准分子激光原位角膜磨镶术治疗近视

目的 全面评价准分子激光原位角膜磨镶术（laser in-situ keratom ileusis,LASIK）治疗近视的疗效。方法 对术前近视度为-2.00～-28.00D的患者429只眼行LASIK手术，观察12个月以上，按术前屈光度分为三组：-2.00～-8.00 D组179只眼，-8.25～-15.00 D组137只眼，-15.25～-28.00 D组113只眼，手术前后检查包括远、近视力、验光，裂隙灯和眼底检查，以及眼压、角膜知觉、对比敏感度、角膜内皮细胞照像、超声角膜测厚及角膜地形图等。手术参数包括：角膜瓣厚度130～160μm，最大切削直径5.8mm。手术后滴0.1%氟甲脱氧泼尼松龙眼液，持续1-2个月，结果 术后裸眼视力和屈光状态于1-3个月趋向稳定，角膜知觉在术后3个月时恢复术羊水平，而对比敏感度于术后3-6个月恢复正常，角膜内皮细胞密度无变化，术后12个月时，三组的屈光度在±1D以内者分别为88.8%、19.6%和70.8%，在±0.5D以内者分别为73.7%、65.0%和46.0%；裸眼视力达0.5或以上者分别为96.6%、81.8%和54.9＆，达1.0或者分别为84.4％、58.4％和15.0％。结论 LASIK手术对于高、中、低度近视均可取得良好的治疗效果，手术安全，但较PRK复杂，依赖于手术者的技术，目前尚无LASIK专用程序，需对PRK程序作一定修改。

Laser in situ keratomileusis for correction of myopia

OBJECTIVE: To evaluate the efficacy and safety of laser in situ keratomileusis (LASIK) for the correction of myopia. METHODS: A total of 429 eyes with preoperative refraction of -2.00 to -28.00 diopters were treated with LASIK and followed up for more than 12 months. Based on the refraction, the patients were divided into 3 groups: Group I, -2.00, to -8.00 diopters, 179 eyes; Groups II, -8.25 to -15.00 diopters, 137 eyes; Group III, -15.25 to -28.00 diopters, 113 eyes. The examinations included cycloplegic refractions, Goldman tonometry, corneal sensitivity, contrast sensitivity, specular microscopy, pachymetry and corneal topography. The parameters of LASIK were: the thickness of corneal cap was 130 or 160 microns, and the maximum diameter of ablation zone was 6.8 mm. After surgery, fluorometholone was given to the patients topically for 1 or 2 months. RESULTS: The vision and refractions tended to be normal 3 months after operation. The contrast sensitivity returned to normal 3 to 6 months after surgery. The endothelium did not show any changes. At 12 months, respectively 88.8%, 79.6% and 70.8% in the above groups were within +/- 1D, 73.7%, 65.0% and 46.0% were within +/- 0.5D; the uncorrected visual acuity was 0.5 or better in 96.6%, 81.8% and 54.9% of the patients, 84.4%, 58.4% and 15.0% had vision of 1.0 or better. CONCLUSIONS: LASIK is effective and safe for the correction of mild, moderate and high myopia. However, it is more complicated than PRK and more dependent on the surgical skills.