准分子激光角膜屈光手术的现状

屈光不正是眼科的一种常见病。自从1983年PRK开始临床应用以来，准分子激光角膜屈光不正治疗手术在世界范围内得到迅速的普及和发展。特别是近十多年来，准分子激光角膜屈光手术从设备到技术经历了一个发展、完善和成熟的过程。准分子激光仪从初期的大光斑切削、多区切削，到目前的“飞点扫描”切削技术；板层角膜刀从手动发展到自动型；近年波前技术（Wavefront Technology）和非球面切削技术应用，使得准分子激光角膜屈光手术进入了新的发展阶段。现概述如下。     

准分子激光角膜屈光手术对不同类型屈光不正的矫治效果

目的 评价准分子激光角膜屈光手术对各种类型屈光不正的矫治效果。方法 使用Keratom-F/Schwind准分子激光治疗仪对3221只不同类型的屈光不正眼行角膜光学屈光切削术或角膜原位磨镶术。随访8个月到3年。比较术前术后裸高力变化程度和观察手术并发症种类及发生率。结果 全部3221只眼术后裸眼视力达到术前矫治最佳视力为76％,小于50％最佳矫正视力仅占0.4%。近视组术后裸眼视力达到术前最佳视力为77％,远视组30cm近视力为88.2%,散光组为53.8%。并发症总发生率0.34%,包括角膜雾浊、各种角膜瓣并发症、眼底出血、视网膜脱离。结论 准分子激光手术有效提高屈光不正眼的裸眼视力。绝大多数近视,远视,散光的患者经治疗后可以达到无需眼镜正常生活和工作的目的。准分子激光手术并发症少,是一种低风险屈光矫治手术。     

准分子激光屈光手术的研究进展

准分子激光屈光手术是近几年眼科领域的研究热点.笔者对准分子激光治疗屈光不正的原理、发展、过程、效果及进展作简要概括,并对准分子激光在治疗屈光不正方面的应用做相应展望.     

准分子激光角膜屈光手术后常见并发症的护理

准分子激光角膜屈光手术因具有安全性、有效性和可预测性等优点而广泛运用临床。近年来，随着准分子激光角膜屈光手术的普遍开展．其术后并发症也时有发生。我院近年实施准分子激光角膜屈光手术1248例，屈光度-1．3DS-14．0DS，经过精心的手术和护理效果满意。现将施行准分子激光角膜屈光手术常见并发症及护理体会报告如下。     

准分子激光角膜屈光手术与视觉质量

目的：探讨并分析近视患者行LASIK手术后出现夜间视觉质量下降的相关危险因素。     

武警某部新兵准分子激光角膜屈光手术后干眼症调查

目的对驻京某部准分子激光角膜屈光手术后的新兵进行干眼症调查。方法在2012年度新兵入伍体检时,选择283例准分子激光角膜屈光手术的新兵(手术组)并随机抽取其他273例新兵(非手术组)纳入研究,首先排除结角膜炎等其他疾患,然后两组分别进行问卷调查及干眼症的特异性检查,之后进行统计分析。结果有干眼症状的(包括:干涩、异物感、疲劳感、不适感等),手术组:79例,占28%,非手术组:17例,占6%;诊断为干眼症的,手术组:53例,占18.72%,非手术组:12例,占6.23%。两组患病率差异有统计学意义(χ2=27.65,P<0.01)。结论准分子激光角膜屈光手术后的新兵干眼症的发病率明显高于非手术者。     

丝裂霉素C在准分子激光表面屈光手术中的应用进展

丝裂霉素C(Mitomycin C,MMC)属细胞周期非特异性抗肿瘤药,它在细胞中经还原酶作用而活化于DNA分子螺旋形成交叉连结,小部分起单链烷化作用,阻碍细胞的分裂、增殖,可有效抑制巩膜瓣下、结膜瓣下成纤维细胞的增殖.     

准分子激光角膜屈光手术后群发性感染的防护措施

随着医学科学技术的发展，眼科准分子激光手术设备及器械日趋精良，术者操作技能的大幅提高，使得准分子激光角膜屈光手术在同一手术间，每日集中连台施行达数十台甚至数百台不等已成为可能。由于其手术日时，患者及其家属汇集于手术区域，人员流动性增大，给术后感染留下隐患。因此，规范手术流程，建立有效的预防感染的护理措施，防范准分子激光角膜屈光手术后的群发性感染，确保患者的安全及手术疗效，具有积极的临床意义。我院自1996年开展准分子激光角膜屈光手术万余例，无1例护理感染并发症发生，现将预防术后感染护理体会报告如下。     

准分子激光角膜手术治疗屈光不正

一个世纪以来，多种治疗屈光不正的手术效果均不十分理想。准分子激光（ｅｘｃｉｍｅｒｌａｓｅｒ）的出现，因其准确性高而负作用小，目前认为该项治疗在设备和技术等方面已日趋成熟，在角膜屈光手术方面有广阔的应用前景。本文综述有关文献，对其应用状况作一介绍。１　准分子激光的生物学特性１９７５年Ｖｅｌａｚｃｏ和Ｓｅｔｓｅｒ发现某些稀有气体和卤素结合会产生一个不稳定的化合物，该化合物在衰变为基态分子过程中，释放出带有较高能量的紫外光子（激光）。１９７６年，Ｈｏｆｆｍａｎ利用线性加速器获得高压电子束轰击氟化氩（Ａ…     

准分子激光上皮下角膜磨镶术治疗准分子激光角膜切削术后屈光回退的临床疗效观察

目的探讨准分子激光上皮下角膜磨镶术（LASEK）治疗准分子激光角膜切削术（PRK）术后屈光回退的疗效及安全性。方法对21例36只眼PRK术后屈光回退患者施行LASEK。LASEK术前的平均屈光度为（-1.98±0.65）D,平均角膜厚度为（470.17±18.46）μm,LASEK平均切削深度为（36.58±11.24）μm。结果术后第12个月裸眼视力1.0以上22只眼（占61.1%）,0.8以上31只眼（占86.1%）,0.5以上36只眼（占100%）,平均屈光度为（-0.18±0.53）D,未见最佳矫正视力下降,术后裸眼视力较术前明显提高,差异有显著意义（P〈0.05）。角膜瓣混浊0级29只眼（占80.6%）,0.5级5只眼（占13.9%）,1级2只眼（占5.5%）。结论 LASEK治疗PRK术后屈光回退安全有效,长期效果有待随访观察。     

Laser ring catheters in excimer laser angioplasty

Percutaneous excimer laser angioplasty is dependent on a reliable and effective energy transmission through fiberoptic devices. Compared with bare fibers, ring catheters provide improved flexibility and a central channel for insertion of guide wires. Peripheral laser catheters (7-9 F) were used in 32 patients with arterial occlusive disease in the lower limbs. The technical success rate was 91%. Vessel wall dissections occurred in nine cases but caused no clinical sequelae in the preliminary follow-up period (1-6 months). The clinical application of the catheter devices proved to be safe.     

The excimer laser sheath technique for embedded inferior vena cava filter removal

An inferior vena cava (IVC) filter became embedded within the IVC of a 45-year-old man after prolonged implantation. Because of incorporation of the filter legs within the caval endothelium, the filter was densely adherent and could not be sheathed using standard retrieval methods. In this patient, the authors performed percutaneous filter retrieval using an excimer laser sheath technique for circumferential ablation of dense fibrotic tissue between the filter and IVC. Endovascular laser ablation allowed facile separation of the filter from the IVC, without tearing of the tissues, and the filter was removed successfully without complication.     

LASIK术后屈光回退和欠矫的再次手术

目的：探讨LASIK术后屈光回退和欠矫再次手术的时机、方法、效果、安全性和手术设计的注意事项。方法：综合首次手术后的时间、角膜基质床厚度、角膜瓣厚度、治疗光区的大小和目前屈光回退的度数，采用瓣下切削（原瓣下或再次超薄瓣下切削）和瓣上切削的方式进行治疗。结果：对43例79只眼LASIK术后屈光回退和欠矫的28例54只眼行瓣上切削，15例25只眼行瓣下切削。二次术后随访6个月以上，所有患者术后3～6个月视力和屈光度基本稳定。瓣下切削者无并发症发生，瓣上切削者中有2例2眼出现0．5级HAZE。结论：再次手术矫正屈光回退和欠矫是安全、疗效可靠的方法，但术前精确的角膜厚度测量、屈光度的确定、患者首次手术资料的获取对手术设计中手术安全性、效果尤为重要。     

Endovascular excimer laser atherectomy techniques to treat complex peripheral vascular disease: an orderly process

Peripheral vascular disease represents the largest obstructive subsegment within the vascular system. Advances in equipment, techniques, biochemical treatments, and the influx of multiple specialties into this arena indicate a coming tidal wave of change to the standard treatment plan for patients with claudication and especially critical limb ischemia. Initial attempts in the 1980s to utilize the "laser" to treat peripheral vascular disease led to a clinical debacle: wavelengths and methods were not optimized; tissue heating was excessive, resulting in restenosis. Since then the "laser" has fallen from grace for endovascular treatment, although it has an infinite set of potential wavelengths, energy levels, and delivery methods. The xenon chloride, excimer laser, a pulsed 308-nm system, has overcome many of these early catastrophes. The long, ongoing success of this method of photoablating thrombus and plaque represents a true step forward in the endovascular treatment of occlusive disease. Although only a tool, the excimer laser provides a means to utilize electromagnetic energy instead of shearing mechanical force to resolve occlusions. With its active element at the tip, the excimer laser requires much less mechanical translation force to cross total occlusions, find the distal lumen, and thereby cause less plaque destabilization. In addition, removing the firm surface layer of plaque, decapping, and some of the plaque volume, debulking, exposes the softer subsegments of the plaque to balloon angioplasty. Utilizing this method, more complex lesions can be approached safely, with a high likelihood of successful revascularization and a low risk of potentially limb-threatening complication.     

308 nm准分子激光联合口服依巴斯汀等药物治疗玫瑰糠疹的效果

 目的 探讨308 nm准分子激光联合口服依巴斯汀等药物治疗玫瑰糠疹的效果。方法 选取2018-05至2019-04武警特色医学中心皮肤性病门诊符合诊断标准、患玫瑰糠疹的武警战士81例,采用随机数字表法分为治疗组与对照组,治疗组42例,对照组39例。治疗组采用308 nm激光联合口服依巴斯汀等治疗,对照组采用外用药联合依巴斯汀等药物治疗,比较两组的治疗效果及不良反应。结果 治疗组和对照组分别出现2例和1例红斑和色素沉着现象,差异无统计学意义。治疗组痊愈30例,显效9例,好转3例,无效0例,总有效率100.0%;对照组痊愈20例,显效6例,好转10例,无效3例,总有效率92.3%;治疗组痊愈率71.4%明显高于对照组的51.3%,两组对比差异有统计学意义(P<0.05),但总有效率差异无统计学意义。治疗组与对照组比较,瘙痒、丘疹、鳞屑、红斑症状缓解时间均明显缩短,差异有统计学意义(P<0.05)。结论 加用308 nm准分子激光治疗玫瑰糠疹治疗过程简单,缩短了症状缓解时间,值得推广。     

Treatment of long superficial femoral artery occlusions with excimer laser angioplasty: long-term results after 48 months

Purpose: To evaluate clinical and hemodynamical long-term results after laser angioplasty of long occlusions of the superficial femoral artery (SFA).

Material and Methods: In a prospective trial of 452 patients with long occlusions of the SFA, excimer percutaneous transluminal laser angioplasty (PTLA) for recanalization was applied. The average occlusion length of the SFA was 25.5 cm (range 16-38 cm). The recanalization attempt was done with the crossover technique in 398 patients, in 36 patients with the antegrade technique and in another 18 patients with the transpopliteal technique.

Results: The application of laser angioplasty demonstrated a successful recanalization of the SFA in 386/452 patients (85.5%). Recanalization with PTLA was not possible in 66 patients (14.5%). The main reason for the unsuccessful PTLAs was obstructing calcified material (n=28) resistant to PTLA application. After a follow-up period of 48 months there was a primary, primary-assisted, and secondary patency rate of 22.3%, 40.9%, and 43.2%, respectively.

Conclusion: Laser angioplasty of long occlusions of the SFA is a feasible procedure with a low failure rate. Long-term results are promising, but additional interventions are required in most patients if a patency rate of 43.2% is to be achieved after 4 years.     

Method of excimer laser personalized ablation in astigmatism correction for the patient with sequelae of corneal penetrating wounds

Aberrations of 25 eyes of patients with posttraumatic corneal scars and artiphakia were investigated using OPD-scan aberrometer. All patients underwent LASIK using the segmental and personalized ablation technology. Clinical and functional results were followed-up during up to 18 months after the surgery. Personalized ablation technology can be safely and effectively used in correction of sphere, cylinder and high order aberrations and allows to achieve maximally high refractive and functional results in the patients with refraction anomaly after eye trauma. Today in most cases such effective results can't be achieved by any other correction method.