OK療法治療近视180例分析

目的 探讨过夜配戴角膜矫形镜(OK镜)对近视的治疗效果。方法 使用OK镜治疗近视患者180例358只眼,按近视程度分为低度、中度、高度近视,观察其治疗前及治疗後1天、1周、1个月、3个月及1年的视力、屈光度、角膜曲率及并发症情况。结果 100％病例治疗後视力迅速提高,但停止治疗後短时间内视力、近视度就回退到治疗前水平。治疗过程中可出现复视、角膜上皮损伤、视力波动等并发症。结论 OK镜治疗近视效果快、简便安全,但作用不持久,仅能暂时改变角膜曲率而降低近视程度。     

角膜塑形镜矫正青少年近视的效果观察

目的探讨角膜塑形镜矫正不同类型(低度近视和中度近视;高曲率组和低曲率组近视)青少年近视的效果。方法选取2009年至2011年在我院就诊患者54人,共102只眼,年龄8～16岁,平均11.24±3.56岁,性别不限;等效球镜度数-1.00～-6.00D,顺规散光<-1.50D,逆规散光<-0.75D,配戴夜戴型角膜塑形镜,戴镜时间8～10h,并按照近视度数和曲率高低分为,低度近视组和中度近视组,低曲率组(≤43D)和高曲率组(43D∽46D);观察戴镜后第1d、1周、2周、1月、2月、3月、6月、12月后患者视力、屈光度、曲率变化情况并进行比较;对所有结果应用SPSS11.5统计软件进行分析。结果所有戴镜者白天视力都基本恢复正常(视力达1.0),其中低度近视组在戴镜后1周、中度近视组在戴镜后1月视力恢复最佳并稳定;所有患者角膜曲率都降低,并在戴镜后一月稳定,高曲率组比低曲率组曲率下降更大,低曲率组平坦曲率下降(2.06±0.78D),高曲率组平坦曲率下降(2.81±0.98D);低曲率组陡峭曲率下降(1.74±0.70D),高曲率组陡峭曲率下降(2.84±1.09D);结论角膜塑形镜是矫正青少年中、低度近视的有效方法,低度近视及高曲率者效果更佳。.     

角膜塑型术治疗近视的临床应用

目的对角膜塑型术治疗近视进行初步分析。方法根据患者眼球参数,选择定制特殊设计的硬性角膜接触镜片治疗近视和近视散光,治疗1d、1、2、3、4wk观察,以后每4wk1次观察视力、屈光度、角膜曲率、角膜偏心率的变化,随访18mo。结果治疗后784眼视力、屈光度、角膜曲率、e值均发生变化。低度近视280眼屈光度平均降低-2.75D±0.50D,水平SimK(D)平均降低1.64±0.21,垂直SimK平均降低0.92±0.27,e值平均减小0.47±0.11;中度近视327眼及高度近视177眼屈光度、角膜曲率、e值呈同方向变化但程度各不相同。中、低度近视治疗预测性较好,高度近视预测性较差。存在视力不稳定,角膜形态异常改变等问题。结论角膜塑型术是一种非创伤性治疗近视的方法,临床应用应严谨而科学。     

LASIK术后再近视的原因分析

目的探讨准分子激光原位角膜磨镶术(excimer laser in situ keratomileusis,LASIK)治疗近视术后再近视的相关因素。方法对36例(68只眼)患者在LASIK术后进行定期随访复查18个月,测定近视屈光度、角膜曲率、角膜厚度、眼轴等数据进行分析其相关因素。结果36例(68只眼)中,屈光度为-1.50D~-2.75D(-1.80±0.63)D,因屈光回退引起视力下降38只眼(占55.90%);与角膜增厚相关t=3.89,P<0.05;与眼轴无关t=1.56,P>0.05。近视屈光度有进展者20只眼(占29.4%),与眼轴增长有关t=3.89,P<0.05;与角膜厚度无关。屈光欠矫10只眼(占14.70%),与角膜曲率无关,P>0.05,无统计意义。结论LASIK治疗高度近视眼,术后再近视的主要原因是屈光回退、欠矫和屈光度进展。屈光回退与术后角膜增厚有关;屈光度进展与眼轴增长有关;欠矫与激光能量不足、基质床湿润程度有关,与角膜曲率无关。     

LASEK与PRK矫正近视及近视散光的疗效比较

目的 比较LASEK与PRK手术矫正不同程度近视及近视散光的有效性、安全性及稳定性。方法 70名患者(140眼)，分为中低度近视组39人(78眼)、高度近视组31人(62眼)。患者一眼行LASEK手术，对侧眼行PRK手术，术后观察术眼疼痛情况、上皮愈合时问、角膜上皮下雾状混浊(haze)、术后裸眼视力6个月。结果LASEK与PRK术后上皮愈合时间及术眼疼痛指数无明显差异；中低度近视组两种手术后裸眼视力无显著差异；高度近视组裸眼视力及角膜haze程度差异显著。结论 LASEK矫正不同程度近视均能取得较好的临床效果，术后裸眼视力及视力稳定程度优于PRK，特别表现在高度近视组。     

中低度近视的准分子激光上皮瓣下角膜磨镶术

目的探讨准分子激光上皮瓣下角膜磨镶术(LASEK)治疗中低度近视的疗效与安全性。方法应用德国ZeissMEL80准分子激光器对<-6.00D的中低度近视患者102例200眼施行LASEK术,术前平均裸眼视力0.17±0.13(0.02～0.6),平均等值球镜-3.87±1.57D。前瞻性地随访6个月,观察术后症状、裸眼和最佳矫正视力、显然屈光度、眼压、角膜愈合程度和并发症。结果LASEK术后6个月裸眼视力≥0.6者占100%,裸眼视力≥1.0者占96%。术后平均裸眼视力1.08±0.23,平均等值球镜-0.35±0.41D。平均角膜上皮愈合时间1～5天。术后10眼(5%)出现haze,0.5级8眼,1.0级2眼。1例患者出现眩光。结论LASEK是一种安全、有效的治疗中低度近视的屈光手术。     

SMILE近视矫正术后前房结构参数的早期变化

目的 探讨飞秒激光小切口角膜基质透镜取出术(SMILE)矫正不同程度近视在术后1个月前房结构参数的变化.方法 回顾性对照研究.选取我院2019年3～6月接受SMILE手术的近视和近视散光患者,共158例(158只眼),均选取右眼,按照等效球镜度分为低度近视组(≥-3.00 D)、中度近视组(＜-3.00 D且≥-6.0...     

PRK矫治近视远期临床疗效观察

目的 评价准分子激光角膜切削术(PRK)治疗近视远期临床疗效.方法 回顾性分析23例(45只眼)PRK术后8年以上(8.78±1.54)年的视力、屈光度、对比敏感度、波前像差及haze情况.分低度近视(＜-3D)、中度近视(≥-3D且＜-6D)和高度近视(≥-6D)三组比较.结果 低度近视组术后裸眼视力(UCVA)均≥1.0,中度近视组术后UCVA≥0.5和≥1.0者分别为:23只眼(85.19％),14只眼(51.85％);高度近视组达0.5以上为4只眼(40％).术后最佳矫正视力下降者三组眼数分别为0、5(18.52％)和3(30％).术后屈光度在预期矫正值±1D以内者三组眼数分别为8(100％)、17( 62.96％)、3(30％).中低度近视组对比敏感度均正常,高度近视组仅1只眼在正常值范围内.术后总高阶像差均方根三组间差异明显(P＜0.05),其中球差增大明显,且随矫正度数增加而增大(P＜0.05).haze低度近视组无,中度组仅1只眼(3.70％)为0.5级,高度组0.5级2只眼,1级2只眼.结论 PRK治疗中低度近视远期疗效满意,治疗高度近视远期效果欠佳,haze可在PRK术后长期存在,尤其在高度近视眼中.     

成人屈光不正性弱视屈光手术的效果分析

目的:观察成人屈光不正性弱视患者的准分子激光原位角膜磨镶术的治疗效果。方法:弱视患者141例(188眼),包括单纯中低度近视21例(24眼)、单纯高度近视36例(44眼)、复合近视散光84例(120眼),回顾性观察这些患者的LASIK手术治疗效果。结果:单纯中低度近视、单纯高度近视、复合近视散光患者术后视力高于术前最佳矫正视力的眼数分别为10眼,27眼,77眼;超常率分别为41.7%,61.4%和64.2%。部分患者LASIK术后视力高于术前最佳矫正视力,其中对单纯高度近视和复合近视散光类患者效果最佳。结论:LASIK手术能有效的治疗弱视患者的屈光不正。     

机械法准分子激光角膜上皮瓣下磨镶术矫治近视的临床观察

目的探讨机械法准分子激光角膜上皮瓣下磨镶术(epipolis laser in situ keratomileusis,Epi-LASIK)矫治近视的手术特点和临床疗效。方法对246例(468只眼)近视患者行Epi-LASIK,术后配戴高透氧的角膜接触镜,5~7d摘镜。对术后患者的刺激症状、角膜上皮生长情况、视力、眼压、角膜上皮下雾状浑浊(Haze)情况进行总结。结果刺激症状多发生在手术后第1天,一般术后第2天就会好转,术后第3天基本正常。术后第1天检查,386只眼(82.5%)角膜上皮瓣基本透明;5~7d摘镜时,448只眼(95.7%)角膜上皮愈合良好。术后2周检查,裸眼视力为0.15~1.5;术后3个月检查,453只眼(96.8%)视力达到和超过术前最佳矫正视力。术后6个月检查,413只眼(88.2%)屈光度在预期值±1.00D以内,55只眼(11.8%)屈光度在预期值±1.00D以外。术后6个月检查,7只眼(1.5%)角膜Haze0.5级,4只眼(0.9%)角膜Haze1级,其余患者角膜透明。结论 Epi-LASIK手术适用范围广,不仅适用于高度近视,对中低度近视也非常好。该方法安全、有效、预测性好。     

Long-term follow-up of Intacs from a single center

PURPOSE: To evaluate the long-term visual results in patients having Intacs placement for the correction of mild myopia. SETTING: Department of Ophthalmology, Mount Sinai School of Medicine and the Mount Sinai Hospital of Mount Sinai NYU Health, New York, New York, USA. METHODS: Patients with mild myopia (spherical equivalent between -0.75 and -4.50 diopters [D]) were enrolled to have Intacs placement between May 1995 and March 1999 under United States Food and Drug Administration Phase II and Phase III clinical trials for intrastromal corneal ring segments (ICRS). Six insert thicknesses were evaluated: 0.21, 0.25, 0.30, 0.35, 0.40, and 0.45 mm. The long-term results evaluated were uncorrected visual acuity (UCVA), maintenance of best spectacle-corrected visual acuity (BSCVA), predictability and stability of the refractive effect, induced manifest refraction cylinder, slitlamp findings, self-reported visual symptoms, and maintenance of mesopic contrast sensitivity. RESULTS: One hundred fourteen eyes of 73 patients were enrolled; 113 eyes of 72 patients received Intacs. There were no serious intraoperative or postoperative complications. The mean follow-up was 17.5 months +/- 8.9 (SD). At the end of this period (number of eyes evaluated = 100), the UCVA was 20/40 or better in 95 eyes (95.0%), 20/20 or better in 72 (72%), and 20/16 or better in 41 (41%). None of the 113 eyes lost 10 or more letters or 2 or more lines of preoperative BSCVA. The mean change in the cycloplegic refraction spherical equivalent for the 6 insert thicknesses was as follows: -0.75 +/- 0.00 D for 0.21 mm; -1.17 +/- 0.42 D for 0.25 mm; -2.00 +/- 0.54 D for 0.30 mm; -2.59 +/- 0.53 D for 0.35 mm; -3.09 +/- 0.54 D for 0.40 mm; and -3.82+/-0.80 D for 0.45 mm. The refractive correction was within +/-1.0 D of the predicted outcome in 103 eyes (92.0%) and within +/-0.5 D in 72 eyes (63.7%). Intacs were removed from 6 eyes (5.3%). All 4 eyes for which data were available 3 months after removal returned to within +/-0.5 D of their preoperative manifest refraction spherical equivalent. Intacs were exchanged because of undercorrection in 2 eyes (1.8%). These eyes gained 3 and 5 lines of UCVA 12 months and 18 months, respectively, after the exchange procedure. Overall, 85.7% (36/42) of the patients were satisfied with the results of the Intacs procedure. CONCLUSION: Intacs safely and effectively corrected mild myopia. Placement is a brief, easy outpatient procedure. The refractive effect was predictable and stable over long-term follow-up. Results from a limited number of removal and exchange procedures indicate that Intacs are removable and adjustable.     

Ten-year follow-up of 360 degrees intrastromal corneal rings for myopia

PURPOSE: To determine the safety, efficacy, and stability of intrastromal corneal rings 10 years after placement for myopia. METHODS: Ten eyes with myopia treated with the placement of 360 degrees complete intrastromal corneal rings with the ends sutured together were evaluated at 10-year follow-up for the following: uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction spherical equivalent (MRSE), induced manifest refractive cylinder, keratometry readings, slit-lamp findings, and ultrasound central pachymetry. Ten-year data were compared to 1-year results to assess visual stability over time. RESULTS: No statistically significant difference was noted between UCVA at 1 year and 10 years. At the 10-year examination, 90% of patients had BSCVA > or = 20/25 and 100% had BSCVA > or = 20/30. There was no statistically significant difference between MRSE at 1 year and 10 years. At the 10-year examination, induced manifest refractive cylinder was >1.00 diopter (D) in 0% of eyes and < or = 0.25 D in 60% of eyes. There was no statistically significant difference between mean central keratometric power at 1-year follow-up compared with 10-year follow-up. No statistically significant difference was noted in central corneal thickness between 1 and 10 years in the eyes studied. CONCLUSIONS: Intrastromal corneal rings are an effective and stable method of correcting mild myopia based on optic parameters.     

准分子激光原位角膜磨镶术对矫正视力差眼的矫治

目的探讨用准分子激光原位角膜磨镶术对矫正视力低于0.5的患眼的矫治效果,并评价其安全性和有效性。方法回顾性总结48例65眼行LASIK手术的患者,全部病例术前最佳矫正视力均小于或等于0.5。术后随访时间>12个月。结果术后裸眼视力0.02～1.0,平均0.52±0.25,较术前最佳矫正视力明显提高(t=3.092,P=0.003);特别是19眼占29.2%的术后最佳矫正视力较术后裸眼视力亦明显提高,其中提高1行的8眼,2行的8眼,大于等于3行的3眼。手术的安全性指数为1.31(P<0.001),有效性指数为1.18(P<0.05)。无明显手术合并症发生。结论对于屈光不正,特别是高度近视或屈光参差者应及时配镜矫治,框镜矫正不足时应选择接触镜。LASIK手术是一安全、有效的治疗矫正视力低下眼的手术方式。     

Effect of punctal plugs in patients with low refractive errors considering refractive surgery

PURPOSE: To study the effect of punctal plug placement in patients undergoing refractive surgery for correction of poor vision. METHODS: A retrospective study was performed of 12 patients (21 eyes) who presented for initial refractive surgery or retreatment after LASIK or photorefractive keratectomy to improve visual acuity. Uncorrected visual acuity (UCVA) was documented in each eye. If tear normalization test was positive (indicating dry eye), silicone punctal plugs were placed in the lower lids of both eyes. Subjective patient UCVA and Snellen UCVA were assessed at 1 month. RESULTS: At 1 month, two eyes improved by three Snellen lines, nine eyes improved by two lines, seven eyes improved by one line, and three eyes remained unchanged. Uncorrected visual acuity was considered statistically significant (P < .0001) using the paired t test. No eye demonstrated decrease in visual acuity. One patient experienced punctal plug extrusion in both eyes. No other adverse outcomes were reported. One patient pursued additional refractive surgery after plug placement. No patient requested plug removal. CONCLUSIONS: Patients with low refractive errors note improvement in visual acuity after punctal plug placement.     

钬激光角膜热成形术的疗效分析

目的:评价钬激光角膜热成形术(LTK)治疗轻度远视的疗效、安全性和并发症。方法:我们的研究对年龄>45岁的患者12例18只轻度远视眼行Ho:YAG激光LTK术治疗,能量密度65J/cm~2,平均随访2a。结果:患者年龄45～65(平均55.25±10.12)岁,术前屈光度+0.50～+2.25(平均+1.30±0.58)D,术前裸眼视力0.44±0.23,术后屈光度得以全部矫正,术后1mo,没有屈光回退,术后3mo,4眼屈光回退+0.25D。术后6mo,剩余屈光度在±0.50D和±1.00D以内的百分率分别为83%,89%,已矫屈光度和预矫屈光度符合率较好。之后存在屈光回退趋势,2a后屈光回退减缓。最佳视力出现在术后2wk内,以后裸眼视力开始回退。术前裸眼视力>1.0者为0,术后1mo,裸眼视力均较术前有非常显著的提高。术后3mo,裸眼视力达1.0者14眼(78%)。术后2a,裸眼视力达1.0者10眼(56%)。结论:Ho:YAG激光LTK术对轻度远视有效。临床观察证实此手术方法简单、安全,见效快以及并发症少等优点,为治疗轻度远视的手术方方法之一,但尚需长期观察其屈光稳定性。     

One year results of European Multicenter Study of intrastromal corneal ring segments. Part 1: refractive outcomes

PURPOSE: To assess the efficacy, predictability, stability, and safety of correcting myopia with intrastromal corneal ring segments (ICRS, KeraVision, Inc.). SETTING: Twelve European investigational sites. METHODS: Patients with myopia of -1.0 to -6.0 diopters (D) and best spectacle-corrected visual acuity (BSCVA) of 20/20 or better (except in 3 eyes) were assigned to receive 1 of 5 ICRS thicknesses (0.25, 0.30, 0.35, 0.40, or 0.45 mm). Efficacy was assessed by postoperative uncorrected visual acuity (UCVA), predictability of refractive outcome (deviation from predicted cycloplegic refraction spherical equivalent), and stability of refractive effect (manifest refraction spherical equivalent [MRSE]). Safety was assessed by maintenance or loss of preoperative BSCVA and induced manifest refraction cylinder. Measurements were made preoperatively and 1 and 7 days and 1, 2, 3, 6, and 12 months postoperatively. RESULTS: One hundred fifty-nine ICRSs were implanted in the eyes of 107 patients (52 patients had bilateral implantation). Preoperatively, UCVA was worse than 20/40 in 98% of eyes (155/159); 12 months postoperatively, it was 20/20 or better in 63% of eyes (83/132) and 20/40 or better in 96% (127/132). Predicted refractive corrections for each ICRS thickness generally correlated with achieved corrections. At 12 months postoperatively, 90% of eyes (124/138) were within +/-1.00 D of plano (MRSE). Two or more lines of BSCVA were lost in 6% of eyes (8/135); all 8 eyes had BSCVAs of 20/25 or better. CONCLUSION: The ICRS safely, effectively, and predictably reduced or eliminated low to moderate myopia. Refractive correction was stable through the 12 month follow-up.     

有晶状体眼后房型人工晶状体植入矫正高度近视

目的观察有晶状体眼后房型人工晶状体（PC—PRL）植入矫正高度近视的临床疗效。方法回顾性系列病例研究。选择2011年1月至2012年5月间行PC．PRL矫正高度近视患者25例（45眼）。术后随访6～17月,平均（10．9＋1．6）个月,应用配对t检验分析手术前后裸眼视力、眼压、角膜内皮细胞计数及前房深度,分析并发症的发生情况。结果术后裸眼视力4．5～5．2,好于术前最佳矫正视力者35眼（78％）。术后平均眼压（13．7±4．2）mmHg,与术前（13．9±4．1）mmHg比较,差异无统计学意义。术后平均角膜内皮细胞计数（2609±296）cells／mm2,与术前（2818±327）cells／ramz比较,差异无统计学意义。术后的平均拱高稳定,为（0．380±0．135）mm,未见人工晶状体与自身晶状体贴近或接触。结论PC—PRL植入矫正高度近视临床疗效确切,具有良好的安全性,是高度近视患者的理想治疗方法。     

PC-PRL植入治疗高度近视眼的临床观察

目的观察可植入式后房型人工晶状体（PC-PRL）植入治疗高度近视眼的临床疗效。方法 2011年1月至12月对16例（30只眼）高度近视患者植入PC-PRL,观察其术后裸眼视力、眼压、前房深度及PC-PRL的拱高等指标。结果术后裸眼视力（UCVA）较术前明显改善,最佳矫正视力（BCVA）均达到或优于术前BCVA,矫正效果确切,有统计学意义;术后平均眼压（14.04±2.48）mm Hg与术前平均眼压（14.74±2.78）mm Hg差异无统计学意义;术后前房深度（2.56±0.21）mm与术前前房深度（3.13±0.22）mm差异有统计学意义;术后PC-PRL的平均拱高稳定（0.37±0.07）mm,未见人工晶状体与自身晶状体贴近或晶状体位置明显改变。结论 PC-PRL植入术治疗高度近视的临床疗效确切,稳定性安全性良好,但是远期疗效有待进一步观察。     

Results of laser in situ keratomileusis for myopia of -10 to -19 diopters with a Technolas 217 laser

PURPOSE: To evaluate the effectiveness, predictability, and safety of laser in situ keratomileusis (LASIK) for correcting myopia greater than -10.00 D. METHODS: Sixty-five eyes of 37 patients with myopia greater than -10.00 D underwent LASIK. Patients were evaluated on day 1, 1 week, 1, 3, and 6 months after surgery. Parameters evaluated were uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA), residual refractive error, regression of correction, and presence of any complication. RESULTS: Mean preoperative BSCVA was 0.745 +/- 0.234, which improved to 0.8070 +/- 0.237 postoperatively. The average preoperative UCVA was 0.022 +/- 0.02; postoperative UCVA at 6 months was 0.536 +/- 0.255. UCVA of 20/40 or better was achieved in 58% (38 eyes) and 20/20 or better in 26% (17 eyes). The average refractive error before LASIK was -12.64 +/- 2.16 D (range -10.00 to -19.00 D). Mean residual refractive error 1 week following LASIK was -0.63 +/- 1.36 D, which regressed to a mean -1.78 +/- 2.08 D at the end of 6 months. Nineteen eyes (29%) were within +/-0.50 D of intended refractive correction. CONCLUSION: LASIK was partially effective in the correction of high myopia. An initial overcorrection may be programmed to offset the effect of refractive regression.     

Refractive lens exchange for correction of high myopia

PURPOSE: To evaluate the efficiency and safety of refractive lens exchange for the correction of high myopia. METHODS: We made a prospective study of the results of refractive lens exchange in 72 eyes that had undergone this surgical procedure between January 1996 and January 2001. Lens extraction by phacoemulsification was done by one surgeon on 34 patients. Follow-up was five months to five years (mean 48 months). The postoperative refractive target was emmetropia or a low degree of myopia. We compared pre- and postoperative uncorrected visual acuity, and preoperative best-corrected visual acuity with postoperative uncorrected visual acuity. Intra- and postoperative complications were recorded. RESULTS: In 72.2% of the eyes best-corrected visual acuity (BCVA) was > or = 0.5 before surgery. Four years after refractive lens exchange, uncorrected visual acuity (UCVA) was > or = 0.5 in 58.3% of eyes, and the proportion of eyes with BCVA > or = 0.5 increased to 83.3%. The sphere was fully corrected in 70.8% of cases, remained within 1.0 D of emmetropia in 87.5% and within 2.0 D of emmetropia in 95.8%. Posterior capsule opacification developed in 22 eyes (30.5%) and was treated with neodymium:YAG (Nd:YAG) laser capsulotomy. Cystoid macular edema with retinal detachment occurred in one eye. No wound leakage or eye infections were observed during five years' follow-up. CONCLUSIONS: Refractive lens exchange seems to be an effective alternative for the correction of high myopia, helping people over 40 years of age regain their distant vision.