飞秒激光制瓣的准分子激光原位角膜磨镶术与全飞秒激光小切口角膜基质内透镜取出术对屈光不正患者眼表的影响

目的 比较飞秒激光制瓣的准分子激光原位角膜磨镶术(FS-LASIK)与全飞秒激光小切口角膜基质内透镜取出术(SMILE)对屈光不正患者眼表的影响.方法 选取2018年1月至2019年6月于郑州大学第一附属医院行角膜屈光手术的63例(126眼)屈光不正患者进行观察.根据患者接受的手术方式不同分为两组,FS-LASIK组3...     

高度近视眼3种角膜屈光手术后角膜神经修复情况及角膜光密度的对比研究

目的:探讨高度近视眼行飞秒激光小切口角膜基质透镜取出术（SMILE）、飞秒激光制瓣的准分子激光原位角膜磨镶术（FS-LASIK）及准分子激光上皮瓣下角膜磨镶术（LASEK）术后12个月角膜不同区域上皮下神经的修复情况和角膜透明度的差异。方法:队列研究。收集于2018年6月至2019年10月在山东省青岛大学附属医院眼科就...     

中低度近视FS-LASIK、SMILE及ICL植入术的效果比较

目的:比较飞秒激光制瓣准分子激光原位角膜磨镶术(FS-LASIK)、全飞秒激光小切口角膜基质透镜取出术(SMILE)和有晶状体眼后房型人工晶状体(ICL V4c)植入术三者矫正中低度近视的效果。方法:采用回顾性研究。以惠州爱尔眼科医院2019年6月至2020年4月矫正中低度近视120例(120眼)作为研究对象,受术者分...     

高度近视SMILE和FS-LASIK术后早期局部调节和中枢视感知觉功能变化

目的：:探讨高度近视患者行飞秒激光小切口角膜基质透镜取出术（SMILE）和飞秒激光制瓣准分子激光原位角膜磨镶术（FS-LASIK）术后早期双眼调节功能和视感知觉功能的变化及差异。方法：:前瞻性临床研究。选取2019年11月至2020年7月在中南大学湘雅医院眼科中心行SMILE和FS-LASIK手术的患者60例（120眼...     

SMILE与FS-LASIK术后调制传递函数在不同空间频率的变化

目的:探讨飞秒激光小切口角膜基质透镜取出术(SMILE)与飞秒激光辅助准分子激光角膜原位磨镶术(FS-LASIK)术后眼调制传递函数(MTF)的变化。方法:采用队列研究设计。收集2015年12月至2016年6月于天津市眼科医院屈光手术中心行SMILE和FS-LASIK的近视患者102例102眼,根据手术方式不同将其分为...     

LASIK制瓣失败后行LASEK矫正屈光不正一例

准分子激光原位角膜磨镶术(Laser in situ keratomileusis,LASIK)因其良好的安全性、稳定性、可预测性已被越来越多的近视患者所接受.但部分患者由于术中制瓣失败[1],不可避免地需要二次手术治疗.而二次手术的方式目前仍没有统一的观点[2].现将本院1例因LASIK术中制瓣失败行准分子激光上皮下角膜磨镶术(laser subepithelial keratomileusis,LASEK)患者,报告如下.     

角膜屈光术后干眼症发病情况和病因的研究进展

随着角膜屈光手术技术的不断进步与完善,角膜屈光手术治疗近视的安全性、稳定性、有效性和可预测性已在临床实践的过程中得到广泛验证.机械刀制瓣的准分子角膜原位磨镶术(laser in situ keratomileusis,LASIK)、特制角膜上皮刀制瓣的准分子激光机械法上皮瓣下角膜磨镶术(epipolis laser in situ keratomileusis,Epi-LASIK)、飞秒激光制瓣的准分子角膜原位磨镶术(femtosecond laser in situ keratomileusis,FS-LASIK)、小切口飞秒激光基质透镜取出术(small incision lenticule extraction,SMILE)是目前治疗近视的主流手术方式.尤其是SMILE手术以其切口小、微创、术后干眼症状轻,已逐渐被广大中青年人所接受.而干眼症是角膜屈光术后早期常见的并发症之一,往往影响术后效果,因此受到患者和手术医生的广泛关注.通过大量的临床及实验研究发现:术前眼表的基本状态、术中术后药物的使用、手术方法的选择及操作、术后角膜损伤及恢复情况等均是影响干眼发病的重要因素.本文就角膜屈光术后干眼影响因素及发病情况作一综述.     

飞秒激光制瓣LASIK术中发生前房气泡51眼临床分析

目的 探讨飞秒激光制作角膜瓣导致前房气泡的原因.方法 回顾性病例对照研究.2009年7月至2010年6月接受飞秒激光制瓣的准分子激光原位角膜磨镶术(LASIK)患者1034例(2058眼),其中发生前房气泡的共48例(51眼)设为观察组,未发生前房气泡的2007眼为对照组,分析前房气泡发生的原因统计学处理采用成组t检验 结果 所有患者手术顺利,术后裸眼视力达到或超过术前矫正视力;观察组角膜直径较对照组小,差异有统计学意义(t=-9.21,P＜0.05);观察组角膜厚度、角膜曲率和Kappa角与对照组比较差异无统计学意义。结论 在瞳孔较大及精确的眼球眼踪系统下,飞秒激光制瓣时产生的前房气泡并不会对患者的术后视力产生影响;对于角膜直径较小的患者,应适当缩小角膜瓣直径,以避免前房气泡的发生.     

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。     

飞秒激光制瓣技术的优势与相关并发症

角膜屈光手术引入飞秒激光制作角膜瓣已经有十年的历史,设备从原先的高脉冲能量低频率逐渐转变为当前的低脉冲能量高频率。与传统的机械式显微角膜板层切开刀相比,飞秒激光具有一定的优势,如制做准分子激光原位角膜磨镶术（LASIK）角膜瓣厚度精确、均匀,术中无角膜瓣破碎等严重并发症;可以个性化地设计角膜瓣形状、大小以及边切角度。也有利用飞秒激光进行角膜透镜切除,即全飞秒激光矫正近视及散光的方法。但飞秒激光也有其特殊的术中及术后并发症,如激光制瓣过程中负压丢失、纽扣瓣、不透明气泡层、彩虹症及光敏综合征等。我们对此要有正确客观的认识,随着设备技术的改进与操作经验的积累,不断提高角膜屈光手术的疗效以及患者的满意度。     

不同光照条件下近视患者Kappa角的特征及变化规律

目的 观察预行飞秒激光原位角磨镶术(FS-LASIK)的近视患者在不同光照条件下Kappa角的特征及其变化规律。方法 采用自身前后对照试验。选取2021年6月至8月在江西省人民医院近视矫正中心预行FS-LASIK的近视患者104例(208眼)。用Sirius三维角膜地形图分别测量患者双眼在明视、黄昏视和暗视条件下的瞳孔直径和瞳孔中心偏移量。并将瞳孔中心偏移量在直角坐标系中转换为Kappa角水平分量和Kappa角垂直分量,并分析其变化规律。分析患者双眼瞳孔直径和Kappa角之间的关系。结果 患者右眼Kappa水平分量在明视、黄昏视和暗视条件下分别为(0.00±0.13)mm、(-0.06±0.13)mm、(-0.12±0.13)mm,差异有统计学意义(P<0.05);患者左眼Kappa角水平分量在明视、黄昏视和暗视条件下分别为(-0.04±0.14)mm、(0.02±0.13)mm、(0.08±0.13)mm,差异有统计学意义(P<0.001)。患者双眼瞳孔直径在不同光照条件下差异均有统计学意义(均为P<0.001)。两两比较结果显示,患者双眼瞳孔直径和Kappa角水平...     

Measurement of the spatial shift of the pupil center

PURPOSE: To evaluate the effectiveness of the pupil center as an anatomic landmark for excimer laser treatments. SETTING: Sekal-Microchirurgia-Rovigo Centre, Rovigo, Italy. METHODS: Pupillometry with the Costruzione Strumenti Oftalmici S.R.L. (CSO) pupil-measuring module (incorporated in Eye Top videokeratoscope) was performed in 52 patients with a diagnosis of myopia and in 25 patients with a diagnosis of hyperopia. Measurements both in mesopic and photopic conditions consisted of pupil diameters, spatial shift of the pupil center, and the distance between the pupil center and keratoscopic axis. RESULTS: The mean pupil diameter in photopic conditions of illumination in myopic eyes was 3.52 mm +/- 0.56 (SD), while in mesopic conditions it was 5.37 +/- 0.78 mm; in hyperopic eyes the mean photopic pupil diameter was 3.01 +/- 0.46 mm, while the mean mesopic diameter was 5.12 +/- 0.48 mm. The mean spatial shift of the pupil center in myopic eyes was 0.086 mm (maximum 0.269 mm), while in the hyperopic eyes it was 0.095 mm (maximum 0.283 mm). The mean distance between the pupil center and keratoscopic axis in myopic eyes was 0.226 +/- 0.13 mm (maximum 0.75 mm), while in hyperopic eyes it was 0.45 +/- 0.19 mm (maximum 0.8 mm). CONCLUSIONS: The mean of the measured pupil sizes was greater in myopic eyes than in hyperopic eyes. The spatial shift of the pupil center, as the pupil dilates, was relatively small in all groups; therefore, the pupil center is a good anatomic landmark for both traditional refractive surgery and wavefront-guided treatments. The mean distance between the keratoscopic axis and pupil center was greater in the hyperopic group than in the myopic group. Therefore, centration of any laser treatment on the basis of the keratoscopic analysis should be done carefully, especially in hyperopic eyes and in cases in which the pupil center is meaningfully shifted from keratoscopic axis, even in photopic conditions of illumination.     

近视患者明暗瞳孔下Kappa角的变化及分析

目的：研究近视患者双眼暗视至明视状态下Kappa角水平偏移量及垂直偏移量的变化规律。方法：横断面研究。选取2020年11月至2021年12月在宁夏医科大学总医院门诊近视中心明确诊断为近视的患者，并采用单纯随机抽样的方法抽取120例（240眼），采用博士伦Orbscan II角膜地形图仪分别于暗视及明视条件下进行检查，记录明暗视下瞳孔直径大小、Kappa角的大小及水平偏移量和垂直偏移量。采用配对t检验比较左右眼在暗视和明视下的瞳孔直径和Kappa角大小；采用散点分布图分析双眼在明暗视下Kappa角的象限分布。结果：左右眼在暗视状态下的瞳孔直径均明显大于明视状态下的瞳孔直径，差异有统计学意义（t=13.67，P<0.001；t=13.48，P<0.001）。暗视与明视状态下左眼的Kappa角均大于右眼的Kappa角，差异有统计学意义（t=4.15，P=0.021；t=5.27，P=0.008）。由暗视转向明视状态时，双眼Kappa角的分布呈现镜像对称，水平方向主要向鼻侧位移，垂直方向主要向上方位移。右眼矢量位移（0.168±0.100）mm，左眼矢量位移（0.171±0.069）mm；87.5%右眼矢量位移小于0.3 mm，92.5%左眼矢量位移小于0.3 mm，绝大多数近视患者的矢量位移在0.3 mm以内。结论：从暗视至明视状态下，随着瞳孔缩小，近视患者的Kappa角分布主要向鼻上方位移。     

Pupil center shift relative to the coaxially sighted corneal light reflex under natural and pharmacologically dilated conditions

PURPOSE: To evaluate the location and shift of the pupil center relative to the coaxially sighted corneal reflex on horizontal and vertical planes under natural and pharmacologically dilated conditions. METHODS: Ninety-four (64 myopic and 30 hyperopic) eyes of 47 patients underwent pupillometry with the NIDEK OPD-Scan under photopic and mesopic conditions before and after instillation of cyclopentolate 1%. Horizontal, vertical, and vectorial shift of the pupil center were calculated between each condition. RESULTS: The pupil center was located temporally to the coaxially sighted corneal reflex a mean distance of 0.336 +/- 0.181, 0.345 +/- 0.195, and 0.339 +/- 0.170 mm under photopic, mesopic, and pharmacologically dilated conditions, respectively. The pupil center shifted primarily inferotemporally (44%), followed by inferonasally (22%), superotemporally (19%), and superonasally (15%) from photopic to pharmacologic dilation. Mean magnitude of pupil shift was 0.084 +/- 0.069 mm (range: 0.010 to 0.385 mm) from mesopic to photopic, 0.149 +/- 0.080 mm (range: 0.013 to 0.384 mm) from photopic to pharmacologic dilation, and 0.102 +/- 0.104 mm (range: 0 to 0.530 mm) from mesopic to pharmacologic dilation. Mean distance between the pupil center and the coaxially sighted corneal reflex was greater in hyperopes than in myopes (P < .05), but no significant difference was observed in pupil center shifts between myopes and hyperopes under all three conditions (P > .05). CONCLUSIONS: The pupil center is located temporally and shifts in every direction, primarily inferotemporally, relative to the coaxially sighted corneal reflex with natural and pharmacologic dilation. The horizontal distance between the pupil center and the coaxially sighted corneal reflex was significantly higher in hyperopes than in myopes.     

Changes in pupil size and centroid shift in eyes with uncomplicated in-the-bag IOL implantation

PURPOSE: To determine changes in entrance pupil size and pupil center shift under low mesopic and photopic conditions of illumination in eyes with in-the-bag intraocular lens (IOL) implantation. METHODS: Entrance pupil size and pupil center shift were measured under low mesopic (0.06 lux) and photopic (60 lux) conditions of illumination in 55 patients with unilateral pseudophakia (study group) and 55 age- and sex-matched patients with bilateral cataracts (control group) using the NIDEK OPD-Scan. Pseudophakic eyes had an uncomplicated intraoperative and postoperative course and best spectacle-corrected visual acuity of 20/20. Cataractous eyes had no additional ocular or systemic problems affecting the pupil. Both groups were analyzed with respect to pupil size and shift in both conditions of illumination. RESULTS: Mean patient age was 64.2 +/- 6.8 and 63.6 +/- 4.3 years in the study and control groups, respectively (P = .45). In the study group, differences in pupil size under low mesopic (5.12 +/- 1.02 and 5.13 +/- 0.96 mm for pseudophakic and phakic eyes, respectively) and photopic (3.44 +/- 0.39 and 3.45 +/- 0.39 mm for pseudophakic and phakic eyes, respectively) conditions of illumination were not statistically significant (P = 1.00 and P = .95 for pseudophakic and phakic eyes, respectively). Differences in pupil shift between pseudophakic (0.11 +/- 0.08 mm) and phakic (0.12 +/- 0.10 mm) eyes were not statistically significant (P = .83) in the study group. In the control group, differences in pupil size under low mesopic (P = .59) and photopic conditions of illumination (P = .60) in the right and left eyes as well as pupil shift (P = .71) were not statistically significant. CONCLUSIONS: Uncomplicated in-the-bag IOL implantation has no influence on pupil size and shift.     

白内障患者Kappa角特点及明暗状态下的变化

目的 探讨Kappa角特点及明暗状态下的变化规律。方法 系列病例研究。选取2016年5月至2017年10月于厦门大学附属厦门眼科中心行白内障手术的患者394例（788眼）,采用OPD-Scan Ⅲ进行检查,搜集的数据包括患者的临床数据（年龄、性别、眼部病史及手术史）,及术前生物测量数据如平均角膜曲率（Mean K）、角膜球差（CSA）、白到白距离（WTW）、明视瞳孔直径（Photopic）、暗视瞳孔直径（Mesopic）,明视瞳孔时Kappa角的大小和位移角度（PDist@Angle）、暗视瞳孔时Kappa角的大小和位移角度（MDist@Angle）、暗视瞳孔中心相对于明视瞳孔中心位移的大小和角度（MPDist@Angle）等。数据采用秩和检验、卡方检验、多元回归统计分析处理。结果 双眼各生物测量因素对比中Mean K、MPDist、PDist、WTW、CSA差异无统计学意义（P>0.05）,而Photopic、Mesopic、MDist左右眼差异有统计学意义（Z=2.276、3.284、2.388,均P<0.05）。双眼明暗状态下均为正Kappa角占多数;双眼由明瞳向暗瞳转变时瞳孔中心多向颞下方位移。分别将双眼临床、生物测量数据与MPDist进行多元回归分析,右眼回归方程为：MPDist=0.033+0.505×MDist+0.041×CSA-0.319×PDist（F=45.0,P<0.001）,左眼回归方程为：MPDist=-0.002+0.547×MDist+0.013×Mesopic-0.350×PDist（F=61.6,P<0.001）。结论 白内障患者正Kappa角占多数;不同明暗度下瞳孔大小的改变会影响Kappa角的大小,而且明暗瞳孔大小及明暗交替时瞳孔中心的大小和位移角度在不同患者间存在较大差异;MPDist的变化与PDist、MDist、Mesopic、CSA存在线性回归关系,其中双眼MPDist均与PDist存在负相关,双眼MDist均对MPDist的变化影响相对较大。     

Higher-order aberrations and visual acuity after LASEK

Background To determine ocular higher-order aberrations (HOAs) in eyes with supernormal vision after myopic astigmatic laser subepithelial keratomileusis (LASEK) and to compare the findings with those in eyes with natural supernormal vision. Methods Ocular HOAs were measured after LASEK in 20 eyes of 12 myopic astigmatic patients with postoperative uncorrected visual acuity (UCVA) of >20/16 (group 1). Patients who were included in the study had no visual symptoms like glare, halo or double vision. The measurements were taken 8.3 +/- 3 months after LASEK surgery. In group 2 ocular HOAs were examined in 20 eyes of 10 subjects with natural UCVA of >20/16 as a control. Measurements were taken across a pupil with a diameter of 4.0 mm and 6.0 mm. Root-mean-square (RMS) values of HOAs, [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text] and [Formula: see text] were analyzed. Results The mean RMS values for each order were higher in group 1 when compared with group 2 at 4.0 mm and 6.0 mm pupil diameters. There was no statistically significant difference between groups in spherical and coma aberrations (P > 0.05). Mean RMS values for total HOAs were 0.187 +/- 0.09 mum at 4.0 mm and 0.438 +/- 0.178 mum at 6.0 mm pupil in group 1 and 0.120 +/- 0.049 mum at 4.0 mm and 0.344 +/- 0.083 mum at 6.0 mm pupil in group 2. The difference between groups in total HOAs was statistically significant at 4.0 mm and 6.0 mm pupil diameters (P < 0.05). Conclusion Ocular HOAs exist in eyes with supernormal vision. After LASEK, the amount of HOAs of the eye increases under both mesopic and photopic conditions. However the amount of HOA increase does not seem to be consistent with visual symptoms.     

Changes in vaulting of myopic and toric implantable collamer lenses in different lighting conditions

Purpose: To evaluate the changes in vaulting of myopic and toric Implantable Collamer Lenses (ICLs) in different lighting conditions. Methods: Thirty‐seven eyes of 37 patients implanted with a myopic ICL and 26 eyes of 26 patients implanted with a toric ICL were examined using Visante optical coherence tomography (OCT) in photopic (257 lux) and mesopic (2 lux) conditions. Pupil diameter and distance changes between the ICL and adjacent intraocular structures were measured. Results: The mean horizontal pupillary diameters in mesopic conditions were 5.3 ± 0.9 (SD) mm. In photopic conditions, a mean decrease of –1.8 ± 0.6 mm [95% confidence interval (95% CI) ?2.0 to ?1.7; p < 0.0001] was observed. The mean distances between the ICL and the crystalline lens in mesopic conditions were 0.33 ± 0.17 mm. In photopic conditions, a mean decrease of ?0.04 ± 0.06 mm (95% CI ?0.05 to ?0.02; p < 0.0001) in the ICL‐crystalline lens distance was found. There was a ?0.02 ± 0.04 mm (95% CI ?0.03 to ?0.01; p = 0.0022) decrease in the anterior chamber depth and a 0.02 ± 0.06 mm (95% CI 0.002 to 0.032; p = 0.0275) increase in the distance between the cornea and the ICL. We found no difference in the change in vaulting between the two ICLs in different lighting conditions. Conclusion: There is a decrease in the central vaulting of myopic and toric ICLs in photopic conditions. This is due to both posterior movement of the ICL and anterior protrusion of the crystalline lens.     

Pupil location under mesopic,photopic, and pharmacologically dilated conditions

PURPOSE: To determine whether there are systematic changes in pupil location with changes in the state of pupil size and with other ocular variables. METHODS: High-resolution images of the pupil of the eyes of 70 subjects were taken using an infrared-sensitive camera. Images were obtained under mesopic, photopic, and pharmacologically dilated conditions. From the images, the center and diameter of the corneal limbus and the pupil were computed. In addition, the location of the first Purkinje image was calculated. RESULTS: The pupil center shifted consistently temporally as the pupil dilated. The total motion was relatively small, with a mean distance of 0.133 mm motion between the mesopic and photopic conditions, with the pupil diameter changing from 6.3 to 4.1 mm. Ninety percent of the subjects had a motion of less than 0.3 mm. One patient showed a motion of almost 0.6 mm. The change in location of the pupil center was not significantly related to refractive error, age, or the change of pupil diameter. CONCLUSIONS: Changes in the location of the pupil center with changes in the dilation of the pupil are typically slight, but can be significant in a few subjects, especially in pharmacologically dilated pupils.     

Higher order aberrations comparison in fellow eyes following intraLase LASIK with wavelight allegretto and customcornea LADArvision4000 systems

PURPOSE: To compare the differences in objective and subjective visual outcomes with wavefront-optimized versus wavefront-guided excimer laser ablations using two different excimer laser platforms. METHODS: In this prospective, randomized, matched, contralateral eye study, one eye was treated with the Alcon CustomCornea system, and the fellow eye was treated with the WaveLight Allegretto Wavefront-Optimized system. The IntraLase FS30 femtosecond laser was used to create all flaps. Treatments were randomized to the dominant eye, and optical treatment zones were matched to 6.5 mm. Patients were observed for 3 months after surgery. Initial data analysis was available for the first 28 eyes of 14 patients. RESULTS: The only statistically significant differences between the groups were seen in the amount of higher order aberrations-the 14 eyes in the WaveLight group had a mean preoperative root-mean-square (RMS) error of 0.37 microm compared to 0.36 microm for 14 eyes in the Alcon group. Of the 8 patients who had 3-month follow-up, 8 eyes in the WaveLight group had a mean RMS error of 0.58 microm at 3 months, compared to 0.41 microm in the 8 eyes in the Alcon group. CONCLUSIONS: Early results from this study have shown that both laser platforms produce accurate refractive outcomes; however, the Alcon CustomCornea LADARVision4000 system induces statistically significantly fewer higher order aberrations than the WaveLight Allegretto system.