白内障超声乳化手术前后的社会医学和心理学分析

目的：研究白内障超声乳化手术前后的心理学和社会医学问题。方法：采用调查问卷的形式对208例白内障超声乳化术后患者进行调查，主要了解手术前后的心理状况，对手术的自觉满意程度以及有关的社会医学问题。结果：手术者以老年人为多，77．51％的患者对手术有过一些或详细的了解，并仔细考虑过。66．83％的患者术前表现心情平稳、信心百倍。术后93.7％自觉手术非常满意或尚满意，不满意的仅为6．25％。尚满意或不满意的原因为术前期望值较高或有并发症。结论：白内障超声乳化手术效果良好，患者的满意度较高。     

角膜屈光手术后膜地形图变化与散光关系

为探讨角膜屈光手术后角膜地形图变化与临床散光的关系，对ＭＬＫ和ＬＡＳＩＫ术后４８例８６只眼行术前及术后６个月角膜地形图测量分析，并与同期的视力和验光结果进行比较。结果表明，术后柱镜屈光度及ＳＲＩ、ＳＡＩ及ＳｉｍＫ较术前明显升高，３２．６％的病人有切削区偏中心，但全中病人的裸眼视力及术后矫正视力均好于术前。裸眼视力好于或术前者占７６．３４％。提示以上现象的发生对手术效果无影响，其原因可能与后巩膜葡萄     

准分子激光角膜切削术和激光原位角膜磨镶术治疗近视疗效比较

采用美国ＣＯＨＥＲＥＮＴ公司生产的激光机，ＳＣＭＤ公司生产的气动式微型板层角膜刀，对近视度－１．５０Ｄ～－３２．００Ｄ６５７眼随机分成ＰＲＫ组（３３７眼）和ＬＡＳＩＫ组（３２０眼），随访３～１２月按低、中、高各屈光段分别统计。结果：术后ＰＲＫ痛苦多，视力恢复慢。达术前最佳矫正视力占９３．８％。ＬＡＳＩＫ术后无痛苦，视力恢复快，达术前最佳矫正视力占９５％。术后屈光度回退ＰＲＫ较ＬＡＳＩＫ快，Ｐ＜０．０１有显著差别。低、中、高各屈光段的屈光回退亦同样比ＬＡＳＩＫ快，各组Ｐ＜０．０１有显著差别。结论：ＬＡＳＩＫ治疗近视比ＰＲＫ稳定性好，不仅对高度近视疗效比ＰＲＫ好，对低、中度近视疗效亦优于ＰＲＫ。     

准分子激光屈光性角膜切削术与激光原位角膜磨镶术治疗中低度近视的对比

目的对准分子激光屈光性角膜切削术（ｐｈｏｔｏｒｅｆｒａｃｔｉｖｅｋｅｒａｔｅｃｔｏｍｙ，ＰＲＫ）和准分子激光原位角膜磨镶术（ｌａｓｅｒａｓｓｉｓｔｅｄｉｎｓｉｔｕｋｅｒａｔｏｍｉｌｌｅｕｓｉｓ，ＬＡＳＩＫ）治疗中、低度近视的疗效进行前瞻性对比研究。材料和方法术前屈光度为－１．２５～－６．００Ｄ的近视５６９只眼，其中１３７只眼接受ＬＡＳＩＫ手术，４３２只眼接受ＰＲＫ手术，随访６－１６个月（平均８．９±２．６个月）。在术后１周、１个月、３个月、６个月和１２个月复查。结果ＬＡＳＩＫ组术后屈光状态较ＰＲＫ稳定，回退幅度较ＰＲＫ小，术后６个月时，ＬＡＳＩＫ组和ＰＲＫ组分别有９４％和８７％屈光度在±１．００Ｄ内（ｐ＜０．０５），分别有８４％和７１％屈光度在±０．５０Ｄ以内（ｐ＜０．０１）。ＬＡＳＩＫ组术后视力恢复较ＰＲＫ快，术后１周的平均裸眼视力超过１．０，术后６个月时，ＬＡＳＩＫ和ＰＲＫ组中裸眼视力０．５或以上者分别占１００％和９４％（ｐ＜０．０１），裸眼视力１．０以上者分别占８６％和７２％（ｐ＜０．０１）。结论ＬＡＳＩＫ不仅适合治疗高度近视，也适合治疗中、低度近视。对于中、低度近视，ＬＡＳＩＫ的疗效优于ＰＲＫ。     

准分子激光原位角膜磨镶术治疗近视的角膜地形图分析

应用角膜地形图仪对２１例（３０只眼）近视患者于准分子激光原位角膜磨镶术（ｌａｓｅｒｉｎｓｉｔｕｋｅｒａｔｏｍｉｌｅｕｓｉｓ，ＬＡＳＩＫ）后进行角膜地形图的检测分析，发现ＬＡＳＩＫ术后角膜表面的球面形状发生一定的改变：ＳＲＩ和ＳＡＩ与术前比较均有显著性差异。术后３个月检查时，激光切削区偏心０．５６±０．３５ｍｍ；角膜地形图主要表现为４种形态：圆形或椭圆形（４６．７％）、哑铃形（１０．０％）、半环形（６．７％）、中央小岛形（３６．７％），且各种形态与最佳视力有着一定的关系。由此证明，角膜地形图的定量分析对ＬＡＳＩＫ术后角膜表面球面形状的评价、手术设计的改进、手术疗效的预测等是有重要的临床意义的     

准分子激光角膜屈光手术后的对比敏感度变化

为观察准分子激光屈光性角膜切削术（ｐｈｏｔｏｒｅｆｒａｃｔｉｖｅｋｅｒａｔｅｃｔｏｍｙ，ＰＲＫ）和准分子激光原位角膜磨镶术（ｌａｓｅｒｉｎ－ｓｉｔｕｋｅｒ－ａｔｏｍｉｌｅｕｓｉｓ，ＬＡＳＩＫ）术后对比敏感度的变化，评价这两种手术后视功能的改变，对术前屈光度为－１．７５Ｄ至－７．７５Ｄ，在我院接受ＰＲＫ手术的３６只眼和接受ＬＡＳＩＫ手术的３１只眼，采用电生理方法检查手术前后远对比敏感度，用Ｆ．Ａ．Ｃ．Ｔ对比敏感度表检查近对比敏感度。所有患者术前最佳矫正视力均为１．０以上。结果：ＰＲＫ和ＬＡＳＩＫ术后几个月内远、近对比敏感度均有不同程度的降低，以中频段下降幅度最大。对比敏感度于ＰＲＫ术后１２个月、ＬＡＳＩＫ术后６个月恢复术前水平。结论：ＰＲＫ和ＬＡＳＩＫ术后均出现暂时的对比敏感度下降，ＬＡＳＩＫ术后对比敏感度恢复较ＰＲＫ快。     

准分子激光原位角膜磨镶术后欠矫的再治疗

对２４例（３６只眼）行准分子激光原位角膜磨镶术（ｅｘｃｉｍｅｒｌａｓｅｒｉｎｓｉｔｕｋｅｒａｔｏｍｉｌｅｕｓｉｓ,ＬＡＳＩＫ）后屈光欠矫的患眼,再行原瓣下准分子激光角膜切削术。其中２只眼在ＬＡＳＩＫ术后１个月内施行,３４只眼在术后３～５个月内施行。３６只眼行ＬＡＳＩＫ前的屈光度数为：－５．００～－１７．８７Ｄ,平均－１０．７５±３．４１Ｄ,ＬＡＳＩＫ后欠矫的度数为：－１．２５～－５．５０Ｄ,平均－３．１２±１．１６Ｄ。再手术后,随诊３～６个月。２６只眼（７２．２％）的裸眼视力达到术前矫正视力,２只眼的裸眼视力较术前矫正视力增加一行,８只眼的矫正视力较术前下降一行。术后角膜瓣平整,角膜界面清晰,因此,ＬＡＳＩＫ后屈光欠矫可于术后３～６个月内于原角膜瓣下的基质层再行准分子激光角膜切削术,手术简便、安全、有效。     

LASIK治疗高度近视半年疗效观察

目的评价准分子激光原位角膜磨镶术治疗高度近视的疗效。方法：采用ＬＡＳＩＫ术治疗高度近视５８例９５眼，并随访３～６月以上。在分析屈光度的变化时，将患者分为两组，Ａ组术前屈光度－１７．１４±２．６９Ｄ，Ｂ组为－１１．２０±１．６０Ｄ。结果：两组患者术后视力逐渐好转，随着时间的推移，屈光度逐渐表现为欠矫。结论ＬＡＳＩＫ手术是治疗高度近视的理想手术，但手术技巧，手术参数仍有待于进一步改进和探讨     

准分子激光屈光性角膜切削术和激光原位角膜磨镶术治疗中低度近视的对比研究

目的：比较准分子激光屈光性角膜切削术（ＰＲＫ） 和激光原位角膜磨镶术（ＬＡＳＩＫ） 治疗中低度近视的临床效果。方法：中、低度近视４００ 例（７１０ 眼） ,其中ＰＲＫ 组３４３ 眼,平均屈光度－４ ．１８±１．２４Ｄ。ＬＡＳＩＫ 组３６７ 眼,平均屈光度－ ４．７５±１．１０Ｄ。两组均于手术后１、３、６、１２ 个月复查视力、屈光度、角膜地形图及角膜上皮下基质混浊等并发症情况。结果：ＰＲＫ组欠矫＞ －１．００Ｄ者９．０３％ ,ＬＡＳＩＫ组为４ ．８０ ％ （Ｐ＜ ０．０１） 。角膜上皮下或层间混浊（Ｈａｚｅ）发生率：ＰＲＫ组０ 级８６ ．５９％ ,１ 级１１．３７％ ,２ 级２ ．０４％ ,３ 级以上无。ＬＡＳＩＫ组０ 级９５．１０％ ,１ 级２．４５％ ,２ 级以上无。结论：ＬＡＳＩＫ术式较之ＰＲＫ术式具有术后视力恢复快而稳定,用药少,痛苦少,并发症少,欠矫率低等优点,中低度近视治疗应首选ＬＡＳＩＫ方法治疗。     

准分子激光原位角膜磨镶术治疗重度近视临床观察

目的研究准分子激光角膜磨镶术（ＬＡＳＩＫ）治疗重度近视的效果。方法对２６８眼（１４５例）－１２．００～－２９．００Ｄ的重度近视患者进行ＬＡＳＩＫ手术治疗并随访１２个月。结果术后１２个月视力≥术前矫正视力者占９４．８％，术后屈光度在±２．００Ｄ以内占９５．５％，术后１２个月与术后６个月的平均屈光度相比较，经统计学处理无显著差异。结论ＬＡＳＩＫ是治疗重度近视的有效方法，且稳定性和预测性好     

LASIK术后角膜像差和视觉功能临床观察

目的　观察ＬＡＳＩＫ术后远期的角膜高阶像差变化及对日常生活中视觉功能的影响。方法　对６７例（１３４眼）接受非球面切削程序引导的ＬＡＳＩＫ的患者随访４ａ。收集术前及术后６个月、４ａ患者的视力、角膜地形图、球差和彗差资料,并由同一名医师完成患者术后视觉功能的评价。结果　术后４ａ随访中无一例患者最佳矫正视力较术前视力下降;术后６个月和４ａ的有效性指数、安全性指数分别达１．０８±０．１６、１．１１±０．１７和１．１２±０．１６、１．１３±０．１４。不管是术后６个月还是４ａ的角膜球差和彗差均较术前显著增加,但术后两个时间点间角膜像差的差异均无统计学意义（均为Ｐ＞０．０５）。大部分患者对日常生活中的各项视觉功能感到满意或很满意（９４．３％、９２．４％）。术后４ａ随访中有７．４％患者诉夜间开车困难。进一步分析视觉功能评分与角膜像差的关系,发现夜间开车困难与角膜球差呈负相关（术后６个月:ｒ＝－０．６６,Ｐ＝０．０４０;术后４ａ:ｒ＝－０．６９,Ｐ＝０．０３９）,而且并没有随时间延长而显著改善。结论　近视患者ＬＡＳＩＫ术后有远期稳定的角膜像差和日常生活中的视觉功能感受。     

LASKI患者术前焦虑度与术后满意度相关性分析

目的　分析LASIK患者术前焦虑度与术后满意度的相关性。方法　LASIK 13 8例 ,分为A(正常 )、B(有焦虑情绪或轻度焦虑 )两组 ,术后随访其疗效及满意度。结果　术后 1年 2 72眼裸眼视力 <0 .5、0 5～ 0 8、>0 8者 ,分别为 4 0 4%、8 82 %、87 14 % ,两组间比较差异无显著性 (P >0 .0 5 ) ;术后裸眼视力较术前最佳矫正视力增加及相同者、下降 1～ 2行者 ,下降 2行以上者 ,分别为 75 0 0 %、18 0 1%、6 99% ,两组间差异无显著性 (P >0 .0 5 ) ;对疗效表示非常满意、满意、不满意者 ,分别为 11 76%、81 99%、6 2 5 % ,两组间差异有非常显著性 (P <0 .0 1) ;相关性分析 ,rs=-0 .76,P <0 .0 5 ,相关系数有统计意义。结论　LASIK患者术前焦虑度与术后满意度相关 ;缓解其焦虑情绪 ,可提高对疗效的满意度     

Visual experience and patient satisfaction with wavefront-guided laser in situ keratomileusis

PURPOSE: To determine the correlation between patient perception and clinical measurements after wavefront-guided laser in situ keratomileusis (LASIK). SETTING: Multicenter clinical trial. METHODS: In this retrospective analysis of clinical study results in 274 eyes, wavefront-guided LASIK procedures were performed in 274 myopic-astigmatic eyes at 6 sites. Comprehensive evaluations of vision and ocular health were conducted preoperatively and for 6 months postoperatively. Visual acuity and contrast sensitivity were measured, and questionnaires were administered. Questionnaire responses were compared with clinical measurements. RESULTS: The overall distribution shifted toward "more satisfied." The "very satisfied" population increased by as much as 70% in all areas. There was no significant change in frequency of visual symptoms. Patients were more expressive about visual decline than visual improvement. Perception of changes in vision appeared to be related to mesopic contrast sensitivity and mesopic contrast sensitivity under glare. Mesopic pupil diameter was not a major predictor of patient satisfaction. Contact lens wearers were more satisfied with postoperative vision than were spectacle wearers. Men were more likely to report visual symptoms and to complain about night vision, although their changes were the same as those of the women. Residual refractive error was a major predictor for most questionnaire items. CONCLUSION: Most patients were as satisfied or more satisfied with their postoperative uncorrected visual acuity than with their preoperative best corrected visual acuity. By continuing to minimize postoperative refractive error through the use of nomograms and improved technology, visual complaints such as night glare and halo could be diminished or even eliminated. The study shows that subjective experience affected satisfaction with results. Some dissatisfaction might be mitigated by being sure patients are educated and have realistic expectations before surgery.     

LASIK术后5年结果分析

目的 评价准分子激光原位角膜磨镶术（LASIK）治疗近视眼的远期疗效。方法 回顾性系列病例研究。选取LASIK术后随访≥5年资料完整者68例（125眼）,根据术前等效球镜度分为低中度近视组76眼,等效球镜度-0.75～-6.00（-3.79±1.41）D;高度近视组49眼,等效球镜度-6.12～-13.25（-8.13±1.35）D。术后1个月、6个月、1年、5年检查裸眼视力（UCVA）、最佳矫正视力（BCVA）、裂隙灯、角膜地形图和眼底情况,最后一次复查填写满意程度问卷调查表。对数据进行χ2检验、配对样本t检验。结果 低中度近视组和高度近视组术后5年裸眼视力≥0.5的比例分别为100%和96%;术后5年等效球镜度在±1.00 D范围的比例分别为93%和84%;术后最后一次复查最佳矫正视力没有变化或增加的占82%眼（103/125）;术后5年等效球镜度分别为（-0.02±0.65）D和（-0.33±0.80）D,与术后1年比较差异均无统计学意义;1眼术中发生部分游离瓣,1眼术后发生上皮植入,8眼进行了增效手术;两组术后1~5年间均没有出现与手术相关的并发症,患者的满意程度较高。结论 LASIK手术治疗近视术后5年有较好的有效性、安全性和满意度,手术并发症少,术后5年屈光度稳定,远期没有手术相关的并发症发生。     

An informal satisfaction survey of 200 patients after laser in situ keratomileusis

PURPOSE: Patient satisfaction following laser in situ keratomileusis (LASIK) is commonly reported as high. This paper reviews the outcome of LASIK both in terms of visual results and satisfaction. METHODS: Two-hundred patients were surveyed telephonically to establish their degree of satisfaction with LASIK and to enquire about postoperative use of glasses, and symptoms of light sensitivity and of night vision problems. Patient anonymity was assured. RESULTS: The majority of patients (95%) never wore distance glasses after LASIK. Reading glasses were used by 49 (24.5%), related to age and presbyopia. Light sensitivity was not a problem or was unchanged from baseline in 73% of patients; 27% said they were worse; a few (5.5%) said their symptoms were better. Night vision was not a problem or was unchanged from baseline in 76% of patients; 24% said they were worse; 17% said their symptoms were better. One hundred ninety-five patients (97.5%) were extremely happy with their results and 197 (98.5%) would have the procedure again. CONCLUSION: After LASIK, 95% of 200 patients wore no distance optical correction; 99% would have the procedure again; and light sensitivity and night vision problems bothered a significant number of patients.     

Visual Quality of Q-value-guided LASIK in the Treatment ofHigh Myopia

 Purpose:To compare visual performance and patient satisfaction following Q-value-guided customized laser-assisted in situ keratomileusis (LASIK) and standard LASIK in the treatment of high myopia.   Methods: A total of 116 patients with high myopia (-6.00 to -9.50D; astigmatism from -0.00 to -2.00D) were treated using Z-217 excimer laser (Bausch &; Lomb). Sixty-six patients (132 eyes) receiving Q-value-guided customized LASIK were assigned into the experimental group, and 50 cases (100 eyes) receiving standard LASIK were used as normal controls.  All subjects were followed up for > 6 months to monitor for night vision problems measure postoperative quality of life.    Results: In the experimental group, night vision acuity decreased in 3 cases (4.5%), and glare was reported in 13 patients (19%) during the 6-month follow up period. In the control group, night vision problems were noted in 9 cases (18%), and glare occurred in 21 patients (42%). These differences between the two groups were statistically significant (P<0.05). According to the postoperative questionnaire,  satisfaction with visual performance and quality of life was reported in 73% of the experimental group, and 52% of the control group (P<0.05).         Conclusion: Patients with high myopia surgically treated by Q-value-guided LASIK had better night-time visual performance and a higher degree of satisfaction compared with subjects receiving standard LASIK.      

LASIK手术常见临床禁忌证分析

目的:探讨常见LASIK手术禁忌证的发生情况。方法:对拟行LASIK手术2693例(5304眼)进行详细术前检查,对未行手术的476例906眼进行原因分析。结果:476例906眼未能手术患者的原因包括角膜厚度不够(<450μm)、矫正视力<0.5、超高度近视、眼压高、圆锥角膜、视网膜变性或裂孔、瞳孔偏大、角膜瘢痕、慢性泪囊炎、瘢痕体质、思想顾虑大等。其中最常见的原因为角膜厚度不够298眼(32.89%)、矫正视力<0.5者155眼(17.11%)和思想顾虑大134眼(14.79%)。结论:LASIK术前必须进行严格的检查,除外手术的禁忌证,以保证手术的安全性。     

角膜瓣蒂在上方的LASIK治疗近视

目的：观察角膜瓣蒂部位于上方角膜的LASIK治疗不同屈光度近视的效果。方法：利用准分子激光器联合微形角膜刀对131例（258眼）进行治疗。按屈光度不同（-8.0D以下,-8.0--15.0D,-15.0D以上）分为3组,该刀前进轨道呈环形,切削角膜瓣后蒂部位于上方,术后6月观察视功能、屈光度及并发症。结果：术后6个月裸眼视力3组达到0.5以上分别为97.8%、93.2%、55.6%,达到1.0以上分别为88.8%、80.7%、19.4%,术后4-6月屈光度趋于稳定。手术并发症包括角膜上皮脱落。层间异物残留等,结论：LASIK对不同屈光度近视治疗均有良好效果。角膜瓣蒂部位于上方比位于鼻侧的术后并发症可能比较少发生。     

LASIK术后主导眼对视功能影响的临床研究

目的:评价LASIK术前近视眼患者主导眼的分布及术后主导眼的变化与视力和视功能的关系。方法:选择拟行LASIK手术的近视眼患者235例470眼,分别于LASIK术前、术后1,3,6,12mo应用卡洞法行主导眼检查眼别,主导眼与非主导眼的术前的矫正视力和术后的视力进行比较,并接受视功能量表调查。结果:LASIK术前近视眼患者主导眼分布以右眼为主(67.2%);术前主导眼眼别与最佳矫正视力眼别一致性好,两者符合率为81.1%;235例近视患者LASIK术后主导眼眼别220例没有发生变化;15例患者眼别发生调换,其中5例有15°左右外斜。结论:主导眼分布以右眼为主,主导眼大多是患者最佳矫正视力眼;主导眼视力下降或低于非主导眼和主导眼调换患者在术后早期对视觉舒适度产生影响,但晚期影响降低患者逐渐适应。