准分子激光上皮瓣下角膜磨镶术治疗近视的疗效观察

目的:评价准分子激光上皮瓣下角膜磨镶术(LASEK)治疗近视的疗效观察。方法:应用日本产。NIDEK EC-5000型准分子激光机对78眼不同程度近视(-1.50-12.00D)行LASEK治疗,术后3-12个月对视力、屈光度及角膜雾样混浊(Haze)进行随访。结果:术后3～12个月96.2％裸眼视力均达到0.5以上,≥1.0者达92.3％,78眼最后一次复查屈光度在±1.00D以内者为74眼,Ⅱ级Haze者为4眼。结论:LASEK是治疗近视的安全有效的方法之一,但尚需临床进一步随访、观察,及基础理论的研究。     

准分子激光上皮瓣下角膜磨镶术36眼探讨

目的　目的探讨准分子激光上皮瓣下角膜磨镶术 (LASEK)治疗近视的临床效果。方法　应用Keracor 2 17z准分子激光对 3 6眼不同程度的近视 ( -2 .0 0D～ -14 .0 0D)行LASEK治疗 ,术后随访 5月。结果　 94.44 %术后裸眼视力达到或超过术前最佳矫正视力 ,88.89%术后屈光度在± 1.0 0D之间 ,术中术后无严重并发症。结论　LASEK治疗近视安全有效。但治疗参数和制作上皮瓣的技巧有待于进一步的改进和探讨     

准分子激光上皮瓣下角膜磨镶术的角膜上皮瓣异常

目的　探讨准分子激光上皮瓣下角膜磨镶术 (laserepithelialkeratomileusis ,LASEK)角膜上皮瓣异常的类型和相关原因 ,总结保护角膜上皮瓣完好的技术和重要性。方法　在行LASEK的16 7例 (30 9只眼 )患者中 ,对在术中和术后出现不同类型角膜上皮瓣异常的 9例患者 (14只眼 )进行相关原因分析 ,并观察术后视力、角膜雾状混浊和角膜刺激症状的程度。平均随访时间 (6 1± 3 7)个月。结果　LASEK术中和术后角膜上皮瓣异常表现为上皮瓣游离、溶解、碎片、皱褶、滑动 ,以及术后4 8～ 72h迟发性角膜上皮瓣局限缺损和存留穿透上皮层异物。角膜上皮瓣异常的发生与微环钻切角膜上皮过浅、角膜上皮瓣预制环过小、酒精溶液浓度不当、溶液预置渗漏、角膜上皮瓣中心区干燥、冲洗性角膜上皮损害、角膜接触镜过早取出等因素有关。术后平均残余屈光度数为 0 0 7D。结论LASEK虽具有较好的安全性和有效性 ,但完好的角膜上皮瓣是LASEK优越性的基础 ,把握手术环节 ,避免角膜上皮瓣发生异常 ,是保证LASEK成功的关键     

经上皮准分子激光角膜切削术和准分子激光上皮瓣下角膜磨镶术治疗中低度近视术后早期疗效观察

目的对比经上皮准分子激光角膜切削术(Trans PRK手术)和准分子激光上皮瓣下角膜磨镶术(LASEK术)两种手术方式治疗中低度近视早期的疗效差异。方法收集2017年5月至2018年1月之间在我院行表面切削手术的患者共156例。观察术前及术后3个月内患者的上皮愈合时间、眼部疼痛评分、裸眼视力、最佳矫正视力、屈光度及角膜像差变化。结果采用SPSS19. 0统计软件进行统计学分析。结果 Trans PRK组角膜上皮愈合时间为(2. 98±1. 02) d。LASEK组为(4. 03±1. 22) d。两组间差异有统计学意义(P <0. 05)。视力方面,两组患者术后视力逐渐提高,Trans PRK组术后1周裸眼视力为0. 8±0. 13,LASEK组为0. 8±0. 26。术后1周时两组患者视力与术前差异有统计学意义(P <0. 05)。Trans PRK组与LASEK组术后1个月和3个月屈光度变化组间差异无统计学意义(P> 0. 05)。Trans PRK组与LASEK组患者术后角膜球差及高阶像差相比各自术前均有升高,差别有统计学意义(P <0. 01)。两组间相比,术后1个月和3个月慧差及高阶像差差别有统计学意义(P <0. 05)。两组患者术后3 d内疼痛评分均逐日降低差异无统计学意义(P> 0. 05)。结论 Trans PRK手术相对于传统LASEK手术角膜上皮愈合时间更快,术后角膜像差更小。     

准分子激光上皮瓣下角膜磨镶术治疗近视临床观察

目的探讨准分子激光上皮瓣下角膜磨镶术（LASEK）治疗近视的临床效果。方法将符合入选标准的病例按屈光度分为2组：组Ⅰ74只眼（等效球镜-2.375～-6 D）及组Ⅱ65只眼（等效球镜-6.25 D～-11.75 D）,术前及术后6个月应用日本NIDEK公司ARK-10000对患者行角膜地形图检查,结合综合验光结果、眼压等进行统计学分析。结果 LASEK术后6个月裸眼视力≥0.8者占99.28%,裸眼视力≥1.0者占95.62%。组Ⅰ和组Ⅱ中分别有4只眼（5.4%）、6只眼（9.2%）的术后裸眼视力（UCVA）较术前最佳矫正视力（BCVA）下降1行,而组Ⅱ中仅有1只眼（1.5%）下降2行,组Ⅰ和组Ⅱ视力改善无显著差异（χ2=1.37,P〉0.05）。LASEK术后眼压稳定,而模拟角膜镜读数（S im K）、角膜表面规则性指数（SR I）及角膜表面非对称性指数（SAI）均较术前变化显著（P〈0.05）。结论 LASEK是手术治疗近视的一种安全、有效、稳定的方法。     

准分子激光上皮瓣下角膜磨镶术矫治薄角膜近视临床分析

目的探讨准分子激光上皮瓣下角膜磨镶术(LASEK)矫治薄角膜近视的安全性、有效性、稳定性和预测性。方法10例(19眼)相对薄角膜近视患者行LASEK。术前近视等效球镜为-2.875～-11.125D,平均(-6.404±2.311)D;术前角膜厚度466～506μm,平均(491.32±9.67)μm,术后随访6个月以上,最长12个月。结果术中无严重并发症,术后最佳矫正视力与术前相比无一例下降。术后等效球镜平均(-0.053±0.407)D,其中17眼(89.5%)在-0.5D～ 0.5D之间,角膜厚度平均(417.47±18.91)μm。1.00D的近视屈光度的改变实际需要切削角膜厚度为11.63μm。结论LASEK对于薄角膜近视治疗安全、有效、稳定、可预测,可作为薄角膜中高度近视的首选术式。     

准分子激光上皮瓣下角膜磨镶术后上皮瓣丢失二例

例1男，22岁，因双眼近视，于2002年9月2日在我院行双眼准分子激光上皮瓣下角膜磨镶术(1aser epithelial keratomileusis，LASEK)术。术前矫正视力：右眼1．2(-3．75DS)，左眼1．2(-4．00DS)，无其他眼部疾患。术中按常规LASEK步骤进行，上皮瓣制作复位满意。术后次日上午复诊诉夜间右眼疼痛明显，左眼无特殊不适。裂隙灯     

准分子激光上皮瓣下角膜磨镶术治疗近视散光

目的　探讨准分子激光上皮瓣下角膜磨镶术 (LaserSubepithelialKeratomileusis ,LASEK)治疗近视散光的疗效。方法　 2 2 5例 42 3眼行LASEK术 ,术前裸眼视力 (UncorrectedVisualAcuity ,UCVA) 0 0 1～ 0 8,平均 0 2± 0 16,最佳矫正视力 (BestCorrectedVisualAcuity ,BCVA )0 5～ 1 5 ,平均 1 14± 0 18。术前近视度数 -0 2 5～ -10 75D ,平均 -4 2 2± -1 88D ,散光度数 -0 2 5～ -5 0 0D ,平均 -1 0 4± -0 74D。随访 3～ 12月。结果　术后裸眼视力 0 2～ 1 5 ,平均 1 0 6± 0 18。术后 3 89眼 ( 92 % )有轻度不适。术后 2 1眼出现haze ,0 5级 15眼 ,1 0级 4眼 ,2 0级 2眼。结论　LASEK兼具了PRK和LASIK的优点 ,无严重并发症 ,手术预测性好 ,是一种安全、有效的屈光手术     

准分子激光角膜原位磨镶术治疗中低度近视572例

1　资料与方法1.1　一般资料　我院 1999～ 2 0 0 2年应用准分子激光角膜原位磨镶术 ( laser in situ keratomileusis,L ASIK )治疗 5 72例中低度近视 ,其中男 2 36例 36 0眼 ,女 336例 5 2 8眼 ;年龄18～ 4 6岁 ,平均 ( 2 8.4± 6 .6 )岁 ;托品酰胺散瞳检影及电脑验光 ,屈光度 (等值球镜 ,下同 ) - 2 .0 0～ - 6 .0 0 D,平均 -4 .6 7D± 0 .93D;其中近视散光≥ 0 .5 0 D者 5 88眼 ( 6 6 .2 % ) ,散光度 - 0 .5 0～ - 1.75 D,平均 - 0 .91D± 0 .38D;术前矫正视力全部≥ 1.0。所有患者的屈光度数均稳定 2 a以上。常规术前检查 ,排除圆…     

准分子激光角膜上皮瓣下磨镶术的临床观察

目的 观察准分子激光角膜上皮瓣下磨镶术（LASEK）治疗近视眼的临床效果。方法：选择术后随访达到6个月的146例（280眼），观察术后3天、10天，1、2、3、6个月的症状、视力、屈光状态、角膜并发症情况。结果 观察Nidek EC-5000准分子激光治疗结果表明，LASEK术后症状轻微，手术稳定性、预测性及安全性优于准分子激光屈光性角膜切削术（PRK）及准分子激光原位角膜磨镶术（LASIK）。结论 LASEK手术有可能成为今后主要的屈光治疗方法。     

Factors Affecting Long-term Myopic Regression after Laser In Situ Keratomileusis and Laser-assisted Subepithelial Keratectomy for Moderate Myopia

PurposeHigh myopia is known to be a risk factor for long-term regression after laser refractive surgery. There have been few studies about the correction of moderate myopias that did not need retreatment after long-term follow-up. We evaluated 10 years of change in visual acuity and refractive power in eyes with moderate myopia after laser refractive surgery.MethodsWe included patients that had undergone laser in situ keratomileusis (LASIK) or laser-assisted subepithelial keratectomy (LASEK) to correct their myopia and that had at least 10 years of follow-up. We evaluated the stability of visual acuity in terms of safety, efficacy, and refractive changes at examinations 6 months and 1, 2, 5, 7, and 10 years after surgery.ResultsThe study evaluated 62 eyes (36 eyes in LASIK patients and 26 eyes in LASEK patients). In both groups, the efficacy index tended to decrease, and it was consistently higher in the LASEK group compared to the LASIK group over the 10 years of follow-up. The safety index improved over 10 years and was always higher than 0.9 in both groups. The difference between the spherical equivalent at 6 months postoperatively and later periods was statistically significant after 5, 7, and 10 years in both groups (LASIK, p = 0.036, p = 0.003, and p < 0.001, respectively; LASEK, p = 0.006, p = 0.002, and p = 0.001, respectively). Ten years after surgery,26 eyes (66.7%) in the LASIK group and 19 eyes (73.1%) in the LASEK group had myopia greater than 1 diopter. In comparison with the thickness at 6 months postoperatively, central corneal thickness was significantly increased after 5, 7, and 10 years in both LASIK and LASEK groups (LASIK, p < 0.001, p < 0.001, and p < 0.001, respectively; LASEK, p = 0.01, p < 0.001, and p < 0.001, respectively).ConclusionsModerately myopic eyes showed progressive myopic shifting and corneal thickening after LASIK and LASEK during 10 years of follow-up. We also found that early refractive regression may indicate the long-term refractive outcome.     

Higher Order Aberrations of the Corneal Surface after Laser Subepithelial Keratomileusis

Purpose

To evaluate the changes of higher order aberrations (HOAs) before and after laser subepithelial keratomileusis (LASEK) and to analyze the influence of tear film instability on HOAs of the corneal surface after LASEK.

Methods

In this cross-sectional study, 31 patients who underwent LASEK were divided into dry eye (16 patients, 32 eyes) and non-dry eye groups (15 patients, 30 eyes). Uncorrected distance visual acuity, spherical equivalent refraction, ablation depth, tear film parameters and Ocular Surface Disease Index (OSDI) questionnaire scores were evaluated in both groups. Total HOA root mean square (RMS), third-order coma, third-order trefoil and fourth-order spherical aberration (SA) of the corneal surface immediately and at 10 seconds after blinking were measured before and after surgery.

Results

The total HOA RMS, coma, trefoil and SA significantly increased after LASEK compared with preoperative values in both groups. In the dry eye group, total HOA RMS, coma and trefoil significantly increased except for SA at 10 seconds after blinking compared with those measured immediately after blinking. In addition, the changes of total HOA RMS, coma and trefoil were negatively correlated with tear film break-up time (R = -0.420, -0.473 and -0.439, respectively), but positively correlated with OSDI score (R = 0.433, 0.499 and 0.532, respectively). In the non-dry eye group, there were no significant differences between HOAs measured at 10 seconds after blinking and those measured immediately after blinking.

Conclusions

The HOAs including coma, trefoil and SA significantly increased after LASEK. The tear film instability in the dry eye can be associated with more deterioration of the optical quality after LASEK, due to more significant increase of total HOA RMS, coma and trefoil.     

Factors Affecting Myopic Regression after Laser in Situ Keratomileusis and Laser-Assisted Subepithelial Keratectomy for High Myopia

To evaluate the factors affecting the amount of myopic regression after laser refractive surgery for high myopia, we retrospectively reviewed medical records of 1591 eyes with high myopia treated by laser in situ keratomileusis or laser-assisted subepithelial keratectomy at Shandong Eye Hospital between January 2008 and December 2012. Thirty-five eyes suffering a postoperative myopic shift of manifest spherical equivalent (MSE) of 0.25 diopter (D) or greater were included in this study. The mean refractive error was ?9.34 ± 1.89 D before surgery, and the mean regression was ?1.22 ± 0.70 D. Correlation analysis and multiple regression analysis were performed to assess the factors that were associated with the refractive regression. The age displayed a negative correlation with the diopter of regression (R = ?0.404, P = .016), while the optical zone diameter had a positive correlation with it (R = 0.406, P = .016). Explanatory variables relevant to the diopter of regression were age (partial regression coefficient B = ?0.045, P = .016) and optical zone diameter (partial regression coefficient B = 0.979, P = .014). Advanced-age patients with small optical zones were more predisposed to a larger amplitude of regression after laser refractive surgery for high myopia.     

准分子激光上皮下角膜磨镶术治疗近视

目的 :研究保留角膜上皮的准分子激光上皮下角膜磨镶术治疗近视早期临床疗效。方法 :2 0例 3 7眼术前近视屈光度平均 -2 48± 1 14D (-1 2 5～ -8 0D) ,采用 2 3 %酒精浸泡 3 0秒制作角膜上皮瓣 ,激光切削采用Chiron117准分子激光系统。结果 :术后平均视力 :1周 0 92± 0 14 ,1月 1 2 8± 0 2 0 ,3月 1 2 5± 0 18。术后 3月角膜Haze 0级 2 8眼 ,0 5级 9眼。术后第 1天疼痛分级 :0级 12眼 (3 2 4% ) ,Ⅰ级 18眼 (4 8 2 % )、 >Ⅰ级 7眼 (19 4% )。结论 :准分子激光上皮下角膜磨镶术术后疼痛症状、角膜Haze明显减轻 ,但是疗效还需要长期观察及与PRK对比研究     

透明质酸钠对上皮下角膜磨镶术后角膜上皮愈合的影响

目的 :研究促进准分子激光上皮下角膜磨镶术治疗近视后角膜上皮早期愈合的方法。方法 :LASEK治疗 2 5例 48眼近视。术后随机分成 2组 ,A组 3 2眼术后早期应用透明质酸钠滴眼剂 (0 1%爱丽 ) ,B组 16眼作为空白对照组。结果 :术后第一天A组较B组疼痛症状轻 (P <0 0 5 ) ,术后 3月两组角膜Haze、裸眼视力没有差别 (P >0 0 5 )。A组术后角膜接触镜粘附细胞较少 ,B组角膜接触镜粘附较多角膜上皮细胞。结论 :透明质酸钠滴眼剂可以促进LASEK后角膜上皮细胞愈合 ,明显减轻术后疼痛症状而对角膜Haze、术后视力没有影响。     

大龄近视患者准分子激光原位角膜磨镶术分析

目的　探讨大龄近视患者LASIK疗效、特点及需要加以关注的问题。方法　对 88例(16 4眼 )大龄 (年龄≥ 4 0岁 )近视患者进行LASIK治疗 ,并对术前屈光度、预矫屈光度、手术疗效等进行统计分析。结果　行LASIK治疗的大龄近视患者术前屈光度 (球镜等量 ) :轻度近视 (≤ -3D) 5眼 ,占 3% ,中度近视 (>- 3D ,≤ - 6D) 2 8眼 ,占 17% ,高度近视 (>- 6D ,≤ - 10D) 4 2眼 ,占 2 6 % ,超高度近视 (>- 10D) 89眼 ,占 5 4 %。为保证角膜的安全性 ,2 0例 (2 2 73% ) 39眼(2 3 78% )术前设计的预矫屈光度需低于术前屈光度。术后裸眼视力 0 0 6～ 1 5 ,平均 0 78± 0 39,其中裸眼视力≥ 0 5者为 6 1眼 ,占 78 2 1% ,裸眼视力≥ 1 0者 2 5眼 ,占 32 0 5 %。结论　大龄近视患者行LASIK治疗以高度、超高度近视患者为主 ,术前角膜厚度的仔细测量、预矫屈光度数的确定、激光切削直径的选择对减少眩光以及术后屈光度数回退 ,提高术后视力、改善视觉质量至关重要。     

LASEK与LASIK治疗高度近视

目的:对比观察准分子激光上皮瓣下角膜磨削术(LASEK)与准分子激光原位角膜磨削术(LASIK)治疗高度近视的临床疗效。评估2种手术的安全性和有效性。方法:对行LASEK治疗的39例75只眼和同期行LASIK治疗的41例79只眼高度近视分别进行6个月以上的临床观察。结果:LASEK组术后1周至1个月达最佳矫正视力,术后3个月部分出现视力回退,术后6个月裸眼视力达术前矫正视力占95.83%,主要并发症有术后高眼压及Haze形成;LASIK组术后6个月裸眼视力达术前矫正视力占94.35%,主要并发症为屈光回退,角膜上皮内生或角膜瓣皱折等。结论:LASIK与LASEK均能安全、有效地矫正高度近视。     

准分子激光上皮下角膜磨镶术治疗高度近视

目的　观察准分子激光上皮下角膜磨镶术 (lasersubepithelialkeratomileusis ,LASEK)治疗高度近视的近期疗效。方法　LASEK治疗 18例 3 1眼高度近视 ,屈光度 -6 0D～ -10 0D ,随访 3～ 10月。结果　术后第 3月 (共 3 1眼 )角膜haze≤ 1级 2 7眼 (87 1% ) ,>1级 4眼 (12 9% ) ;裸眼视力 2 9眼 (93 5% )≥ 0 8,2 4眼 (77 4% )≥ 1 0。术后第 6月 (共 2 6眼 )角膜haze≤ 1级 2 4眼 (92 3 % ) ,>1级 2眼 (7 7% ) ;裸眼视力 2 3眼 (88 5% )≥ 0 8,2 0眼 (76 9% )≥ 1 0。结论　LASEK为治疗高度近视提供了一种新的方法 ,但是其长期的安全性、有效性和预测性有待进一步研究     

LASEK手术并发症的预防及处理

目的：探讨准分子激光上皮下角膜磨镶术(LASEK)手术并发症的预防及处理方法。方法：应用LASEK治疗近视131例258眼。结果：LASEK术中主要并发症有：酒精环错位，上皮瓣剥离困难，瓣撕裂或破碎，瓣游离、皱褶、瓣偏离中心、瓣蒂位置变更、LASEK转PRK等；术后并发症主要有迟发性48～72h上皮瓣局限性缺损、瓣下异物、角膜上皮下雾状混浊(haze)、上皮瓣丢失、最佳矫正视力下降、上皮瓣溶解、角膜感染等。结论：对LASEK技术的熟练掌握，把握手术环节，正确处理上皮瓣的各种并发症是LASEK手术成功的关键；LASEK是安全有效的。