飞秒激光角膜屈光手术后视觉质量

目前飞秒激光在角膜屈光手术的应用主要有两类,飞秒激光制作角膜瓣联合基质面行准分子激光切削(FS-LASIK)以及全飞秒激光手术;后者可分为飞秒激光基质透镜切除术(FLEx)和飞秒激光小切口基质透镜切除术(SMILE).本文回顾了与传统LASIK相比,FS-LASIK手术后裸眼视力、矫正视力、安全指数、有效指数的差别,FS-LASIK术后对比敏感度、高阶像差等客观视觉质量以及主观视觉质量问卷的影响;与FS-LASIK相比,FLEx对术后裸眼视力、波前像差等客观视觉质量以及主观满意的影响;并对三种手术方式的术后的安全性、有效性、可预测性以及在角膜知觉方面的优缺点进行综述.     

飞秒激光在角膜屈光手术中的应用进展

准分子激光原位角膜磨镶术是目前矫正近视的主要方法,其术中及术后的并发症主要来源于角膜瓣的制作。激光制作角膜瓣可以减少这些并发症的发生,而飞秒激光是目前所知惟一可以用于角膜瓣制作的激光。本文就飞秒激光的作用原理以及用于角膜瓣制作的动物实验和早期临床结果进行综述。     

飞秒激光制瓣LASIK术后角膜上皮下混浊研究分析

目的:探讨飞秒激光制瓣LASIK术后角膜上皮下混浊(haze)的原因。方法:对99例198眼采用飞秒激光制作角膜瓣LASIK术。使用FemtoLDV达芬奇飞秒激光作上方带蒂角膜瓣。激光参数:脉冲频率1MHz,预定制角膜瓣厚度110μm,角膜瓣直径8.5～9.0mm。日本TOMEYSP100超声波角膜测厚仪,实际测量厚度为95～103(平均98.00)μm。结果:发现haze10例19眼,haze多发在光学区中央,直径约3.0～4.5mm,小部分在鼻侧。患者术后1,14d;1,3,6mo的平均裸眼视力分别为0.82±0.24,0.94±0.16,0.98±0.17,1.0±0.26,0.97±0.13。而患者发生haze后的术后14d;1,3,6mo之间裸眼视力比较差异无统计学意义(P>0.05),与术前最佳矫正视力(0.98±0.25)比较差异无统计学意义(P>0.05)。结论:飞秒激光制作的薄角膜瓣与haze的发生有关,轻度的haze对患者术后的裸眼视力未产生影响。     

Applications for the femtosecond laser in corneal surgery

PURPOSE OF REVIEW: Little has changed in how corneal surgery, particularly full-thickness penetrating keratoplasty, has been performed since the introduction of the operating microscope and microsurgery more than 40 years ago. The introduction of IntraLase Enabled Keratoplasty represents the first true advancement in corneal surgery in that time. There are numerous studies that have documented the high degree of complications seen in procedures such as penetrating keratoplasty. The advent of IntraLase Enabled Keratoplasty affords an opportunity to improve the safety and effectiveness of such procedures. RECENT FINDINGS: Complications and visual outcomes remain an ongoing concern when it comes to managing patients following corneal surgery. The intensive postoperative follow up represents a significant undertaking for clinicians, staff and patients. Initial studies indicate that the use of the femtosecond laser in corneal surgery can simplify surgery, improve wound healing and lower levels of induced astigmatism. SUMMARY: This review will examine the uses of the femtosecond laser in corneal surgery, as well as early results that have been reported.     

近视LASIK术后角膜生物力学参数变化的相关性

目的:观察近视LASIK术后角膜生物力学参数与形态参数变化的相关性。方法:近视患者69例136眼,于LASIK术前及术后1mo行眼反应分析仪(ORA)测量角膜滞后(CH)和角膜阻力因子(CRF),Pentacam眼前节分析仪测量眼前节参数。计算术后角膜生物力学参数变化ΔCH及ΔCRF,Pentacam测量角膜中央厚度变化ΔCCT,中央2,4,6mm平均角膜厚度变化(ΔCCT2mm,ΔCCT4mm和ΔCCT6mm),角膜容积变化ΔCV,角膜前后表面曲率半径变化ΔRa和ΔRp,分析ΔCH和ΔCRF与角膜形态参数的相关性。结果:LASIK术前平均CH及CRF(9.99±1.38和9.96±1.30mmHg)明显高于术后1moCH和CRF(7.90±1.16和6.49±1.28mmHg),差异具有统计学意义(P<0.05)。LASIK术后ΔCH和ΔCRF与ΔRp和ΔCCT6mm无相关性,ΔCH和ΔCRF与ΔCCT,ΔCCT2mm,ΔCCT4mm和ΔCV呈正相关(r:0.513,0.397,0.329和0.314,P<0.05;r:0.616,0.504,0.484和0.466,P<0.01);ΔCRF与ΔRa呈负相关(r:-0.374,P<0.01)。结论:近视LASIK术后角膜CH和CRF变化与角膜厚度及容积有关,CRF评价LASIK术后角膜生物力学变化比CH更有价值。     

SMILE与飞秒激光制瓣LASIK矫正近视的疗效对比

目的 对比和评价SMILE和飞秒激光制瓣的LASIK （FS-LASIK）矫正近视的效果.方法 前瞻性对照研究.71例患者（142眼）分为2组：SMILE组36例和FS-LASIK组35例.术前及术后1d、7d、1个月、3个月、6个月分别检查记录2组患者的UCVA和屈光度,并用Zywave波前像差仪检查总高阶像差、球差、三阶垂直彗差、三阶水平彗差.对数据进行卡方检验和独立样本t检验.结果 术后1 d FS-LASIK组UCVA较SMILE组好,术后7d、1个月时2组UCVA相近,术后3个月后,SMILE组显示出较FS-LASIK组更好的UCVA,术后不同时间点2组UCVA≥术前BCVA的比例差异均无统计学意义;术后7d和6个月时2组等效球镜度差异均无统计学意义（t=0.56、0.41,P＞0.05）;2组术后早期总高阶像差均较术前明显增加,术后3个月有所下降,术后6个月SMILE组低于FS-LASIK组;2组术后1d、7d、1个月、3个月球差均较术前明显增加,术后6个月有所下降,但仍高于术前水平;术后2组垂直彗差均较术前增加,术后3个月开始有所下降,术后6个月时接近于术前;术后各时间点2组水平彗差较术前均明显增加.术后不同时间点2组总高阶像差、球差、垂直彗差、水平彗差相比较差异均无统计学意义.结论 SMILE和FS-LASIK矫正近视安全、有效,术后均有较好的视力矫正效果;2种手术都会造成总高阶像差、球差、彗差的增加.     

Theoretical analysis of peripheral imaging after excimer laser corneal refractive surgery for myopia

PURPOSE: To explore theoretically the retinal point images in the peripheral fields of eyes that have had excimer laser refractive surgery.University research laboratory. METHODS: Model eyes were based on Navarro's finite schematic eye, the eyes being made myopic by an increase in axial length. To simulate photorefractive keratectomy (PRK), the anterior shape and thickness of the cornea were modified. Variables included pupil size, ablation zone size, preexisting refractive error, and the addition of a blending zone. Image-quality criteria for each retinal point image were its size and the angular separation of the centroids of those parts of the image produced by rays passing through ablated and unablated corneal zones. RESULTS: In the peripheral visual field, the boundary between the ablated and unablated cornea caused a separation of the retinal image of a single point into 2 parts. The separation increased with the preexisting refractive error. Image quality was correspondingly reduced by ablation. As pupil size increased, the field angle at which the retinal image doubling first occurred decreased. Increasing the diameter of the ablation zone or using a blending zone increased the angle at which the doubling first occurred, and the blending zone improved image quality considerably. Chromatic effects appeared to be relatively unimportant. CONCLUSIONS: This analysis provides further evidence of the disadvantages of small central ablation zones in excimer laser refractive surgery and of the advantages of well-designed blending zones in improving postsurgical peripheral image quality. Image quality in the peripheral field of the pseudoemmetropic post-PRK eye is generally worse than in a naturally emmetropic eye, even though the axial image quality may be similar.     

提高飞秒激光角膜屈光手术术后视觉质量的关键点

虽然飞秒激光角膜屈光手术的安全有效性已被大量的临床数据结果所证实,但飞秒激光角膜屈光手术较常规手术能否提供更优的视觉质量尚需要更多的证据。笔者针对提高飞秒激光角膜屈光手术术后的视觉质量的关键要点进行论述,旨在指导临床合理有效开展飞秒激光角膜屈光手术,加强其安全性,防范其相关并发症,从而给患者提供更加完美的视觉质量。     

飞秒激光在眼屈光手术中的应用

飞秒激光的光致分解作用允许在角膜组织内任意位置进行精确切削。可用于角膜基质内切割、制作角膜基质环植入的切口、准分子激光原位角膜磨镶术中制作角膜瓣、完成飞秒激光角膜磨镶术,是一种全新的屈光不正矫正方法。     

飞秒激光制瓣LASIK术后角膜层间上皮植入

目的探讨飞秒激光制瓣准分子激光原位角膜磨镶术（LASIK）后角膜上皮植入的发生率及防治。方法回顾性系列病例研究。选择天津爱尔眼科医院2013年10月至2014年7月接受飞秒激光制瓣LASIK手术患者1 122例（2 236眼）。术前最佳矫正视力（BCVA）均＞1.0。应用60 kHz的Intralase飞秒激光制作角膜瓣,常规基质切削后完成手术,数码摄像机记录手术全程,术后随诊3个月。结果术后1个月15例（28眼,1.25%）发生角膜层间上皮植入。其中18眼（0.81%）为Ⅰ级上皮植入;8眼（0.36%）为Ⅱ级上皮植入,未出现局部角膜瓣融解及不规则散光;2眼（0.09%）于术后1 d发生Ⅱ级弥漫性层间角膜炎,应用1%醋酸泼尼松龙滴眼液点眼4次/d,1周后消失,但在术后1个月时发生Ⅲ级角膜层间上皮植入伴角膜瓣边缘融解。结论飞秒激光术后上皮植入发生率低,术前严格筛查、规范手术操作,术后密切观察及时处理,是防治角膜层间上皮植入的有效手段。     

近视眼角膜激光手术要三思而行

近视眼角膜激光手术的光学矫正效果肯定.由于特殊的社会原因,角膜激光手术在我国发展迅速.由于人眼具有特殊的结构可变性与功能的互补性,因此,仅把远视力当作唯一或主要追求目标,轻易采取不可逆的方法一劳永逸地改变屈光,而忽略人们在不同年龄对远视力与屈光的不同生理需要及对其它视功能（近视力、对比觉、色觉、光觉及眩光适应功能等）的影响,结果可能有得有失,甚或得不偿失.考虑到近视眼角膜手术的特点,分析利弊得失,建议医患双方端正目的,三思而行.     

飞秒激光LASIK术后早期不同部位角膜敏感性变化研究

目的 评估飞秒激光LASIK术后早期角膜中央和周边区敏感性的恢复情况.方法 观察飞秒激光LASIK手术的患者40例(71只眼),分别在术前、术后1周、1月、3月使用Cohet-Bonnet角膜知觉计检查角膜中央、上方、下方、鼻侧和颞侧五个部位的敏感性,统计方法采用Kruskal Wallis H秩和检验和Mann-Whitney检验,以P＜0.05表示有统计学意义.结果 飞秒激光LASIK手术后早期,在五个测量部位,术后1周、1月、3月角膜敏感性均低于术前,差异具有统计学意义(P＜0.05).术后1周、1月、3月各个时间段,角膜上方敏感性均高于其他部位,差异具有统计学意义(P＜0.05).术后3个月,中央区角膜敏感性小于其他部位,差异具有统计学意义(P＜0.05).中央角膜敏感性与角膜中央切削深度、中央角膜厚度、术前等效球镜度无相关性(r=0.005;-0.105;0.03,P=0.97;0.38; 0.80).结论 飞秒激光LASIK术后早期角膜敏感性明显下降,角膜瓣蒂所在位置的敏感性较其他位置下降程度低,中央区角膜敏感性的恢复慢于其他位置,角膜中央敏感性与中央切削深度、角膜中央厚度、术前等效球镜度无相关.     

飞秒激光辅助的LASIK治疗高度近视术后高阶像差和角膜后表面高度的变化

目的　分析飞秒激光ＬＡＳＩＫ术后角膜后表面变化和角膜前表面高阶像差变化。方法　选择我院于２０１４年２月至８月收治的５２例（１０４眼）高度近视患者,随机分为对照组和观察组,各２６例。两组患者均在本院行ＬＡＳＩＫ术,对照组接受传统术式,观察组给予飞秒激光辅助手术,比较两组患者术后高阶像差和角膜后表面高度变化。结果　观察组术后１个月鼻上、颞下、鼻下和角膜顶点的角膜后表面高度与对照组比较,差异均有统计学意义（均为Ｐ＜０．０５）。观察组术后３个月四个象限内及角膜顶点的角膜后表面高度与对照组比较,差异均有统计学意义（均为Ｐ＜０．０５）。观察组和对照组术后１个月、３个月的四个象限内及角膜顶点的角膜后表面高度比较,差异均有统计学意义（均为Ｐ＜０．０５）。观察组术后６个月彗差、初级球差显著低于对照组,差异均有统计学意义（均为Ｐ＜０．０５）;观察组总高阶像差均方根值与对照组比较,差异无统计学意义（Ｐ＞０．０５）;观察组和对照组总高阶像差均方根值、彗差、初级球差较术前均显著升高,差异均有统计学意义（均为Ｐ＜０．０５）。结论　飞秒激光辅助的ＬＡＳＩＫ术后角膜前表面高阶像差和角膜后表面高度变化相对较小,是一种理想的辅助ＬＡＳＩＫ技术。     

All laser cataract surgery compared to femtosecond laser phacoemulsification surgery: corneal trauma

The aim of this study was to evaluate corneal tissue trauma after femtosecond laser-assisted cataract surgery (FLACS) and phacoemulsification (femtophaco surgery) compared to FLACS and nanolaser emulsification (all laser surgery). This is a prospective nonrandomized clinical study conducted at the Ophthalmology Clinic, University “G. d’Annunzio” of Chieti-Pescara, Italy, involving forty-two eyes of 42 patients candidates to cataract surgery. Patients were enrolled in two groups: femtophaco surgery (group 1 with 21 eyes) and all laser surgery (group 2 with 21 eyes). Main outcome measures included uncorrected visual acuity and distance corrected visual acuity, corneal endothelial cell count, and corneal thickness at the tunnel site and at the center of the cornea. Best correct visual acuity was not significantly different between the two groups. Postoperatively, a significant decrement of endothelial cell count at the center of the cornea was observed in group 1 compared with preoperative values at 90 days (p < 0.001) while t remained stable in group 2. The central corneal thickness showed a statistically significant increase for both groups that reached a maximum thickness at 7 days and then returned to presurgery levels after 90 days for group 1 and after 60 days for group 2. The tunnel corneal thickness showed a statistically significant increase for both groups that reached a maximum thickness at 7 days, which did not return to presurgery level for group 1 but did return to presurgery levels after 60 days for group 2. All laser surgery induced lower central endothelial cell loss and lower increase of corneal thickness compared to femtophaco surgery.     

FS-LASIK矫正不同程度近视术后角膜高阶像差的早期变化

目的:探究轻中度和高度近视患者飞秒激光制瓣准分子激光原位角膜磨镶术(FS-LASIK)术后角膜前后表面和整体角膜高阶像差的变化。方法:对2018-12/2019-12在我院行FS-LASIK手术的近视患者129例129眼进行回顾性病例研究,按术前等效球镜度(SE)分为轻中度近视组(SE<-6.00D,76眼)和高度近视组(SE≥-6.00D,53眼)。分别于术前和术后6mo用Pentacam眼前节分析系统测量角膜前后表面和整体角膜的高阶像差。结果:术后6mo,两组角膜前表面和整体角膜的总高阶像差、球差和水平彗差较术前增加,且高度近视组高于轻中度近视组(均P<0.01);两组角膜后表面的水平彗差较术前有差异(均P<0.01),且高度近视组高于轻中度近视组(P<0.01)。两组患者角膜前表面和整体角膜的术源性总高阶像差、球差和水平彗差与术前SE有明显相关性(均P<0.01)。结论:FS-LASIK术后6mo角膜前表面及整体角膜的总高阶像差、球差和水平彗差均较术前增加,且与术前SE明显相关;角膜后表面高阶像差除水平彗差外无明显变化,其远期变化有待进一步研究。     

国人近视屈光手术人群Q值的相关因素分析

目的探讨我国近视屈光手术人群的角膜前表面非球性参数（Q值）的分布及其相关因素。方法随机选择18～44岁行近视分子激光角膜屈光手术者120例（240眼）。按屈光度分为低、中、高度3组,各组均为40例（80眼）。应用AstraMax二三维角膜综合检查站行角膜地彤网检查,记录角膜曲率及Q值;并行综合验光、角膜中央厚度、眼轴长度及其他常规术前检查。分别将Q值与各参数进行统计学分析。结果总体Q值均数为-0．16±0．17,呈正态分布;Q〈0者206眼,占85．83％;Q值与性别、眼别间差异无统计学意义;Q值与屈光度之间存在线性相关关系（F=9．6665,P〈0．05）,高度近视组和低度、中度组问的差异有统计学意义（q=4．0037,P〈0．05;q=3．1218,P〈0．05）;低中度近视组问差异无统计学意义。Q值与角膜中央厚度、平均角膜曲率、眼轴长度呈无相关性。结论我国近视屈光手术人群的Q值呈正态分布,大部分人群角膜为长椭圆形（prolate）。Q值与屈光不正程度相关,而与性别、角膜中央厚度、平均角膜曲率、眼轴长度之间无相关性。     

微创超声乳化手术前后角膜前后表面及不同区域范围角膜参数的变化

目的:比较白内障微创超声乳化手术前后角膜前表面屈光力(ASF)、角膜真实净屈光力(TNP)和总角膜屈光力(TCRP)分布特点及角膜前后表面曲率半径比(B/F ratio)差异。方法:前瞻性研究。收集2020-12/2021-05就诊于潍坊眼科医院行2.2mm微切口超声乳化白内障吸除联合人工晶状体植入术的年龄相关性白内障患者156例156眼。术前及术后3mo行Pentacam眼前节生物测量仪检查,收集以角膜顶点和以瞳孔为中心2、4、6mm环上和区域内ASF、TNP和TCRP,以及手术前后B/F ratio。结果:术后3mo,以角膜顶点为中心2mm直径环上和区域内ASF值较术前均无差异(均P>0.05),而4、6mm直径环上和区域内ASF值较术前均有差异(均P<0.05);以瞳孔为中心2mm直径环上及区域内ASF值较术前均无差异(均P>0.05)。以角膜顶点为中心和以瞳孔为中心2、4、6mm直径环上和区域内TNP、TCRP值较术前均有差异(均P<0.05)。术前以角膜顶点为中心和瞳孔为中心在2mm与6mm之间环上和4mm与6mm之间环上TCRP值均有差异(均P<...