LASIK术后眼调节状态的改变及其与视疲劳的关系

目的探讨准分子激光原位角膜磨镶术（LASIK）对近视患者眼调节状态的影响，同时对眼调节状态的变化与视疲劳症状的关系进行探讨。方法回顾性研究。选取2009年3月至8月来东风总医院眼科行LASIK的双眼近视患者60例（120眼），年龄18-35岁，术前等效球镜值为（-5．52±1．60）D，散光度〈2．00D．最佳矫正视力（BCVA）≥1．0。选择正视者20例（40眼）作为对照组。术前及术后1周、2周、1个月，分别对两组测定其单眼及双眼调节幅度，并对其进行近距工作视疲劳症状的问卷调查。采用独立样本t检验对两组的调节幅度和视疲劳评分进行比较，对近视组各时间点的调节幅度行单因素方差分析．并对术后1周调节幅度下降程度与术前屈光度的关系采用Pearson相关分析。结果①调节状态：LASIK术后第1周，近视组单眼及双眼调节幅度分别为（7．82±0．58）D和（8．10±0．54）D，较术前下降（P均〈0．05），之后逐渐恢复，至术后1个月时超过术前水平，且与正视组相比差异无统计学意义。②视疲劳症状：LASIK术后第1周，近视患者视疲劳症状均较术前明显加重，之后症状逐渐减轻，至术后1个月时视疲劳症状较术前明显减轻。③相关性分析：术后1周时，调节幅度的降低程度与术前屈光度呈正相关（r=0．83，P〈0．01）；近视组视疲劳症状与双眼调节幅度呈负相关（r＝-0．79，P〈0．01）。结论LASIK术后患者视近时调节需求增加，且单眼及双眼调节幅度均有短暂下降，术后第1周显著下降，之后逐渐恢复。LASIK术后视疲劳症状和眼调节状态的变化有关。

Changes in accommodation status after LASIK and its relationship with asthenopia

Objective Investigate the influence for accommodation status and discuss the relationship between the accommodation status and asthenopia after laser in situ keratomileusis （LASIK）. Methods In this retrospective study, 20 emmetropes and 60 myopes （SE=-5.52±1.60 D, astigmatism 〈2.00 D,BCVA≥1.0） experienced LASIK from March 2009 to August 2009 aged 18-35 years old were selected form the Department of Ophthalmology in DongFeng General Hospital. Twenty emmetropes were selected as control. Monocular and binocular accommodative amplitudes for all people before surgery, 1 week, 2 week, 1 month after surgery were surveyed, while symptoms of asthenopia were evaluated by questionnaire. Independent samples t test, ANOVA and Pearson correlation were used to analyze the data. Results ①Accommodation status： monocular and binocular accommodative amplitudes were （7.82±O.58）D and （8.10±0.54）D 1 week after LASIK, descended compared to preoperation （P〈0.05）, while recovered and surpassed the preoperative level at 1 month after LASIK, and there was no significant difference between the myopes and emmetropes after 1 month. ②Symptoms of asthenopia： the asthenopia symptoms of myopes aggravated significantly during the first week after LASIK, and recoverd at 1 month after LASIK. ③Correlation analysis showed that the symptoms of asthenopia has a negative correlation with binocular accommodative amplitude in the first week after surgery （r=-0.79, P〈0.O1）. The descending extent of the accommodative amnlimde had nasitive correlation with therefractive power before surgery （r=0.83, P〈0.01）. Conclusion After LASIK, the accommodative amplitude appears to decrease temporarily, especially in the first week after LASIK, and then recovered progressively; the demand of accommodation increases after surgery. The symptoms of asthenopia after LASIK are associated with the change of accommodative amplitude.