传导性角膜成形术治疗老视眼的临床效果观察

目的:探讨应用单眼视原理采用传导性角膜成形术(Conductive keratoplasty,CK)治疗老视的临床效果、安全性及可预测性。方法:选择31例(40眼)有明显老视症状的患者,术前屈光度球镜+0.50~+2.50D,散光≤+0.75D,采用CK进行治疗,术后预期目标屈光度主导眼矫正为0.00~-0.50D,非主导眼术后目标屈光度为-1.50~-2.50D,且近视力≥0.5(J3),术后随访1a以上。结果:术后1a双眼裸眼远视力≥0.8且近视力≥0.5(J3)或近视力≥0.33(J4)者分别为61.3%,74.2%;与术前相比均有显著性差异(P<0.01);术后1a等效球镜屈光度与预期目标差值在±0.50D、±1.00D以内者分别为45.0%,82.5%;术后1a术眼散光度在±1.00D以内者为87.5%;术后双眼各空间频率对比敏感度与术前相比较差异无统计学意义(P>0.05);术后1a无最佳矫正视力下降,无严重干眼症的发生;术后1a90.3%的患者表示满意。结论:应用单眼视原理采用CK治疗老视取得了较好的临床疗效,但其远期疗效和稳定性有待进一步观察。     

单眼视LASIK治疗伴有老视的屈光不正临床观察

目的:探讨单眼视准分子激光原位角膜磨镶术(单眼视LASIK)治疗伴有老视的屈光不正对患者视觉质量、生活质量的影响。方法:屈光不正伴老视的患者172例中124例施行单眼视LASIK(主视眼按最佳矫正远视力完全矫正,非主视眼近视者低矫-0.75~-2.00D,远视者过矫0.75~2.00D),35例放弃手术,13例患者双眼全部矫正。观察术后1d;1wk;3mo时的检查结果。结果:术后3mo单眼视LASIK组124例患者双眼远视力0.7~1.2,双眼近视力J1~J3。无因为难以耐受的不适而需要戴镜补充矫正或再次手术者。双眼完全矫正组术后双眼远视力0.7~1.2,双眼近视力J3~J6,8例(62%)视近困难,需配近用眼镜。结论:单眼视LASIK治疗伴有老视的屈光不正安全有效。单眼视治疗在设计手术方案时需根据患者年龄及调节能力、近附加度数、阅读距离、工作性质等综合考虑。     

准分子激光原位角膜磨镶术治疗近视眼远期疗效分析

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:对接受LASIK治疗近视术后≥8a的患者术前及术后的裸眼视力、屈光度、角膜曲率、角膜厚度及并发症等情况进行回顾性分析。按术前屈光度数分3组:A组-1.00~-6.00D者92眼,B组-6.25~-10.00D者68眼,C组≥-10.00D者27眼。结果:术后≥8a三组裸眼视力≥1.0者依次为73.9%,52.9%,22.2%,平均屈光度数分别为-0.21±0.06,-0.54±0.12,-2.33±0.36D。术后≥8a屈光度在±1.00D范围内占83.4%,±0.50D范围内占59.4%,A组与B,C组分别比较,差异有统计学意义(P<0.05)。术后≥8a屈光度与术后1a比较,屈光度回退≥1.00D占9.09%。结论:LASIK治疗近视手术安全有效、预测性好,远期疗效稳定;特别是对于低中度近视眼患者可获得更为满意的治疗效果。     

传导性角膜成形术矫治老视2年临床观察

目的观察传导性角膜成形术（conductive keratoplasty，CK）治疗老视的长期疗效。方法有老视症状者33例54眼，术前屈光度为＋0.75-＋3．00D，且散光〈0．75D，采用传统的CK方法，使射频能量通过探针在周边角膜基质刺8—32个点。手术后主视眼目标屈光度为0D，非主视眼术后目标屈光度为-0.75--2．25D。术后随访2年。结果术后2年，85％的患者双眼远视力为0.8，近视力为0.33（J4）或者更好；视近眼的等值球镜和目标屈光度的差值在±1．00D内者为97％；视近眼屈光度和目标屈光度的差值为（0.52±0．38）D；术眼散光的绝对变化在1．00D范国内。术后1—2年，术眼等值球镜平均每月变化0.03D。双眼各空间频率对比敏感度与术前比较，差异无显著性（P〉0．05）。术后1个月96％的患者比较满意或者特剐满意。结论CK手术治疗老视的长期效果稳定。     

Moria M2型90刀头在LASIK手术中治疗高度和薄角膜近视患者的临床观察

目的:观察MoriaM2型90刀头在治疗高度和薄角膜近视患者LASIK手术中的有效性和安全性。方法:采用MoriaM2型90刀头在不能行普通LASIK的高度近视和薄角膜的患者中行LASIK手术。结果:术后6mo裸眼视力≥1.0者,A,B组分别达95%,76.1%;裸眼视力≥0.5者,分别达100%,91.4%;术后6mo屈光度±0.75D,残余散光±0.50D,A,B组分别为16.4%,37.5%;97.1%术眼术后与术前相比,未有低于2行以上者。结论:使用M2型90刀头对于矫治高度近视和薄角膜患者行LASIK手术是安全有效的,远期结果需进一步观察。     

准分子激光原位角膜磨镶术治疗近视的初步研究

目的评价准分子激光原位角膜磨镶术(LASIK)治疗低中度和高度近视的疗效.方法对127例(249眼)屈光度在-1.25～-14.00D的近视和近视散光行LASIK手术.术后观察6月以上.按术前屈光度分为A、B两组.A组中低度近视(-1.25D～-6.00D)137眼,B组高度近视(-6.25D～-14.00D)112眼.结果术后6月两组的屈光度在±1D以内者分别为92.7%、84.8%.在±0.5D以内者为83.2%、72.3%;裸眼视力0.5以上者分别为97.8%、92.0%,1.0以上者为89.1%、73.2%.术中及术后无任何严重并发症.结论LASIK手术矫正低中度、高度近视均有良好的效果,治疗低中度近视的准确性优于高度近视,是一种安全有效、预测性好的屈光手术.     

Epi-LASIK和LASIK治疗近视散光的早期疗效对比观察

目的:探讨分析角膜微型刀上皮瓣下准分子激光原位角膜磨镶术(epipolis laser in situ keratomileusis,Epi-LASIK)和准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)治疗近视散光的疗效。方法:近视散光行Epi-LASIK治疗的患者32例64眼,LASIK治疗的患者63例126眼,将患者根据柱镜度数分为2组:Ⅰ组(柱镜-0.25～-2.75D,Epi-LASIK 20例、LASIK 48例)、Ⅱ组(柱镜-3.00～-5.00D,Epi-LASIK 12例、LASIK 15例)。随访6mo观察两种术式的疗效。对比两组患者的术后裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)、残余散光度、角膜愈合情况、眼压及角膜地形图等。结果:术后6mo,Ⅱ组中UCVA较术前明显提高,EpiLASIK为21眼(87.5%),LASIK为19眼(63.3%),两术式相比较差异有显著性(χ2=4.055,P<0.05);残余散光度Epi-LASIK为-0.41±0.30D,LASIK为-0.74±0.36D,两术式相比较差异有显著性(t=2.672,P<0.05);角膜散光Epi-LASIK为0.63±0.34D,LASIK为0.81±0.52D,两术式相比较差异有显著性(t=2.234,P<0.05)。结论:Epi-LASIK治疗≥-3.00D散光与LASIK相比具有更好的效果和预测性。     

准分子激光原位角膜磨镶术治疗近视二年疗效分析

目的 探讨准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)治疗近视2年疗效.方法 对2007年3月至2009年4月在杭州师范大学附属医院眼科就诊的500例996只近视眼进行LASIK治疗,按术前预矫等效球镜屈光度分为3组,Ⅰ组:-1.50～-6.00 D,Ⅱ组:-6.10～-10.00 D,Ⅲ组:-10.10～-14.00 D,术后随访2年.结果 术后2年,Ⅰ组:裸眼视力≥0.5和≥1.0分别为100％和96.03％,术后屈光度±0.50 D、±1.00 D以内者分别占87.03％和94.98％,术后散光±1.00 D以内者占97.91％.Ⅱ组:裸眼视力≥0.5和≥1.0分别为100％和84.12％,术后屈光度±0.50 D、±1.00 D以内者分别占83.89％和91.00％,术后散光±1.00 D以内者占94.79％.Ⅲ组:裸眼视力≥0.5和≥1.0分别为89.58％和75.00％,术后屈光度±0.50 D、±1.00 D以内者分别占64.58％和76.04％,术后散光±1.00 D以内者占87.50％.结论 采用LASIK治疗近视具有良好安全性、有效性、可预测性和稳定性.     

准分子激光角膜原位磨镶术治疗高度近视合并中高度散光

目的:观察准分子激光原位角膜磨镶术(LASIK)治疗高度近视合并中高度散光的临床疗效。方法:采用准分子激光原位角膜磨镶术治疗43例(79眼)高度近视合并中高度散光患者,屈光度为-6.0～-15.5D,散光为-2.0～-5.0D。结果:术后随访6mo,裸眼视力≥术前矫正视力者占91%,屈光度在±0.75D以内者占86%,残留散光平均为-0.45D。结论:LASIK治疗高度近视伴中高度散光,效果明显,安全可靠。     

单眼行LASIK或LASEK术后疗效观察

目的:探讨单眼行准分子激光原位角膜磨镶术(laserin situkeratomileusis,LASIK)或准分子激光上皮下角膜磨镶术(laser epithelial keratomileusis,LASEK)治疗单眼近视所致屈光参差的效果。方法:采用对单眼等效球镜度>-2.50D的近视性屈光参差患者62例,进行单眼LASIK或LASEK手术。术眼及非术眼手术前后平均屈光度、屈光参差度数、最佳矫正视力和裸眼视力进行评价,术后随访6~24mo。结果:术眼术前平均等值球镜度数为-3.66(-2.50~-6.25)D,术后减少至-0.62(0.00~-1.00)D。LASIK或LASEK对平均等值球镜改变为-3.38(-2.50~-5.50)D。术前两眼平均屈光参差为-3.25(-2.50~-6.25)D,术后减少至-0.85(0.00~-1.75)D。术前术后最佳矫正视力(BCVA)范围均为0.6~1.0,平均最佳矫正视力从术前0.8提高到1.04;术后裸眼视力≥1.0者59眼,平均裸眼视力从术前的0.1提高至术后的1.0。非术眼术前平均等值球镜度数为-0.85(+0.25~-1.50)D,术后平均等值球镜度数为-1.85(-0.50~-3.50)D,平均裸眼视力从术前的0.5术后下降至0.1。结论:单眼LASIK或LASEK治疗近视性屈光参差虽然能提高患眼的最佳矫正视力和裸眼视力,解除单眼近视、散光所致的屈光参差对眼镜或角膜接触镜不能耐受的痛苦,而且对恢复双眼单视功能具有积极意义,但是同时我们也发现术后非术眼有近视加深的趋势,而且非术眼原近视度数越高近视加深越快越多。     

Conductive keratoplasty for presbyopia: 1-year results

PURPOSE: To assess the safety, efficacy, and stability of conductive keratoplasty (CK) in the treatment of presbyopia. METHODS: Ten near plano presbyopic patients (6 women and 4 men) underwent unilateral CK in the non-dominant eye to improve their near vision. Mean age was 51 +/- 3.1 years (range: 46 to 56 years). The surgeries were the author's first 10 CK procedures performed. The postoperative target for these eyes ranged from -1.25 to -1.75 diopters (D). RESULTS: Preoperative mean manifest refraction spherical equivalent (MRSE) was -0.18 +/- 0.27 D (range: -0.75 to -0.25 D), yielding a mean near uncorrected visual acuity (UCVA) of J10 (range: J12 to J5). Twelve months after CK, the mean near UCVA was J1 (range: J3 to J1) with 90% (9/10) eyes J1 and 100% (10/10) eyes J3 or better. The mean MRSE was -1.31 +/- 0.53 D (range: -2.25 to -0.75 D). Treated eyes lost an average of 2.2 +/- 2 lines (range: 0 to 5) of distance UCVA but gained an average of 8.7 +/- 2 lines (range: 4 to 11) of near UCVA. No eye lost best spectacle-corrected visual acuity or had induced cylinder > or = 0.75 D. Nine (90%) of 10 patients had binocular distance UCVA < or = 20/20 and near UCVA < or = J1 and all 10 (100%) patients had binocular distance UCVA < or = 20/25 and near UCVA < or = J3. CONCLUSIONS: Conductive keratoplasty for the treatment of presbyopia provided safe and effective results 1 year following the initial surgery. Longer follow-up will be needed to describe refractive stability. The mean near and distance UCVA results were better than expected for the amount of refractive change observed during this study.     

Conductive keratoplasty for presbyopia: 3-year results

PURPOSE: To assess the long-term safety, efficacy, and stability of conductive keratoplasty (CK) in the treatment of presbyopia. METHODS: Ten near-plano presbyopic patients (6 women and 4 men) underwent unilateral CK with standard-pressure technique in the non-dominant eye to improve their near vision. Mean age was 51+/-3.1 years (range: 46 to 56 years). Nine of the 10 patients were available for both 1- and 3-year follow-up examinations. RESULTS: Preoperative mean manifest refraction spherical equivalent (MRSE) was -0.17+/-0.29 diopters (D), yielding a mean near uncorrected visual acuity (UCVA) of J10. Three years after CK, the mean near UCVA was J3. The mean MRSE at 3 years was -1.06+/-0.81 D, which represents a 0.25 D change from the MRSE at 1 year. The MRSE in the dominant untreated eyes had a +0.26 D change during the 3-year period, which was not statistically different when compared to the CK-treated eyes during the 3-year postoperative period. No eye lost best spectacle-corrected visual acuity or had induced cylinder > or =0.75 D. Seventy-eight percent had binocular distance UCVA 20/20 or better and near UCVA J3 or better. The average keratometry remained stable at 45.09 D 3 years postoperatively compared to 45.08 D 1 year postoperatively. CONCLUSIONS: Conductive keratoplasty for the treatment of presbyopia provided safe, effective, predictable, and stable results 3 years following the initial surgery. Refractive stability was similar for both the CK-treated and untreated eyes with a small hyperopic shift noted during the 3-year follow-up period.     

准分子激光原位角膜磨镶术治疗远视眼老视的临床观察

目的 探讨准分子激光原位角膜磨镶术(LASIK)治疗远视眼老视的临床效果.方法 回顾性病例分析研究.收集32例(64只眼)因远视眼老视行LASIK患者的资料.术前屈光度数:球镜为+0.75～+3.00 D,柱镜为0.00～+1.75 D.术后预期目标屈光度数:主视眼为0.00～-0.50 D视远,非主视眼为-1.50～-2.50 D视近,目标近视力等于或高于J3.术后随访时间12个月,观察术后双眼裸眼远近视力、角膜形态、屈光度数及对比敏感度等.本研究采用t检验、X2检验、SNK-q检验方法对数据进行统计学分析.结果 LASIK术后12个月双眼裸眼远视力≥0.8且近视力等于或高于J3及等于或高于J4的患者分别为53.1%(17/32)及87.5%(28/32).术后不同时间角膜屈光力较术前[角膜直径3 mm区域为(44.12±1.38)D、5 mm区域为(43.42±1.53)D]均有明显增加,且对应的角膜非球面参数Q值,如主视眼术后1、3、 6、 12个月分别为-0.514±0.053、-0.416±0.065、-0.389±0.076、-0.368±0.087,亦呈负值增加(t=19.25,12.14,9.82,8.11;P<0.01).术后12个月等效球镜屈光度数与预期目标差值在±0.50 D和±1.00 D以内者主视眼分别为87.5%(28/32)、100.0%(32/32),非主视眼分别为56.2%(18/32)、90.6%(29/32).术后6个月双眼各空间频率对比敏感度与术前比较,差异均无统计学意义(t:0.63,0.45,0.37,1.06,0.64;P0.05);术后12个月主诉有干眼症状的患者占15.6%(10/23),满意度调查84.4%(27/32)患者对疗效满意.结论 根据单眼视原理采用LASIK治疗远视眼老视可获得较好的临床效果,但其远期疗效和稳定性有待进一步观察.     

Treatment of presbyopia with conductive keratoplasty: six-month results of the 1-year United States FDA clinical trial

PURPOSE: To provide 6-month results of a 1-year clinical trial evaluating conductive keratoplasty (CK) for the treatment of presbyopic symptoms in emmetropic and hyperopic eyes. METHODS: A total of 143 patients with presbyopic symptoms were enrolled in this 1-year United States FDA clinical trial and treated to improve near vision in 1 eye (unilateral treatment). In addition, 33 fellow eyes were treated to improve distance vision (bilateral treatment). For near vision correction, the target refraction was up to -2.0 D in the nondominant eye, and for distance vision correction, 0.0 D. Enrolled patients had a preoperative spherical equivalent of plano to +2.00 D, no more than 0.75 D of refractive astigmatism, and were 40 years of age or older. No retreatments were performed. RESULTS: Of the eyes treated for near, 77% had uncorrected near vision of J3 or better at 6 months postoperatively. A total of 85% of all patients had binocular distance UCVA of 20/25 or better along with J3 or better near, a combination that represents functional acuity for a presbyope. Sixty-six percent of eyes treated for near had a manifest refractive spherical equivalent (MRSE) within +/- 0.50 D of intended at 6 months. In 89% of eyes, the MRSE changed 0.05 D or less between 3 and 6 months postoperatively. After month 1, the incidence of variables associated with safety was 1% or lower. Seventy-six percent were very satisfied or satisfied with their procedure. CONCLUSIONS: CK appears to be very safe and effective in producing functional visual acuity in presbyopic eyes up to 6 months following the procedure. Patient satisfaction with the procedure is similar to that of monovision LASIK.     

大龄近视患者LASIK疗效分析

目的：探讨大龄近视患者LASIK特点及采用Monovision矫正方法设计的LASIK术后疗效。

方法：对104例186眼大龄近视患者(年龄≥40岁)采用Monovision矫正方法设计并进行LASIK手术,并对术前后视力、屈光度、手术疗效等进行统计分析。

结果：术后1mo,所有术眼的裸眼视力均明显提高(P<0.01),达到1.0的百分率分别为非主导眼83.7%(87/104),主导眼91.5%(75/82); 术后裸眼视力与术前最佳矫正视力比较,非主导眼差异不显著(P>0.05),而主导眼提高明显(P<0.01); 术后屈光度非主导眼为-0.70±0.12D,与术前欠矫设计量基本一致(P>0.05),主导眼为-0.04±0.28D,两组差异显著(P<0.01); 患者对远视力满意度100%、近视力满意度82.7%。

结论：大龄近视患者行LASIK治疗以高度、超高度近视患者为主,大屈光参差(>2.50D)患者占比例较高; 采用Monovision矫正方法设计的LASIK术对改善大龄患者术后视近功能、缓解视疲劳以及提高其视觉满意度是切实有效的,将这一临床经验用于个体化手术方案的设计可以使其更为完善。     

Photopic pupillometry-guided laser in situ keratomileusis for hyperopic presbyopia

PURPOSE: To evaluate a method of surgically treating presbyopia in hyperopic patients having laser in situ keratomileusis (LASIK) by selecting excimer ablation optical zone diameters based on the photopic pupil. SETTING: Private practice, Beverly Hills, California, USA. METHODS: This prospective analysis comprised 46 patients having hyperopic LASIK for presbyopia. The distance-dominant eye was treated with a standard 6.0 mm optical and 9.0 mm outer zone for full distance correction with no nomogram adjustment from the final preoperative manifest refraction. In the nondominant eye, an algorithm was used to select the optical and blend zone diameters and the optical zone size-dependent programmed amount of correction augmentation. Variables evaluated at the 6-month postoperative visit included preoperative and postoperative manifest refractive spherical equivalent (MRSE), refractive cylinder, and monocular and binocular near and distance uncorrected visual acuities. Patient satisfaction and spectacle dependence were also evaluated. RESULTS: In the near-corrected eye, the mean preoperative and postoperative MRSE was +1.10 diopters (D) +/- 1.20 (SD) and -1.30 +/- 0.56 D, respectively, and the mean refractive cylinder, -0.76 +/- 0.91 D and -0.36 +/- 0.33 D, respectively (P<.05). The mean uncorrected near acuity in the near-corrected eye was J10 preoperatively and J1 postoperatively (P<.0001) and the binocular mean uncorrected near acuity, J10 and J1, respectively (P<.0001). The mean uncorrected logMAR distance acuity in the near-corrected eye was +0.38 +/- 0.31 (20/50) preoperatively and +0.36 +/- 0.25 (20/50) postoperatively (P>.05). The mean binocular uncorrected logMAR distance acuity was +0.30 +/- 0.30 (20/40) and +0.01 +/- 0.08 (20/20) (P<.0001), respectively. The mean overall patient satisfaction score was 8.8 (scale 1 to 10). After LASIK, no patient reported using spectacles full time for near or distance and 15% reported part-time use. CONCLUSION: Photopic pupillometry-guided LASIK may be an effective option when considering surgical treatment of presbyopia in hyperopic patients.     

Monovision LASIK的临床研究

目的:研究Monovision LASIK的临床疗效。方法:回顾性分析来我院接受LASIK手术屈光不正的患者110例(220眼),年龄40岁以上,术后随访1a,术后接受问卷评估。分析术前及术后1a的裸眼视力(远视力、近视力)、屈光等数据,结合问卷评估结果进行统计学分析。结果:78例接受Monovision LASIK手术,32例患者接受双眼完全矫正手术。Monovision组和完全矫正组患者术后裸眼远视力分别为1.21±0.13,1.19±0.15,两者比较统计学上差异无显著性(P=0.35)。Monovision组术后裸眼近视力(0.68±0.25)好于完全矫正组(0.43±0.21,P=0.04),两组术后屈光参差分别为1.41±0.26D,0.12±0·11D,两两比较统计学上具有显著性差异(P=0.03)。术后满意度Monovision组与完全矫正组分别为87%与85%,统计学上无显著性差异(P=0.65)。术后驾车、行走、运动等不戴镜分别为91.5%,97.2%,差异无统计学意义(P=0.55)。术后近距离工作从不佩戴老视眼镜分别为48.6%,15.6%(P=0.03),差异具有统计学意义。结论:Monovision LASIK是一种矫治老视的有效方法。     

Q值优化Micro-Monovision矫正近视合并老视的短期临床效果

探讨Q值优化Micro-monovision准分子激光手术矫正近视合并老视的安全性、有效性及预测性。方法：前瞻性临床研究。收集2017 年8 月至2018 年5 月在青岛大学附属医院行Q值优化Micro-monovision准分子激光手术的近视合并老视患者35例（70眼）。术后3个月观察单眼和双眼的远、近视力（logMAR视力）、屈光状态、对比敏感度（CS）及立体视，并进行近距离工作视觉疲劳问卷及满意度调查。采用配对t检验对手术前后数据进行分析。结果：35例患者术前双眼视远最佳矫正视力（BCVA）为0.01±0.06，术后3个月为-0.04±0.21，且术后无一眼BCVA下降1行及以上。术后主视眼裸眼视力（UCVA）为-0.04±0.19，非主视眼UCVA为0.04±0.13。所有患者主视眼视近UCVA 均达20/25及以上，非主视眼均达20/20。所有术眼实际获得等效球镜度（SE）与预期切削SE的差值均在±1.00 D以内，而差值在±0.50 D以内为60眼（86%）。术后3个月CS在昼+周边眩光条件下18.0 c/d频段较术前显著提高（t=-2.504，P=0.017）；在昼1.5、6.0、18.0 c/d频段，昼+周边眩光6 c/d频段，夜1.5 c/d频段，夜+周边眩光18.0 c/d频段CS均较术前显著下降（P<0.05），其他各条件频段CS均恢复至术前水平。立体视术后3个月与术前比较差异均无统计学意义。所有患者术后均未出现近距离工作后头痛、恶心、阅读模糊及视近困难。所有患者对手术效果均表示满意，满意度为100%。结论：Q值优化Micro-monovision准分子激光手术矫正近视合并老视，可同时获得较好的双眼远、近视力及双眼视功能，是一种安全、有效且预测性好的手术方法。