激光手术矫正老视的应用和研究进展

尽管老视矫正方法日趋繁多,但手术矫正老视仍是屈光领域一个重大难题.近年来激光手术矫正老视逐渐得到重视.主要包括作用于角膜的激光老视手术如准分子激光原位角膜磨镶术、飞秒激光角膜基质内老视矫正术、激光角膜热成形术、角膜层间镜片植入术,以及作用于晶状体的飞秒激光晶状体老视矫正手术等.本文对激光矫正老视的临床应用和最新研究进展进行综述.     

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。     

Monovision与老视矫正手术

Monovision(MV)矫正是一种成熟的矫正老视的方法,近10 a来,老视矫正手术逐渐开展,一些准分子激光角膜屈光手术(PRK、LASIK等)、激光角膜热成形术和传导式角膜成形术、人工晶状体植入术也采用MV矫正方法治疗老视,取得很好的效果,本文就MV矫正在这些老视矫正手术中的应用进行综述.     

老视矫正方法的研究进展

目的老视矫正方法的日趋多样化。配戴框架凸透镜是矫正老视最常见的方式,包括传统的单光（单焦）眼镜及近年出现的双光（双焦）、渐变多焦眼镜及衍射镜片。屈光手术矫正老视可分为角膜屈光性手术、眼内晶状体摘除联合可调节型人工晶状体（IOL）植入手术和巩膜屈光性手术。角膜屈光性手术包括激光角膜手术、角膜层闻植入物手术及传导性角膜成形术。鼎状体摘除联合可调节IOL植入术的IOL可分为单焦和多焦调节型两种,有引起眩光或光晕等视觉症状的情况,疗效需进一步观察。巩膜手术视觉完整性并不理想,且可能出现严重并发症,仍需临床观察。同时monovision（MV）被越来越多的引入到老视矫正手术中并且取得了较好效果。老视矫正方法的多样化为不同的需求者提供更多的选择。     

老视矫正的多样化研究进展

配戴框架凸透镜是矫正老视的主要方式，如单光眼镜、双光眼镜、渐变多焦镜及其他新兴衍射镜片。屈光性手术也为矫正老视提供了新的途径，可分为角膜屈光性手术、晶状体摘除联合可调节型人工晶状体（IOL）植人手术以及巩膜屈光性手术。角膜屈光性手术通过改变角膜的屈光力而改变眼球的屈光状态，包括激光角膜手术和角膜层间植人物手术两类。晶状体摘除联合人工晶状体植人术的关键在于可调节型人工晶状体的研发，现有的单焦调节型及多焦调节型人工晶状体优点是减少眩光或光晕，获得较好的夜间视觉，临床效果仍需进一步研究。巩膜屈光性手术通过增加晶状体赤道部与睫状肌的距离治疗老视，包括睫状体前巩膜切开术、激光老视逆转术和巩膜扩张术。老视矫正逐渐向多样化发展，为不同需求的老视者提供了更多的选择。     

老视的矫治研究现状

随着近视矫正技术的日趋成熟,老视逐渐成为屈光不正治疗下一个巨大的挑战.近年来,老视矫正呈现多样化发展,包括传统的配戴框架凸透镜、角膜接触镜,及近年来成为研究热点的屈光性手术,分为角膜途径、晶状体途径及以Schachar调节假说为基础的巩膜途径等.     

预防为主提高准分子激光角膜屈光手术的安全性

准分子激光角膜屈光手术的首要问题是安全,贯穿着准分子激光矫正屈光不正手术流程的每一个环节。本文主要从预防的角度总结准分子激光角膜屈光手术的术前、术中与术后注意事项及经验和方法,从细节做起,提高准分子激光角膜屈光手术的安全性。     

飞秒激光辅助的角膜透镜植入技术研究进展

目前的准分子激光原位角膜磨镶术、准分子激光上皮下角膜磨镶术、飞秒激光辅助准分子激光原位角膜磨镶术、飞秒激光透镜切除术和小切口透镜切除术等都是以牺牲角膜厚度为前提来矫正屈光不正的,矫正的屈光度必然受到角膜厚度的限制。转变在角膜厚度上做"减法"来矫正屈光不正的理念,尝试在角膜基质层内植入一定度数的透镜,用"加法"来矫正屈光不正已经成为可能。本文就飞秒激光辅助的角膜透镜植入技术近10年来的研究进展及发展前景进行综述。     

准分子激光治疗高度近视的临床进展

进入九十年代，准分子激光角膜切削术已成为矫正屈光不正的一种有希望的手术方法，并且有逐渐取代放射状角膜切开术的趋势。准分子激光角膜切削术在矫正低度和中度近视中表现出良好的临床矫正效果，具有较好的可预测性和安全性。然而在矫正高度近视中，由于屈光回退，角膜混浊等严重并发症的发生率明显增高，其矫正屈光不正的范围受到一定的限制。本文就目前准分子激光治疗高度近视的临床进展作一综述，对多区切削技术、同时进行的两步法技术、延迟进行的两步法技术、二次手术以及Ｌａｓｉｋ手术做一介绍。     

应用Monovision矫正老视的研究进展

Monovision矫正方法常用于老视和老视前期患者,即一眼矫正看远,另一眼矫正看近,其机制是双眼间的模糊抑制,MV可应用于单焦点角膜接触镜,并且还可应用于人工晶状体植入术和PRK,LASIK等激光屈光手术中,以及目前最新的非激光手术—传导性角膜成形术。本文就MV矫正的机制、对双眼视力功能的影响以及研究进展作一综述。     

Lentes intraoculares fáquicas: recientes avances e innovaciones

Phakic intraocular lenses (pIOL) are recommended when counselling refractive surgery candidates presenting with high ametropia or ocular surface and/or corneal conditions that contraindicate corneal refractive surgery. This review aims to present the state-of-the-art regarding pIOL models currently available in Europe, addressing their newer indications and recent design innovations. These include, in the case of posterior chamber pIOLs, the addition of a central hole to improve aqueous humour circulation, the availability of larger optical zones, and multifocal optics for the compensation of presbyopia. The review also highlights their good safety and efficacy results, as well as the role of patient education to ensure adequate outcomes in the medium-long term. The indications of pIOLs in special situations, as well as bi-lensectomy, a procedure that most pIOL patients may eventually require as they age and develop cataracts, are also addressed.     

小孔角膜嵌入环矫治老视的研究进展

渐变镜、多焦点型和可调节型人工晶状体（IOL）植入是矫治老视的主要方法,但戴镜会影响生活质量,IOL植入存在内眼手术的风险等问题;广泛用于矫治屈光不正的准分子激光原位角膜磨镶术（LASIK）目前缺少精准的老视激光切削模式。新近出现的角膜嵌入环（Corneal Inlay）KAMRA与LASIK联合矫治老视,具有安全有效、可重复定位、可逆等优点。现对KAMRA的临床有效性和安全性的相关研究进展进行综述,以期临床医生对其有更深入的了解,有助于选择合适的矫治方案,提高手术安全性和患者生活质量。     

Pseudophake additive Intraokularlinsen

Non-corrected residual refractive errors after cataract extraction and implantation of an artificial intraocular lens (IOL) lead to limited visual acuity or suboptimal usage of enhanced optical properties of IOLs, such as bifocal implants, which are dependent on postoperative emmetropia. In addition to the established corneal procedures for correction of ametropia (excimer laser surgery or limbal relaxing incisions) sulcus supported pseudophakic supplementary IOLs can also be implanted. These IOLs have been designed to deal with the problem associated with sulcus implantation, such as pigment dispersion glaucoma, intralenticular opacification or iris capture. Other possible fields of application of these lenses are the correction of higher astigmatism after any form of keratoplasty in pseudophakic eyes, reversible presbyopia correction by implementing bifocal optics or reversible, bulbus growth-adjusted treatment of ametropia in pediatric cataract surgery     

Surgical correction of presbyopia

There are a lot of surgical procedures to correct refractive errors, but the surgical correction of presbyopia is still a problem. In this paper the authors present surgical procedures, which can be used to correct presbyopia. There are three groups of surgery: the corneal, scleral and intrabulbar procedures.     

Conductive keratoplasty

PURPOSE OF REVIEW: Conductive keratoplasty is a noninvasive, in-office procedure for the correction of hyperopia, hyperopic astigmatism, and management of presbyopia. It serves as an alternative to laser-based refractive surgery with essentially no intraoperative or postoperative complications. RECENT FINDINGS: In the past decade, photorefractive keratectomy and laser in-situ keratomileusis have been the most popular refractive surgical procedures to correct myopia, hyperopia and astigmatism. Although relatively safe, flap-related complications often result in undesirable visual acuity. Since US Food and Drugs Administration approval in 2002, conductive keratoplasty has become a promising technique to correct low to moderate hyperopia and astigmatism. The procedure was first used by Mendez and colleagues in 1993. It is a nonlaser, no cutting procedure that delivers radio-frequency energy to corneal stroma in a circular fashion to steepen the cornea. Multiple studies have shown that conductive keratoplasty offers equal or superior efficacy, predictability, stability and safety than currently used refractive procedures to correct hyperopia or hyperopic astigmatism. In addition, monovision conductive keratoplasty has been shown to be successful for the management of presbyopia. SUMMARY: Conductive keratoplasty, an alternative to the laser-based procedure, is effective, predictable, and safe to correct low to moderate hyperopia, astigmatism, and manage presbyopia.     

准分子激光原位角膜磨镶术后皮质类固醇性高眼压研究进展

准分子激光原位角膜磨镶术（laser in situ ker-atomileusis,LASIK）是治疗屈光不正的主要方法之一,由于该手术是在相对健康眼上进行,手术后的并发症引起了广泛重视。皮质类固醇性高眼压是手术后并发症之一。LASIK手术中需要制作角膜瓣,手术后由于角膜瓣的存在,改变了原有角膜的解剖和生理特点,使LASIK术后皮质类固醇性高眼压的临床表现呈现出多样性和复杂性的特点。角膜上皮水肿、角膜瓣水肿、角膜层间积液、弥漫性板层角膜炎性反应、角膜扩张及＂低眼压＂等表现,使早期诊断困难,易造成漏诊、误诊。对皮质类固醇性高眼压进行分型有利于增加对该病的认识,有助于早期正确诊断,避免严重并发症的发生。     

Keratoreformation by contact lenses after radial keratotomy

Since the number of patients undergoing radial keratotomy has increased, more have required contact lens fitting to correct residual ametropia. A number of practitioners suggest that the postoperative changes stabilize after 12 months, so contact lens fitting on the unusual resultant corneal topography can begin. This paper discusses corneal and refractive changes that are revealed even when correctly fitting lenses are worn 1-5 years postoperatively. These changes indicate that lens wear may influence corneal topography and refraction even several years after radial keratotomy.     

晶状体手术矫正老视的治疗进展

老视是与眼睛调节能力下降密切相关的生理现象。不论年轻时屈光状态如何,老视都是人一生中必须经历的阶段。随着老龄化人口数量的增多,老视问题得到越来越多眼科工作者的关注,各种治疗老视的方法与技术也应运而生。现就晶状体手术用于矫正老视进行综述。     

Refractive enhancement following presbyopia-correcting intraocular lens implantation

PURPOSE OF REVIEW: Presbyopia-correcting intraocular lenses are widely available. Residual ametropia is one of the most common issues that can result in patient dissatisfaction. Options for correcting refractive surprises include piggyback intraocular lens implantation, corneal incisional surgery and laser correction. Excimer laser surgery is a safe and predictable method to correct residual amounts of ametropia in pseudophakic patients with monofocal intraocular lenses; however, there is scant published literature regarding this technique. RECENT FINDINGS: Presbyopia-correcting intraocular lenses require emmetropia for the best visual outcome, as small amounts of astigmatism or residual refractive errors can limit their visual performance. Laser-assisted in-situ keratomileusis and photorefractive keratectomy are safe and effective results in pseudophakic patients. Surgeons can refine the refractive outcome after intraocular lens implantation with the excimer laser to achieve better results and higher patient satisfaction. SUMMARY: Excimer laser corneal surgery for fine-tuning residual ametropia after presbyopia-correcting intraocular lenses is a safe adjunct treatment to increase patient satisfaction. Which technique (photorefractive keratectomy or laser-assisted in-situ keratomileusis) to use depends on surgeon preference and patient characteristics, as both demonstrate similar results in published literature. Knowledge of all available refractive methods and technologies are crucial for improving outcomes in these patients.     

老视的角膜矫正手术

老视是随着年龄增长、调节能力丧失出现视近物困难的一种生理现象,发病机制尚不明确。人口老龄化使老视人口及老视矫正的需求逐渐增多,老视的手术矫正方法正成为眼科医师关注的热点。随着技术和材料的不断发展,出现了多样化的老视矫正手术,包括经角膜老视矫正手术、晶状体老视矫正手术和巩膜老视矫正手术。尽管还没有一种完美的老视矫正手术能真正恢复眼的调节功能,现有的手术已取得一些临床效果。现对老视的角膜手术矫正方法做一综述。