准分子激光原位角膜磨镶术治疗儿童高度远视屈光参差性弱视的效果

目的评价准分子激光原位角膜磨镶术（LASIK）矫治儿童高度远视性屈光参差的安全性、有效性、可预测性和稳定性，并探讨其对术后弱视治疗效果的影响。方法采用前瞻性自身对照法观察42例高度远视屈光参差性弱视儿童病例，年龄范围6～14岁。使用SVS Apex plus准分子激光系统（其中联合L型mask盘矫正单纯远视9例，联合P型mask盘矫正远视合并散光12例）及鹰视世纪波准分子激光系统（21例），在局部麻醉或全身麻醉下对患儿高度远视眼行LASIK，术后进行弱视治疗。术后对视力、屈光度和双眼视功能进行分析。随访时间6～24个月。结果矫治屈光度数为＋3．00-＋7．50D，术后2年66．6％术眼残余屈光度数在预计矫正屈光度数±1．00D的范围内。术后随访发现睫状肌麻痹下等值球镜屈光度数波动范围为＋0．99～＋0．67D。最佳戴镜矫正远、近视力均不丢失。术后2年平均最佳戴镜矫正远视力为0．40±0．28，平均最佳戴镜矫正近视力为0．78±0．39。经规范弱视治疗，双眼不等像、同时视、融合、立体视及隐斜均得以改善。结论对患有高度远视性屈光参差且不能耐受戴镜矫治的儿童，采用LASIK矫治屈光参差是安全、有效的，具有良好的可预测性和稳定性，且这一手术有助于提高高度远视屈光参差性弱视的治愈率。

Laser in situ keratomileusis for treatment of high hyperopic anisometropia in children

OBJECTIVE: To assess the safety, efficacy, predictability and stability of the laser in situ keratomileusis (LASIK) procedure in high hyperopic anisometropia with amblyopia in pediatric patients and to study the effect of amblyopic therapy after the surgery. METHODS: This is a prospective and self-control study which included 42 children with high hyperopic anisometropic amblyopia. The age of the children ranged from 6 to 14 years. LASIK was performed in the eyes with higher degree of hyperopic under topical or general anaesthesia using the Summit's SVS Apex plus (L mask for simple hyperopia, 9 eyes; P mask for hyperopia and astigmatism, 12 eyes) and the Lumenis's Allegretto Wave (21 eyes). Postoperative visual acuity, refraction and the binocular vision were analyzed. Minimum follow-up period was 6 months; 24 children had a 2-year follow-up. RESULTS: In eyes with +3.00 diopters (D) to +7.50 D preoperatively, the postoperative refraction in 66.6% of eyes was within +/- 1.00 D of the expected correction. From 6 to 24 months postoperatively, there was a mean variation from +0.67 to + 0.99 D in cycloplegic equivalent refraction. Best spectacle-corrected visual acuity (BSCVA) of distance and reading did not decrease after the surgery. The mean BSCVA of distance was 0.40 +/- 0.28 (P < 0.001) and reading BSCVA was 0.78 +/- 0.39 (P < 0.001) 2 years after the surgery. Simultaneous vision, fusion, stereopsis and heterophoria were improved 2 years postoperatively. CONCLUSIONS: LASIK is a safe and effective procedure for the correction of high hyperopic anisometropia in children who cannot tolerate contact lens. This procedure provides a satisfactory predictability and refractive stability results 2 years postoperatively. The effects of amblyopia therapy can be improved after the surgery.