PRK后角膜混浊与屈光回退分析

为探讨准分子激光屈光性角膜切削术（ＰＲＫ）后,角膜上皮下雾状混浊（ｈａｚｅ）和屈光回退的相关因素,对３５６例（６２５眼）近视施ＰＲＫ随访１２个月后,按术前等值球镜屈光度分为Ａ组（≤—３．００Ｄ）,Ｂ组（－３．２５～－６．００Ｄ）,Ｃ组（－６．２５～１０．００Ｄ）和Ｄ组（＞－１０．００Ｄ）。观察各组术后视力恢复,角膜ｈａｚｅ和屈光回退情况。结果：术后裸眼视力在１．０以上的Ａ、Ｂ、Ｃ、Ｄ各组分别是８３．３３％、７４．３１％、４９．６２％和１３．７５％（Ｐ＜０．００１）;在０．８以上的各组是９５．０８％、９３．１２％、７７．０６％和３１．２５％（Ｐ＜０．００１）。屈光回退在－１．００Ｄ以上的分别是３．２８％、５．９６％、２２．９３％和４９．７５％（Ｐ＜０．００１）。角膜ｈａｚｅ在２级以上的仅在Ｃ组和Ｄ组中出现,分别为１０．５２％和１７．５０％（Ｐ＜０．００１）。结论：术后视力提高,角膜ｈａｚｅ和屈光回退与术前屈光度有关。ＰＲＫ治疗低中度近视,术后并发症轻、预测性和稳定性好,而用于治疗高度近视则应慎重。     

准分子激光屈光性角膜切削术后的再治疗

目的 评价准分子激光屈光性角膜切削术（ｐｈｏｔｏｒｅｆｒａｃｔｉｖｅ ｋｅｒａｔｅｃｔｏｍｙ,ＰＲＫ）术后因屈光回退,欠矫出现的残留近视及严重角膜上皮下雾状混沌（ｈａｚｅ）而再次手术治疗的疗效及安全性。方法 采用准分子激光仪对－１．００～－１６．５０Ｄ的近视眼及近视散光患者进行治疗。ＰＲＫ术后３５例（５１只眼）患者出现残留近视及严重ｈａｚｅ。结合ＰＲＫ手术及准分子激光治疗性角膜切削术（ｐｈｏｔｏｐ     

PRK术后角膜上皮下雾状混浊的相关因素分析

为探讨准分子激光角膜切削术（ｐｈｏｔｏｒｅｆｒａｃｔｉｖｅｋｅｒａｔｅｃｔｏｍｙ，ＰＲＫ）后角膜上皮下雾状混浊（ｈａｚｅ）的原因及影响因素，对ＰＲＫ后６个月时屈光度在－１．００～－１８．５０Ｄ的３１６例（６１５只眼）近视眼的ｈａｚｅ相关因素进行观察和比较。结果：ＰＲＫ后６个月时ｈａｚｅ发生率为４４．７％，１级或以上ｈａｚｅ为１３．３％。ｈａｚｅ的发生率及密度随屈光度增高而增加（Ｐ＜０．０００１），也随切削深度的增加而增加（Ｐ＜０．０００１），术前非接触眼压超过１８ｍｍＨｇ者，ｈａｚｅ的发生率和密度增加（Ｐ＜０．００５），男性较易发生ｈａｚｅ（Ｐ＝０．０００１），与年龄呈负相关（Ｐ＜０．０５）。而角膜厚度、术前戴用接触镜及散光对ｈａｚｅ的影响不显著。结论：高度近视（＞－６．０Ｄ）和过深的切削（＞８０μｍ）是引起ｈａｚｅ的主要原因。术前眼压偏高、年龄偏低对ｈａｚｅ也有明显影响。对ＰＲＫ治疗高度近视应持审     

预矫度对准分子激光角膜切削术疗效影响的自身对照研究

目的研究同一个体,不同预矫度对准分子激光屈光性角膜切削术治疗近视疗效的影响。方法双 眼近视度相差≥一２．００Ｄ的 １３６例（２７２眼）近视患者,分为低屈光度组（Ⅰ 组）和高屈光度组（Ⅱ 组）,对．ＰＲＫ术后 随访１年的裸眼视力、残余屈光度及角膜ｈａｚｅ等作统计学分析。结果ＰＲＫ术后１年,Ⅰ组及Ⅱ组的裸眼视力分 别为 ０． ６９±０． ３３和 ０． ６２±０． ３８,组间差异无统计学意义（ Ｐ ＞０．０５）;残余近视度在预矫度±０． ５０Ｄ和±１． ００Ｄ以 内者,Ⅰ组为 ７６眼（５５． ８８％）和 ９５眼（６９． ８５％）,Ⅱ组为 ４５眼（３３． ０９％）和 ７２眼（５２． ９４％）,组间差异极显著（ Ｐ ＜ ０．０１）;±２．００Ｄ以内者,Ⅰ组为９８眼（７２．２２％）,Ⅱ组为８７眼（６３．９７％）,组间差异无显著性（Ｐ＞０．０５）;角膜 ｈａｚｅ在随访的 １、３、６及 １２个月中,组间均无显著差异（Ｐ＞０． ０５）;角膜 ｈａｚｅ与切削深度两组均无显著相关关系 （ Ｐ＞０． ０５）。结论同一个体,预矫度高的一眼,ＰＲＫ术后的预测性及屈光稳定性较另一眼降低,但不显著加重角 膜ｈａｚｅ的程度;个体差异性是ＰＲＫ术后角膜ｈａｚｅ的一个重要的影响因素     

准分子激光角膜切削深度与术后角膜上皮下雾状混浊的关系

目的研究准分子激光角膜切削术（ｐｈｏｔｏｒｅｆｒａｃｔｉｖｅｋｅｒａｔｅｃｔｏｍｙ，ＰＲＫ）后角膜上皮下雾状混浊（ｈａｚｅ）与角膜切削深度之间的关系。方法选择治疗条件基本相同，对双眼同时接受ＰＲＫ治疗的３１例（６２只眼）近视性屈光参差（平均４．９７Ｄ）患者进行前瞻性自身对照研究，将高近视度数眼（－１４．１０±４．１７Ｄ）作为治疗组，低近视度数眼（－９．１３±３．５３Ｄ）作为对照组，术后随访６～１２个月，平均１０个月。结果术后两组的角膜上皮下雾状混浊程度经统计学分析差异有显著性（Ｐ＜０．０５）。结论准分子激光角膜切削术治疗近视，矫正度数越高，角膜切削越深，术后发生角膜上皮下雾状混浊的危险性则越大。     

PRK后近视回退的LASIK再矫正

为探讨准分子激光原位角膜磨镶术（ｅｘｃｉｍｅｒＬａｓｅｒｉｎｓｉｔｕｋｅｒａｔｏｍｉｌｅｕｓｉｓＬＡＳＩＫ）在准分子激光屈光性角膜切削术（ｐｈｏｔｏｒｅ－ｆｒａｃｔｉｖｅｋｅｒａｔｅｃｔｏｍｙＰＲＫ）治疗中、高度近视后，屈光回退的疗效，用波长１９３ｎｍ的ＡｒＦ准分子激光对２７人（４８眼）行ＰＲＫ后屈光回退的患眼，再行ＬＡＳＩＫ，其中４眼在ＰＲＫ后１０个月施行，４４眼在ＰＲＫ后１年～１年半施行。结果：ＰＲＫ术后屈光回退为－１．７５Ｄ～１２．２５Ｄ平均为－５．４４Ｄ±３．０９Ｄ；再手术后，随访３～１０个月，４３眼的屈光度在±１．００Ｄ之内，５眼有－３．００Ｄ的欠矫。４５眼的裸眼视力达到或超过术前矫正视力，３眼低于术前矫正视力。结论：ＰＲＫ后的屈光回退可行ＬＡＳＩＫ再矫正，手术方法与第一次行ＬＡＳＩＫ完全相同，再次手术时间应在ＰＲＫ后一年以上。     

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。     

准分子激光角膜切削术后屈光回退伴角膜雾浊再次手术疗效

近视眼准分子激光角膜切削术（ｐｈｏｔｏｒｅ－ｆｒａｃｔｌｖｅｋｅｒａｔｅｃｔｏｍｙ，ＰＲＫ）后，部分病例存在远期屈光回退、角膜雾浊（Ｈａｚｅ）影响疗效。我院ＰＲＫ中心于１９９６年８月～１９９７年２月对６例８眼ＰＲＫ术后屈光回退伴角膜Ｈａｚｅ病例行再次ＰＲＫ治疗，效果满意，总结报道如下。１材料与方法１．１临床资料８眼病例为我院ＰＲＫ中心治疗后随访１１．２±１．４ｍｏ出现屈光回退伴角膜Ｈａｚｅ的近视眼患者，男６眼，女２眼，年龄２４．０±４．０６ａ（１９～４０ａ）。首次ＰＲＫ术前平均等值球镜屈光度为一…     

PRK治疗近视术后2年随访分析

目的：评价准分子激光屈光性角膜切削术（ＰＲＫ）治疗轻、中、高度近视眼的临床效果。方法：对在我院接受ＰＲＫ治疗的２３９只近视眼的术后２年随访结果进行统计分析结果：Ⅰ组术前近视－１．００～－６．００Ｄ（等值球境，下同），术后２年裸眼视力≥１．０者占８７．１％，≥０．５者占９７．０％，剩余屈光度为－０．３４±０．３９Ｄ，９５．０％，角膜已完全恢复透明；Ⅱ组术前近视－６．２５～－１２．００Ｄ，术后２年裸眼视力≥１．０者占４７．８％，≥０．５者占８８．４％，剩余屈光度为－０．７７±０．６３Ｄ，７８．２％角膜已完全恢复透明。结论：ＰＲＫ治疗－１２．００Ｄ以下，特别是－６．００Ｄ以下近视眼安全有效，预测性及稳定性好     

准分子激光角膜切削术治疗低、中度近视术后五年疗效分析

目的评价准分子激光角膜切削术（ｐｈｏｔｏｒｅｆｒａｃｔｉｖｅｋｅｒａｔｅｃｏｍｙ,ＰＲＫ）治疗低、中度近视的远期疗效。方法对１４８只眼屈光度为－１５０～－６００ＤＰＲＫ术后５年以上患者的视力、屈光度及角膜曲率进行随访观察。结果ＰＲＫ术后５年未矫正视力≥１０者１３６只眼（９１９％）,０８者４只眼（２７％）,≥０６者８只眼（５４％）。术后等值球镜（－０１２±０２２）Ｄ,角膜曲率Ｋ值术前（４３８１±１１０）Ｄ,术后（４１３６±１３０）Ｄ两者间比差异有显著性（Ｐ＜００１）。结论ＰＲＫ治疗低、中度近视的远期疗效可靠。     

准分子激光屈光性角膜切削术后屈光回退的多因素分析

目的：探讨准分子激光屈光性角膜切削术后屈光回退的主要因素。方法：采用VISX20／20型准分子激光仪对121例214眼近视患者行准分子激光角膜切削术,术后随访2年。分二组进行比较,Ⅰ组为低中度近视（－1．00D－－6．00D）124眼,Ⅱ组为高度近视（－6．25D－－16．00D）90眼。结果：术后2年低中度近视回退率9．7％,高度近视回退率27．8％（P＜0．005）,高度近视中高龄组较低龄组回退率高（P＜0．005）,较严重的角膜上皮下雾状混浊与回退伴行。结论：准分子激光角膜切削术后屈光回退的主要因素有预期矫正屈光度,角膜Haze及年龄。     

激光角膜上皮瓣下磨镶术和激光原位角膜磨镶术治疗中高度近视的对比研究

目的比较激光角膜瓣下磨镶术(LASEK)和激光原位角膜磨镶术(LASIK)治疗中高度近视的临床效果. 方法中高度近视患者198例(394只眼).其中LASEK手术治疗93例(184只眼), LASIK手术治疗105例(210只眼). 结果术后1天,LASIK 组28 %裸眼视力达到1.0,LASEK组无1例裸眼视力达到1.0.术后1周、1、3、6月裸眼视力大于或等于1.0者,两组比较差异无显著性 (P=0.36,P=0.58,P=0.44,P=0.64).角膜地形图分析平均角膜中央屈光力与周边屈光力的差异,LASEK组(0.69)明显小于LASIK组(2.62).结论 LASEK手术矫正中高度近视均有良好的治疗效果,是一种安全、有效、预测性好的屈光手术.     

Late-onset corneal haze and myopic regression after photorefractive keratectomy (PRK)

OBJECTIVE: To report the incidence and clinical course of a series of patients who developed both delayed-onset, clinically significant progressive haze and myopic regression after photorefractive keratectomy (PRK). METHODS: In this retrospective case series, the charts of 542 consecutive patients who had undergone PRK with the VISX Star Excimer or Nidek EC-5000 laser between July 1996 and October 1998 and who had a minimum of 6 months of follow-up were reviewed. Ten eyes of 8 patients developed progressive haze to greater than 1+ and myopic regression equal to or more than -1 D 3 months or more after PRK. The historical and clinical features were reviewed. RESULTS: The incidence of combined progressive haze and myopic regression was 1.8%. The average age was 40.5 years. Three of the 8 patients were female. The median spherical equivalent (SE) attempted correction was -6.69 D (range -4.00 to -12.25 D). Five patients who underwent bilateral PRK had unilateral involvement. The mean SE regression was -2.01 +/- 0.79 D (range -1.00 to -3.00 D). Regression plateaued at a mean of 9.8 months. Haze ranging up to 4+ peaked at a mean of 7.4 months. Topical steroid treatment and/or epithelial scraping was attempted in 3 eyes but was ineffective. CONCLUSIONS: Combined delayed-onset progressive haze and myopic regression can occur after PRK. In such cases, the amount of haze appears to correlate with the magnitude of attempted initial correction (r = 0.639, P = 0.046) although not with the magnitude of subsequent regression. Patients may need at least 10 months of follow-up to achieve a stable refraction and level of haze. These observations suggest a need for improved understanding of corneal wound healing following PRK and of biologic factors that may contribute to variability in outcomes.     

A prospective, randomized comparison of the use versus non-use of topical corticosteroids after laser in situ keratomileusis.

OBJECTIVE: To evaluate the benefit and safety of topical corticosteroids after laser in situ keratomileusis (LASIK). DESIGN: Prospective, randomized, double-masked clinical trial. PARTICIPANTS: A consecutive series of 1747 eyes in 897 patients desiring surgical correction of myopia from plano to -16 diopters (D) with up to 6 D of astigmatism. INTERVENTION: Patients were randomly assigned to topical corticosteroids or artificial tears. MAIN OUTCOME MEASURES: The primary outcome measure was stability of refraction. Secondary outcome measures were differences in best-corrected visual acuity, decrease in spherical refractive myopia, improvement in uncorrected visual acuity, predictability of achieved corrections versus planned corrections, evaluation of postoperative haze, preservation of best-corrected visual acuity, intraocular pressure, and incidence of complications and adverse events. RESULTS: No difference was found between the groups for refractive accuracy, best-corrected or uncorrected visual acuity, or safety. Topical corticosteroids were associated with a prolonged period of refractive regression in moderate to high myopes (-7.25 to -16.00 D) (P = 0.01). Increased haze was noted at the 1 week examination for eyes not receiving topical steroids (P = 0.008); however, in most cases this was clinically insignificant. Thirty-six eyes (2.1%) required supplemental topical corticosteroids unrelated to reoperation. Two eyes received these on the first postoperative day and 15 at the 1-week examination. CONCLUSIONS: Topical corticosteroids did not seem to play any beneficial role in routine postoperative treatment after LASIK, and they were associated with decreased stability of refraction in more highly myopic eyes. Eyes that require additional topical corticosteroids are easily identified at either the initial postoperative examinations or during the course of routine postoperative care.     

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.     

Epi-LASIK治疗中高度近视术后视觉质量的临床研究

目的:研究机械法准分子激光角膜上皮瓣下磨镶术(Epi-LAS1K)矫治中、高度近视对视觉质量的影响。方法:回顾分析采用Epi-LAS1K手术矫治中、高度近视并随访1a的病例128例256眼的临床资料。患者根据术前等效球镜分为3组:A组:<-3.00D,均值-2.11±0.35D(30例60眼);B组:-3.00D～-6.00D,均值-4.93±0.68D(46例92眼);C组:>-6.00D,均值-8.45±1.62D(52例104眼)。手术采用美国AMO公司AmadeusⅡ自动角膜板层刀制作上皮瓣,以德国ZEISS公司MEL80型准分子激光仪进行激光切削,术后配戴绷带式角膜接触镜7d,术后随访时间为1,7d;1,3,6mo;1a,研究术后视力和屈光状态、高阶像差及haze形成情况。结果:术后随访1a,A组58眼(97%)的UCVA>1.0,B组87眼(95%)的UCVA>1.0,C组89眼(86%)的UCVA>1.0;A组60眼(100%)等效球镜屈光度数在预期值的±1.00D内,B组92眼(100%)等效球镜屈光度数在预期值的±1.00D内,C组7眼(7%)等效球镜屈光度数大于预期值的±1.00D。术后高阶像差较术前增大(P<0.05),B组与C组各时间点与A组相比无统计学意义。A组术后1mo有3眼(5%)的患者有0.5级haze,术后3mo有1眼(2%)的患者有0.5级haze,术后6mo到1a,所有患者均无明显haze;B组术后1mo有6眼(7%)的患者有0.5级haze,术后3mo有4眼(4%)的患者有0.5级haze,术后6mo～1a,所有患者均无明显haze;C组术后1mo有10眼(10%)的患者有0.5级haze,2眼(2%)的患者有Ⅰ级haze,术后3mo有8眼(8%)的患者有0.5级haze,2眼(2%)的患者有Ⅰ级haze,术后6mo有5眼(5%)的患者有0.5级haze,术后1a所有患者均无明显haze。结论:Epi-LAS1K手术术后具有视力恢复满意,haze程度轻等优点,是治疗中、高度近视的一种安全、有效的手术方式。     

LASEK治疗中高度近视疗效分析

目的:观察准分子激光上皮瓣下角膜磨镶术(LASEK)治疗中高度近视的临床效果。方法:对46例85眼中度以上近视进行LASEK矫正,根据等效球镜度分为I组(-3.25～-6.00)D、II组(-6.25～-10.00)D、III组(-10.25～-12.9)D。观察术后裸眼视力和最佳矫正视力、显然屈光度、眼压及haze情况。术后随访6mo以上。结果:术后6mo时裸眼视力达到术前最佳矫正视力或更好者3组分别为100%,78%,75%,裸眼视力≥0.5分别为100%,96%,88%,未见最佳矫正视力较术前最佳矫正视力低于2行以上的眼;3组的屈光度稳定在±1.00D内者分别为68.4%,58.0%,43.7%;3组的平均屈光度分别为(-0.38±0.66)D、(-0.77±1.25)D、(-1.25±1.97)D。II组和III组术后发生不同程度的haze(≤2级)。结论:LASEK治疗中高度近视安全有效。haze和屈光回退是治疗高度和超高度近视主要并发症,从某种角度说,控制了haze的发生也就在很大程度上控制了术后的屈光回退的速率。     

Corneal haze among blue eyes and brown eyes after photorefractive keratectomy

BACKGROUND: To compare the incidence and severity of corneal haze after photorefractive keratectomy (PRK) among white patients with blue eyes and Saudi patients with brown eyes. DESIGN: Retrospective, nonrandomized, comparative trial. PARTICIPANTS: A total of 150 patients (71 females and 79 males) were included in this study. Two hundred sixty-six eyes of 150 patients were subjected to PRK. One hundred blue eyes of 50 white patients and 166 brown eyes of 100 Saudi patients were included in this study. METHODS: Two hundred sixty-six eyes of 150 patients were subjected to PRK with the Chiron Technolas Keracor 117C for the correction of myopia and astigmatism. MAIN OUTCOME MEASURES: All patients had complete ophthalmologic examinations, visual acuity testing, intraocular pressure, pachymetry, corneal haze assessment (0-4+), and computerized corneal topography. RESULTS: There were 266 eyes of 150 patients with 100 blue irides and 166 brown irides. The spherical equivalent was -0.50 diopter (D) to -8.75 D. The mean postoperative spherical equivalent at 6 months was -0.063 D (standard deviation [SD], +/-0.595) in blue eyes compared to -0.28 D (SD, +/-0.683) in brown eyes (P = 0.006). Ninety-five (95%) of 100 of the blue eyes achieved +/- 1 D of attempted correction compared to 148 (89.2%) of the 166 brown eyes. All patients with blue eyes had a visual acuity of 20/30 or better compared to 153 (92.2%) of the 166 brown eyes (P = 0.009). Forty-eight (18.04%) eyes had minimal to mild haze, 3 (1.12%) eyes had moderate haze, and 2 (0.75%) eyes had severe haze. The incidence of corneal haze among brown eyes was 48 (28.9%) of 166 eyes compared to 5 (5%) of 100 in blue eyes (P < 0.001). The difference remained significant after adjustment for age and gender with a P value of 0.0283. The relative risk for developing haze in brown eyes was found to be 7.72. CONCLUSION: The incidence of corneal haze after PRK was significantly higher among Saudi patients with brown irides than among white patients with blue irides. This suggests that racial factors may play a role in the development of corneal haze.     

近视患者LASIK术后夜间眩光的相关因素

目的:探讨近视患者LASIK术后发生夜间眩光的术前相关因素。方法:将665例(1257眼)近视患者按屈光度分为两组:组Ⅰ(低、中度近视)-1.00～-6.00D;组Ⅱ(高度近视)-6.25～-14.25D。以ObscanⅡ眼前节分析系统测量术前暗光下瞳孔直径,所有手术均为标准的LASIK手术,术后3mo调查患者夜间眩光情况。结果:低、中度近视组术前暗光下瞳孔直径6.81±0.50mm,高度近视组6.98±0.57mm,两组差异有显著性(P=0.001)。低、中度近视组58眼(7.9%)发生夜间眩光,高度近视组为137眼(26.2%),两组差异有显著性(P=0.000)。低、中度近视组发生眩光眼和无眩光眼在术前暗光下瞳孔直径上差异有显著性(P=0.000),拟矫正屈光度上差异无显著性(P=0.104);高度近视组在暗光下瞳孔直径和拟矫正屈光度上差异均具有显著性(P=0.001,0.002)。结论:LASIK术后夜间眩光与术前暗光下瞳孔直径有关,高度近视患者也与拟矫正屈光度有关。