飞秒激光角膜屈光手术后视觉质量

目前飞秒激光在角膜屈光手术的应用主要有两类,飞秒激光制作角膜瓣联合基质面行准分子激光切削(FS-LASIK)以及全飞秒激光手术;后者可分为飞秒激光基质透镜切除术(FLEx)和飞秒激光小切口基质透镜切除术(SMILE).本文回顾了与传统LASIK相比,FS-LASIK手术后裸眼视力、矫正视力、安全指数、有效指数的差别,FS-LASIK术后对比敏感度、高阶像差等客观视觉质量以及主观视觉质量问卷的影响;与FS-LASIK相比,FLEx对术后裸眼视力、波前像差等客观视觉质量以及主观满意的影响;并对三种手术方式的术后的安全性、有效性、可预测性以及在角膜知觉方面的优缺点进行综述.     

飞秒激光在眼屈光手术中的应用

飞秒激光的光致分解作用允许在角膜组织内任意位置进行精确切削。可用于角膜基质内切割、制作角膜基质环植入的切口、准分子激光原位角膜磨镶术中制作角膜瓣、完成飞秒激光角膜磨镶术,是一种全新的屈光不正矫正方法。     

飞秒激光在角膜屈光手术应用中的并发症

飞秒激光是一种以脉冲发射的低能量红外线激光,具有切削精确、安全性高、重复性好等特点,可用于角膜屈光手术中制作角膜瓣、角膜基质内切割、制作角膜切口等。尽管飞秒激光的应用使得角膜屈光手术更加安全,但仍然存在一些不容忽视的并发症,本文就飞秒激光在角膜屈光手术中的并发症作一综述。     

飞秒激光在基质内屈光手术中的应用

飞秒（10^-15S）激光经证实可以有效的降低切割组织所需的能量并可减少对周围组织的损伤。该激光系统的灵活性使得它不仅可以完成传统的角膜基质内手术,而且可以进行新的角膜屈光手术。本研究就其机制、手术方法和过程、并发症等方面做一综述。     

飞秒激光用于角膜屈光手术应注意的问题

虽然大量的临床数据显示飞秒激光辅助下角膜屈光手术治疗屈光不正安全、可靠,但尚需在视觉质量上与常规方法相比较来证实。在飞秒激光角膜屈光手术中合理选择手术适应证,注意操作要点,个性化选择手术方案,防范并发症的发生是提高患者视觉质量的重要前提。（眼科, 2014, 23： 289-291）     

Comparison of visual acuity, refractive results and complications of femtosecond laser with mechanical microkeratome in LASIK

AIM:To compare the outcomes of laser in situ keratomileusis (LASIK) performed with a femtosecond laser (Femtec, Technolas Perfect Vision GmbH, Germany) versus a mechanical microkeratome (Hansatome, Bausch and Lomb, USA) for the correction of myopia and astigmatism.METHODS: In this retrospective study, patients who had undergone LASIK using the 80-kHz Femtec femtosecond laser were compared to age- and refraction-matched patients in whom the Hansatome microkeratome was used. Refractive and visual results 1 month and 3 months postoperatively, and complication rates were compared between the two groups.RESULTS:A total of 280 eyes were analyzed (140 in each group).At 3 months postoperatively in the Femtec vs Hansatome group, spherical equivalent refraction was within ±1.00D of emmetropia in 140 vs 138 eyes (P=0.498), the cylinder was within ±0.50D in 137 vs 139 eyes (P=0.622), and the UDVA was 20/20 or better in 136 vs 137 eyes (P=0.724), respectively. There was no statistically significant difference in the complication rates between the two groups (P=0.099).CONCLUSION:LASIK performed both with Femtec femtosecond laser and Hansatome microkeratome achieved satisfactory refractive and visual results at 3 months postoperatively, without significant differences in efficacy, safety, and complication rates between the two procedures.     

In vivo corneal confocal microscopy comparison of intralase femtosecond laser and mechanical microkeratome for laser in situ keratomileusis

PURPOSE: To assess and compare corneal modifications induced by IntraLase PulsionFS femtosecond laser and mechanical microkeratome Hansatome for laser in situ keratomileusis (LASIK) using the new-generation Heidelberg Retina Tomograph II (HRT II)/Rostock Cornea Module confocal microscope. METHODS: In this case-control study, 24 eyes of 12 patients were examined with the HRT II in the follow-up of IntraLase femtosecond laser for LASIK myopic surgery. Twenty eyes of 10 patients were also examined after microkeratome Hansatome-LASIK surgery. In both groups, the patients underwent the first follow-up examination on day 7 and the last 12 months after surgery. Morphologic modifications of corneal architecture were evaluated, and comparisons were made between the two flap-formation techniques. RESULTS: Evaluation of both groups on day 7 showed keratocyte transformation, most likely related to cellular activation beneath the interface. The flap margin after the IntraLase technique appeared microscopically as a clear-cut edge that included the epithelial plug. At month 2, secondary fibrosis, adjacent to the still well-defined IntraLase flap edge, was observed. This reaction diminished with time, leaving a fibrotic scar adjacent to a wound constriction originating from the surrounding stroma. The flap margin of the mechanical microkeratome had the appearance of a less clearly identified fibrotic scar with no epithelial plug. CONCLUSIONS: This study reveals morphologic similarities between the interfaces obtained by femtosecond laser and mechanical microkeratome, probably because the same excimer laser performed the photoablation. However, the IntraLase flap margin showed greater fibrotic scarring than that induced by the mechanical microkeratome.     

飞秒激光和机械刀行LASIK术后角膜神经形态学特征的共焦显微镜观察

目的在共焦显微镜下观察飞秒激光和机械刀行准分子激光原位角膜磨镶术（LASIK）术后角膜神经的形态差异。方法近视眼患者34例（68只眼）,一组行飞秒激光下的LASIK（28只眼）,另一组行Moria-2机械刀下的LASIK（40只眼）,术后1个月、3个月对两组角膜在共焦显微镜下进行观察。结果术后各时期两组裸眼视力无显著性差异,术后1个月两组角膜瓣界面均可见高反光颗粒,未见完整神经纤维,术后3个月,飞秒激光组角膜神经完整性明显高于机械刀组（P〈0.01）。结论飞秒激光行LASIK术后角膜神经的修复快于机械刀。     

飞秒激光和角膜板层刀行LASIK术后视觉质量及角膜瓣的比较

目的:对比分析飞秒激光和角膜板层刀行准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)术后患者的视觉质量及角膜瓣变化。方法:选取2009-03/2012-03将接受飞秒激光35例70眼患者和接受角膜板层刀的患者45例90眼进行对比研究,两组术后视觉质量和角膜瓣进行对比。结果:视觉质量比较:两组患者所行的手术均有显著的可预测性、有效性及安全性,且术后像差和对比敏感度及视力差异不显著,组间差异无统计学意义(P>0.05);角膜瓣比较:两组患者在水平方向的角膜瓣厚度组间差异无统计学意义(P>0.05)。结论:飞秒激光和角膜板层刀行LASIK术后具有良好的视觉效果,且角膜瓣厚度差异不显著,值得临床推广使用。     

全程飞秒激光屈光手术的研究进展

应用飞秒激光实施全部屈光性切削步骤的全程飞秒激光屈光手术已逐步应用于临床,可用于矫治包括近视、远视、散光和老视在内的所有屈光手术,其矫治效果已得到初步验证.随着飞秒激光技术的不断发展和飞秒激光系统设备的进一步普及,全程飞秒激光屈光手术将具有广阔的应用前景.     

全程飞秒激光屈光手术的研究进展

应用飞秒激光实施全部屈光性切削步骤的全程飞秒激光屈光手术已逐步应用于临床,可用于矫治包括近视、远视、散光和老视在内的所有屈光手术,其矫治效果已得到初步验证.随着飞秒激光技术的不断发展和飞秒激光系统设备的进一步普及,全程飞秒激光屈光手术将具有广阔的应用前景.     

飞秒激光制瓣与机械板层刀制瓣的LASIK术后临床疗效的比较

目的：比较飞秒激光制瓣的LASIK(Femto-LASIK)与经典的机械板层刀制瓣的准分子激光原位角膜磨镶术两种手术方式矫治近视患者的安全性、有效性及术后视觉质量的区别。

方法：回顾性病例对照研究,选取2016-07/2017-06在襄阳市中心医院飞秒激光中心进行板层刀制瓣-LASIK(62例124眼)或Femto-LASIK(58例116眼)手术的近视患者120例240眼。测量两种不同制瓣术式中制作的角膜瓣厚度以及术后视力、屈光状态及角膜地形图参数和像差等并进行比较。

结果：所有患者角膜瓣均制作成功,并且都顺利地完成了手术,术中及术后无明显的并发症发生。术后两组间患者的裸眼视力、屈光度差异无统计学意义(P>0.05)。术中Femto-LASIK组制作的角膜瓣厚度与预设差值小于板层刀制瓣-LASIK组(t=26.67,P<0.01),且球差、彗差和总高阶像差增幅均小于板层刀制瓣-LASIK组(t=-4.16、-4.92、-22.19,均P<0.01)。板层刀制瓣-LASIK组和Femto-LASIK术后角膜表面规则指数(SRI)分别为0.31±0.09、0.25±0.04,二者比较差异有统计学意义(t=6.59,P<0.01)。

结论：飞秒激光制作角膜瓣比板层刀制瓣较为精确,并且术后角膜的像差相对较小,飞秒激光制瓣可提供相对较好的视觉质量,但是这两种制瓣方式术后患者的裸眼视力和屈光状态无明显差异。     

飞秒激光与机械板层刀制瓣LASIK对眼表的影响

目的：探讨飞秒激光与机械板层刀制瓣准分子激光角膜磨镶术(LASIK)对眼表的影响,研究制瓣方法不同对术后眼表的影响。

方法：本研究纳入对象选择2016-01/2017-01于我院眼科进行屈光手术治疗的218例436眼近视患者,进行病历资料回顾性分析,所有患者均采用LASIK术治疗,术后主诉有不同程度的眼干、异物感及不适症状。将采用机械板层刀制瓣的61例122眼患者设为对照组,观察组采用飞秒激光制瓣的157例314眼设为观察组。比较两组患眼术前、术后1wk,1、3mo干眼症状评分,角膜荧光素染色(FL)评分、泪膜破裂时间(BUT)以及基础泪液分泌试验(SⅠt)。

结果：两组患者术前干眼症状评分差异无统计学意义(P>0.05),手术前后两组患者干眼症状评分比较差异有统计学意义(P<0.05),术后1wk,对照组干眼症状评分大于观察组,两组患者干眼症状评分差异有统计学意义(P<0.05),术后1、3mo,两组干眼症状评分差异无统计学意义(P>0.05)。术前两组患者BUT比较差异无统计学意义(P>0.05),两组患者手术前后BUT差异有统计学意义(P<0.05),对照组术后BUT显著低于观察组,差异有统计学意义(P<0.05)。术前两组患者FL评分比较差异无统计学意义(P>0.05),两组患者手术前后FL评分差异有统计学意义(P<0.05),对照组术后1wk,1mo FL评分显著高于观察组,差异有统计学意义(P<0.05),术后3mo两组患者FL评分差异无统计学意义(P>0.05)。术前两组患者SⅠt比较,差异无统计学意义(P>0.05),两组患者手术前后SⅠt评分差异有统计学意义(P<0.05),对照组术后1wk,1mo SⅠt显著低于观察组,差异有统计学意义(P<0.05),术后3mo两组患者SⅠt比较,差异无统计学意义(P>0.05)。两组患者术后均无严重的并发症发生。

结论：飞秒激光较机械板层刀制瓣LASIK对眼表影响更小,干眼症症状更轻,影响时间更短。     

Effect of age on visual and refractive results after LASIK: mechanical microkeratome versus femtosecond laser

AIM: To evaluate the effect of age on visual and refractive results after laser in situ keratomileusis (LASIK) obtained with a mechanical microkeratome or a femtosecond laser. METHODS: Retrospective, nonrandomized, cohort study. A total of 3826 eyes were included in the study (1725 eyes treated with mechanical LASIK and 2101 eyes treated with femtosecond LASIK). The relationship between patient age and the 3-month postoperative visual and refractive results of both procedures were analyzed by linear regression analysis. RESULTS: Three months postoperatively, we found a significant correlation between age and the postoperative spherical equivalent (SE; r2=0.004, P=0.006), efficacy (r2=0.006, P=0.001), and safety indexes (r2=0.05, P=0.0001) in the mechanical LASIK group. On the other hand, we found a significant correlation between age and the postoperative SE (r2=0.02, P=0.0001) and the efficacy index (r2=0.01, P=0.0001) but not the safety index in the femtosecond laser group. Mechanical LASIK provided slightly but significantly better efficacy and predictability in patients 18 to 40 years of age and femtosecond LASIK did so in patients older than 40 years of age. The femtosecond laser provided better safety results than the mechanical microkeratome in both age groups. CONCLUSION: A tendency toward undercorrection and less predictability is found with aging after myopic LASIK regardless of whether the flap was created with a mechanical microkeratome or a femtosecond laser. However, femtosecond laser provides significantly better outcomes in terms of efficacy, safety and predictability compared to mechanical microkeratome for the correction of myopia in patients over 40y.     

Comparison of the IntraLase femtosecond laser and mechanical microkeratome for laser in situ keratomileusis

PURPOSE: To compare clinical outcomes between the IntraLase femtosecond laser and the mechanical microkeratome for creating flaps during laser in situ keratomileusis. DESIGN: Nonrandomized clinical trial. METHODS: The study involved a total of 55 eyes of 30 patients, with 27 eyes of 16 patients comprising the microkeratome group and 28 eyes of 14 patients comprising the IntraLase group. Refractive errors, visual acuity, higher-order aberrations, contrast sensitivity, and corneal sensitivity were compared between the two groups. RESULTS: There were no statistically significant differences between the two groups in terms of refractive errors and postoperative uncorrected visual acuity. There was no loss of best-corrected visual acuity in either group. The higher-order aberrations were similar in both groups (P > .05), except for spherical aberration, which was greater in the microkeratome group (P < .05). In the IntraLase group, the contrast sensitivity value at 12 and 18 cycles per degree under mesopic conditions was significantly improved at three months postoperatively (P < .05). The IntraLase group showed faster corneal sensitivity recovery compared with the microkeratome group, and corneal sensitivity in the peripheral area was nearly normalized at three months postoperatively in the IntraLase group. CONCLUSIONS: The femtosecond laser may have advantages over the microkeratome in the flap-making procedure. However, the IntraLase femtosecond laser failed to have significant superiority over the mechanical microkeratome in clinical outcomes, except for faster recovery of corneal sensation, lesser degree of spherical aberration, and some contrast sensitivity value.     

飞秒激光与角膜板层刀制作角膜瓣的厚度及形态比较

目的应用前节光学相干断层扫描仪（OCT）,比较WaveLight FS200飞秒激光与Moria M2 90角膜板层切开刀制作角膜瓣的厚度及形态特点。方法前瞻性病例对照研究。对61例行双眼准分子激光原位角膜磨镶术（LASIK）的近视患者分别采用WaveLight FS200飞秒激光制瓣（WaveLight组,36例）和Moria M2 90角膜板层切开刀制瓣（Moria组,25例）。术后1周,采用Visante 前节OCT测量180°、90°、45°、135°轴位上距离角膜顶点0、±2、±3.5 mm处的角膜瓣厚度。运用独立样本t检验对2组数据进行统计学分析。结果WaveLight组中央角膜瓣厚度为（105.53±5.86）µm,而Moria组为（132.96±13.91）µm（t=-13.16,P<0.01）。WaveLight组中央角膜瓣精确度为（6.17±3.98）µm,而Moria组为（23.60±12.64）µm（t＝-15.20,P<0.01）。WaveLight组角膜瓣均匀性指数为（4.07±0.94）µm,Moria组为（8.48±2.35）µm（t＝-12.60,P<0.01）。WaveLight组角膜瓣的对称性指数[（33.81±11.28）µm]明显小于Moria组[（68.46±26.66）µm],差异有统计学意义（t＝-8.67,P<0.01）。结论前节OCT显示WaveLight FS200飞秒激光制作的角膜瓣与Moria M2 90角膜板层切开刀相比,中央厚度更精确、重复性更好,角膜瓣形态更均匀。