准分子激光原位角膜磨镶术治疗超高度近视远期疗效分析

目的探讨准分子激光原位角膜磨镶术(LASIK)治疗超高度(等效球镜度数>-10.00 D)近视的远期效果和安全性.方法对99例(173只眼)超高度近视行LASIK矫正,术前屈光度数-10.00～-23.50 D,平均(-13.7±3.6)D(等效球镜),其中-15.00 D以上41只眼.常规行裂隙灯显微镜、三面镜眼底检查、OrbscanⅡ眼前段分析系统、眼压、A超、角膜测厚、电脑验光、散瞳检影、主观验光等检查.术后随访18个月以上.结果术后18个月时裸眼视力≥0.5者148只眼(85.6%),最佳矫正视力高于或等于术前最佳矫正视力者147只眼(84.4%),未见术后最佳矫正视力较术前最佳矫正视力低于2行以上的眼;屈光度数稳定在±1.00 D以下者109只眼(63.0%),术前屈光度数在-14.75 D以下和-15.00 D以上达到±1.00 D内者的百分数分别为73.5%(97只眼/132只眼)和29.3%(12只眼/41只眼).术后角膜后表面前移,术后3个月时后表面顶点距理想球面的距离为(0.069±0.031)mm,18个月为(0.065±0.025)mm,均大于术前的(0.029±0.010)mm;角膜微皱褶2只眼,诉暗视力下降眩光6例(10只眼).结论 LASIK矫正超高度近视有效安全,同时在选择手术适应证方面应谨慎从之.对于屈光度数太高而角膜厚度偏薄者行LASIK应慎重,可考虑其他方法矫正如晶状体屈光手术或联合手术.(中华眼科杂志,2004,40816-818)

Long-term evaluation of laser in situ keratomileusis for extremely high myopia

OBJECTIVE: To evaluate the long-term efficacy and safety of laser in situ keratomileusis (LASIK) for extremely high myopia (with a preoperative refraction more than -10.00 diopters). METHODS: 173 eyes of 99 patients with a mean spherical equivalent (SE) of (-13.70 +/- 3.60) D (range -10.00 approximately 23.50 D), including 41 eyes with more than -15.00 D, were treated with LASIK and followed up for more than 18 months. The examinations included slitlamp microscopy, fundus examination, Orbscan II corneal topography system, tonometry, pachymetry, cycloplegic and subjective refraction. RESULTS: At 18 months postoperatively, the uncorrected visual acuity (UCVA) was 0.5 or better in 148 eyes (85.6%), and the best spectacle-corrected visual acuity (BSCVA) remained the same or increased in 147 eyes (84.4%). No eye lost more than two lines of BSCVA. 109 eyes (63.0%) were within +/- 1.00 D of emmetropia. The percentage was 73.5% and 29.3% in eyes with a preoperative SE of less than -14.75 D and more than -15.00 D, respectively. Postoperatively, the posterior corneal surface bulge was detected in all eyes. The mean elevation of the posterior corneal surface against the best-fit sphere was (0.029 +/- 0.010) mm preoperatively, (0.069 +/- 0.031) mm at 3 months, (0.065 +/- 0.025) mm at 18 months. At final follow-up, corneal flap folds were found in 2 eyes, and 6 patients (10 eyes) complained of glare or decreased scotopic vision. CONCLUSION: LASIK appeared to be an effective and safe treatment for correction of extremely high myopia. Meanwhile the candidates should be carefully screened.