D or less between 3 and 6 months postoperatively. After month 1, the incidence of variables associated with safety was 1% or lower. Seventy-six percent were very satisfied or satisfied with their procedure. CONCLUSIONS: CK appears to be very safe and effective in producing functional visual acuity in presbyopic eyes up to 6 months following the procedure. Patient satisfaction with the procedure is similar to that of monovision LASIK.