准分子激光原位角膜磨镶术后角膜扩张

准分子激光原位角膜磨镶术（laser in situ keratomileusis，LASIK）是近几年来发展起来并逐步趋向完善的一种角膜屈光手术。LASIK术后角膜扩张是少见而严重的并发症之一，严重影响手术效果，近年来引起广泛关注。现就当前研究现状做一综述     

准分子激光原位角膜磨镶术后视野改变

目的:探讨准分子激光原位角膜磨镶术(laser in situ keratom ileusis,LASIK)对近视及近视散光患者30°中心视野的影响。方法:将实施LASIK的近视患者45例89眼分为两组:中低度近视组和高度近视组。Ⅰ组:中低度近视组60眼,近视-1.50～-6.00D;Ⅱ组:高度近视组29眼,近视-6.00～10.00D。用Humphrey视野计30-2SITA快速阈值检测程序对所有患者的术前、术后1wk;1,3,6mo的视野进行检查,观察其视野改变情况。观察指标为平均缺损(mean defect,MD)和模式标准差(pattern standard deviation,PSD)。统计学分析采用重复测量的方差分析和非参数分析的秩和检验,分析各时间点视野指数。结果:中低度近视组:术后1wk;1,3mo的MD与术前相比,差异有统计学意义(P<0.05),术后6mo时MD值与术前相比差异无统计学意义;PSD值术后各时间点与术前相比差异无统计学意义。高度近视组:术后1wk;1,3mo时的MD均较术前增加,并且随时间变化的差异有统计学意义(P<0.05);其中,1wk时MD值上升最明显,以后逐渐下降,但仍高于术前水平;术后6mo时恢复至术前水平(P>0.05);术后1wk时的PSD与术前相比差异有统计学意义(P<0.05),其余各时间点PSD值与术前相比差异无统计学意义。结论:LASIK手术对高度近视眼患者1wk的视野有影响,对中低度近视患者的视野改变无影响。     

准分子激光原位角膜磨镶术治疗远视

目的　评价准分子激光原位角膜磨镶术 (LASIK)治疗的效果和安全性。方法　对 16例 ( 3 0眼 )远视行LASIK。术前远视度数为 3 5 0～ 12 .5D ,平均 ( 7 0 9± 2 .62 )D。术后随访观察 12月。结果　术中无严重并发症 ,术后 3月屈光度基本稳定 ,术后 12月残余屈光度在 1 0 0D和 2 0 0D以内的分别占 40 0 0 % ( 12眼 )和 63 3 3 % ( 19眼 ) ,裸眼近视力≥ 0 .5者 3 0眼 ( 10 0 0 0 % ) ,≥ 1 0者 2 4眼 ( 80 0 0 % ) ,裸眼远视力≥ 0 .5者 2 6眼 ( 86 67% ) ,≥ 1.0者 9眼 ( 3 0 0 0 % ) ,1眼 ( 3 3 3 % )最佳矫正视力下降一行 ,5眼 ( 16 67% )有眩光。结论　LASIK治疗远视安全有效。治疗软件进一步完善及治疗参数进一步的调整将有助于提高手术的可预测性和稳定性     

全景200广角激光眼底镜在准分子激光原位角膜磨镶术术前检查中的应用

目的 评价全景200广角激光眼底镜（Panoramic 200）在准分子激光原位角膜磨镶术（laser in situ keratomileusis,LASIK）术前检查中的应用价值.方法 回顾性研究我院共301例（601眼）要求行LASIK手术的近视患者Panoramic 200的眼底检查结果,将Panoramic 200检查结果与三面镜检查确诊结果相比较.结果 Panoramic 200发现了有较大临床意义的眼底病变31眼,三面镜检查确诊眼底病变40眼.Panoramic 200对眼底疾病筛查的敏感度达到77.50%.结论 Panoramic 200为LASIK术前眼底疾病的筛选提供了一条简便、高效的途径,但不能完全替代三面镜眼底检查.     

准分子激光角膜原位磨镶术治疗近视

目的 评价准分子激光角膜原位磨镶术（ＬＡＳＩＫ）在治疗近视眼中的作用。方法 将６７８例（９２８只眼）近视眼患者（－２．００￣－２０．００Ｄ）分为３组：Ｉ组为－２．００￣－６．００Ｄ、Ⅱ组为－６．１０￣－１０．００Ｄ及Ⅲ组为－１０．１０￣－２０．００Ｄ,均采用ＬＡＳＩＫ进行治疗,术后平均随访１年（６￣１８个月）,并对其资料进行分析。结果 Ｉ组：术后１年时平均残余屈光度为－０．２４±０．５０Ｄ,屈光度     

准分子激光原位角膜磨镶术与干眼症

干眼症是常见的眼表疾病 ,随着角膜屈光手术 ,尤其是准分子激光原位角膜磨镶术 (laserinsitukeratomileusis,LASIK)的广泛开展 ,干眼症的发病率也逐年上升。LASIK术前大多数患者有干眼症 ,术后必然发生干眼症 ,从而影响LASIK的手术效果。我们就干眼症的诊断、LASIK引起干眼症的机制进行综述 ,并提出防治措施。     

准分子激光原位角膜磨镶术后视网膜脱离

目的：分析LASIK治疗近视术后发生视网膜脱离的临床特征和处理原则。方法：回顾性分析LASIK术后发生视网膜脱离的3只眼（3例患者）。结果：术前平均屈光度（等值球间，下同）为－9．3D（范围－7．37－－11．50D）。LASIK与网脱发生的间隔时间为0．5－26个月（平均11．8个月）。视网膜裂孔类型和数目：1例为马蹄形，1个；1例为锯齿缘断离；1例为小圆形裂孔，3个，裂孔位置；3例均在赤道部前方，3例通过一次手术后即成功复方。结构：具有视网膜病变的高度近视病在LASIK术后易发生视网膜脱离。     

准分子激光原位角膜磨镶术治疗高度近视

目的评价准分子激光原位角膜磨镶术治疗高度近视的疗效。方法采用LASIK治疗高度近视186例308眼,按术前屈光度将患者分为2组。对1a随访结果进行统计分析。结果A组术前近视-6.0～-10.0D(等值球镜,下同)术后1a裸眼视力达到0.5和1.0者分别为95.76%和77.58%,剩余屈光度为-0.32D±0.46D。B组术前近视-10.25～-20.00D,术后1a裸眼视力达0.5和1.0者分别为62.24%和37.06%.剩余屈光度-0.92D±1.13D。结论LASIK治疗高度近视安全有效,并有较好的预测性和稳定性。     

准分子激光原位角膜磨镶术中角膜瓣保湿技术

目的：探讨准分子激光原位角膜磨镶术（ｌａｓｅｒ ｉｎ ｓｉｔｕ ｋｅｒａｔｏｍｉｌｅｕｓｉｓ,ＬＡＳＩＫ）中角膜瓣干燥的预防方法。方法：完成角膜瓣制作后常夫将瓣自身反折,将瓣的颞侧缘与瓣的近蒂部平齐,依靠瓣的基质面的微量水份的表面张力吸附折叠。结果：选择双眼接受ＬＡＳＩＫ的患者３０例,右眼为保湿组,左眼为对照组,激光切事后见保湿组无一眼瓣干燥,对照组２６眼瓣干燥,占８６．７％。结论：角膜瓣折叠保湿     

准分子激光原位角膜磨镶术后角膜扩张

准分子激光原位角膜磨镶术(1aser in situ keratomileusis，LASIK)后角膜扩张是近年才认识的LASIK术后的一种并发症，其发生率不高，但可导致患视力严重损害，且不可逆转。本对其发病机制、组织病理学、临床特征和治疗等进行综述。     

复性近视散光LASIK术后角膜散光的动态分析

目的　观察、分析准分子激光角膜原位磨镶术 (LaserinSituKeratomileusis,LASIK)治疗复性近视散光手术前后角膜地形图的变化规律 ,研究LASIK术对角膜各区散光度及散光轴的影响。方法　对 6 5例复性近视散光患者 (12 6眼 )行LASIK手术 ,术前、术后 1月、 3月、 6月分别行角膜地形图检查。将患者按散光程度不同分为两组 ,观察、比较两组手术前后不同时期角膜不同区的散光度及散光轴的变化规律。结果　复性近视散光患者LASIK术后角膜散光度降低以 3mm区最为明显 ,而 5mm、 7mm区表现为散光轻度增加 ,术后 3～ 6月恢复至与术前差异无显著意义 (P >0 0 5 )。角膜 3mm区散光部分欠矫与非角膜散光因素呈正相关系 :角膜 3mm区散光欠矫度 (D) =1 196×非角膜散光因素 +1 117;角膜各区之间散光轴位差异无显著意义 (P >0 0 5 ) ,术前、术后不同时期差异均无显著意义 (P >0 0 5 )。结论　复性近视散光LASIK术后角膜散光以 3mm区散光值减少明显 ,且散光高度组减少更明显 ,而 5mm、 7mm区早期散光轻度增加 ,术后 3～ 6月逐渐恢复至术前水平。角膜 3mm区散光部分欠矫与非角膜散光因素密切相关。手术前后角膜各区散光轴均保持良好的一致性。     

Automated, computerized, feature-based phenotype analysis of slit lamp images of the mouse lens

Longitudinal studies of a variety of transgenic mouse models for lens development can create substantial challenges in database management and analysis. We report a novel, automated, feature-based informatics approach to screening lens phenotypes in a large database of slit lamp images. Digital slit lamp images of normal and abnormal lenses in eyes of wild type (wt), SC1 null and SPARC null transgenic mice were recorded for quantitative evaluation of their structural phenotype. The images were processed to improve the contrast of structural features that corresponded to rings of opacity and fluctuations in scattering intensity in the lenses. Measurable attributes were assigned to the features in the lens images and given as an output vector of 46 dimensions. Characteristic patterns were correlated with the structural phenotype of each mutant and wt lens and a statistical fit for each phenotype was defined. The genotype was identified correctly in nearly 85% of the slit lamp images on the basis of an automated computer analysis of the lens structural phenotype. The automated computer algorithm has the potential to evaluate a large database of slit lamp images and distinguish mouse genotypes on the basis of lens phenotypes objectively using a neural network analysis of the structural features observed in the slit lamp images. The neural network approach is a promising technology for objective evaluation of genotype/phenotype relationships based on structural features and light scattering in lenses. Further improvements in the automated method can be expected to simplify and increase the accuracy and efficiency of the feature based analysis of structural phenotypes linked to genetic variation.     

Advantages of using newly developed quartz contact lens with slit illumination from operating microscope

The purpose of this article is to report the characteristics and advantages of using a newly designed quartz contact lens with slit illumination from an operating microscope for intraocular surgery. The new contact lens is made of quartz. The lens is convex–concave and is used in combination with slit illumination from an operating microscope. The optical properties of quartz make this lens less reflective with greater transmittance. The combination of a quartz contact lens with slit illumination provided a brighter and wider field of view than conventional lenses. This system enabled us to perform bimanual vitrectomy and scleral buckling surgery without indirect ophthalmoscope. Small intraocular structures in the posterior pole or in the periphery were detected more easily. In conclusion, the newly designed quartz lens with slit beam illumination from an operating microscope provided a bright, clear and wide surgical field, and allowed intraocular surgery to be performed more easily.     

正常人裂隙灯光学相干断层成像测量前房角参数分布

目的利用裂隙灯光学相干断层成像术（SL-OCT）对正常志愿者前房角各参数进行初步研究,讨论其变化规律。方法选择正常志愿者52例102眼使用海德堡SL-OCT进行眼前节测量,对房角开放距离（AOD）500μm、750μm,及2个AOD情况下的小梁-虹膜空间面积（TISA）、房角隐窝面积（ARA）、房角角度（ACA）4个反映房角开放程度的参数进行研究。结果各参数500μm系列变异较750μm系列大;反映房角开放程度的各参数值在上方象限较小,鼻上方最小,下方象限较大,以颞下象限最大;房角各测量值随着年龄的增加逐渐变小,但60岁后有增加趋势。结论在SL-OCT测量的反映房角开放的AOD、TISA、ACA、ARA4个参数中,ARA对房角开放程度的反映较其他参数差,500μm系列参数的变异性较750μm系列大,正常人房角左右眼各参数无差异,上方象限房角较窄,下方象限较宽,并且随着年龄的增加,正常人房角变窄,50～60岁时最窄,60岁后房角有加宽趋势。     

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.     

Intraocular light scatter,reflections, fluorescence and absorption: what we see in the slit lamp

Purpose

Much knowledge has been collected over the past 20 years about light scattering in the eye‐ in particular in the eye lens‐ and its visual effect, called straylight. It is the purpose of this review to discuss how these insights can be applied to understanding the slit lamp image.

Results

The slit lamp image mainly results from back scattering, whereas the effects on vision result mainly from forward scatter. Forward scatter originates from particles of about wavelength size distributed throughout the lens. Most of the slit lamp image originates from small particle scatter (Rayleigh scatter). For a population of middle aged lenses it will be shown that both these scatter components remove around 10% of the light from the direct beam. For slit lamp observation close to the reflection angles, zones of discontinuity (Wasserspalten) at anterior and posterior parts of the lens show up as rough surface reflections. All these light scatter effects increase with age, but the correlations with age, and also between the different components, are weak. For retro‐illumination imaging it will be argued that the density or opacity seen in areas of cortical or posterior subcapsular cataract show up because of light scattering, not because of light loss.

Notes

(1) Light scatter must not be confused with aberrations. Light penetrating the eye is divided into two parts: a relatively small part is scattered, and removed from the direct beam. Most of the light is not scattered, but continues as the direct beam. This non‐scattered part is the basis for functional imaging, but its quality is under the control of aberrations. Aberrations deflect light mainly over small angles (<1°), whereas light scatter is important because of the straylight effects over large angles (>1°), causing problems like glare and hazy vision. (2) The slit lamp image in older lenses and nuclear cataract is strongly influenced by absorption. However, this effect is greatly exaggerated by the light path lengths concerned. This obviates proper judgement of the functional importance of absorption, and hinders the appreciation of the Rayleigh nature of what is seen in the slit lamp image.     

特殊复杂条件下眼底激光治疗中＋90D透镜的临床应用与分析

眼底疾病的激光治疗中通常采用Ｇｏｄｍａｎｎ三面镜或其它种类的角膜接触镜，临床上由于某些特殊眼科状态如屈光间质混浊，瞳孔散大受限，眼科术后结膜水肿，结膜或角膜缝存在，色素膜反应，角膜上皮损伤，玻璃体腔注气注油术后等条件下使用上述角膜接触镜进行激光治疗则十分困难，甚至无法进行。为此我们将＋９０Ｄ透镜应用到这些特殊的眼科激光治疗中心，取得了较满意的效果，本文总结了最近我们使用该技术治疗各种复杂眼科情况，     

FS-LASIK术中不同掀瓣时机进行静态眼球自旋识别成功率的对比

目的：探讨在飞秒激光辅助的准分子激光原位角膜磨镶术（FS-LASIK）中不同的掀瓣时机之间静态眼球自旋（SCC）定位识别成功率的差异。方法：前瞻性临床研究。选取2017年7-9月在南京医科大学附属明基医院眼科行角膜屈光手术的近视患者205例（410眼），其中行FS-LASIK的患者183例（366 眼）为FS-LASIK组，行经上皮准分子激光角膜切削术（TransPRK）的患者22例（44眼）为TransPRK 组。FS-LASIK组的366眼根据SCC定位识别时机不同分别为掀瓣前测量组（130眼）、掀瓣后测量组（126眼）和掀瓣后再覆盖测量组（110眼）。测量各组术眼的SCC方向和程度。采用卡方检验比较各组间SCC定位识别成功率差异。采用独立样本t检验和方差分析比较不同组别的SCC度数差异。结果：所有患者的SCC定位识别成功率为77.3%。FS-LASIK组和TransPRK组SCC成功率分别为74.9%和 97.7%，2组比较差异有统计学意义（χ²=11.71，P<0.001）。右眼SCC成功率为82.4%，左眼为72.2%，两眼间差异有统计学意义（χ²=6.13，P=0.013）。性别在SCC成功率方面差异无统计学意义。掀瓣前测量组、掀瓣后测量组和掀瓣后再覆盖测量组SCC定位识别成功率分别为63.8%、84.1%和77.3%，3 组间差异有统计学意义（χ²=14.47，P<0.001）。所有识别成功患者（317眼）SCC度数为3.0°±2.3°。而性别、眼别在SCC度数方面差异无统计学意义。FS-LASIK组和TransPRK组SCC度数分别为3.1°±2.4° 和2.2°±1.7°，组间比较差异有统计学意义（t=1.99，P=0.007）。掀瓣前测量组、掀瓣后测量组和掀瓣后再覆盖测量组SCC度数比较差异无统计学意义。SCC>2°的占59.3%，>4°的占28.7%，>6°的占9.2%。结论：在FS-LASIK术中，掀开角膜瓣后进行SCC定位识别的成功率较高。     

术前配戴软性角膜接触镜对LASIK术后高阶像差的影响

目的探讨术前配戴软性角膜接触镜对波前引导和传统准分子激光原位角膜磨镶术(LASIK)术后高阶像差的影响。方法采用前瞻性随机双盲比较性研究,将拟行LASIK的青壮年近视患者48名(96眼),其中,术前配戴软性角膜接触镜者26名(52眼),随机分为波前引导组和传统组,分别检查术前、术后不同时间的视力、对比敏感度和高阶像差,并比较术前戴角膜接触镜组(contactlens,C组)与未戴组(non-contactlens,N组)术后高阶像差变化。结果无论是传统组还是波前引导组术后不同时间的裸眼视力(UCVA)、最佳矫正视力(BSCVA)、安全指数、有效指数和对比敏感度增加倍率等方面C组与N组均无显著差异(P>0.05)。传统组和波前引导组术后总高阶像差和各高阶像差RMS值(RMSh和RMS3～6值)均较术前增加,平均增加约1倍。传统组中术后RMSh和RMS3～6值增加倍率和下降比例C组与N组无显著差异,术后6个月时RMSh值增加倍率分别为1.28倍、1.17倍。引导组中术后RMSh、RMS3～5值增加倍率C组均明显高于N组(P<0.05),术后6个月时RMSh值增加倍率分别为1.58倍、0.77倍(P<0.05),N组术后不同时间RMSh、RMS3～5值下降比例均高于C组。术后6个月时,RMSh值下降比例C组与N组分别为9.1%和22.7%。结论术前配戴软性角膜接触镜影响波前引导LASIK对高阶像差的矫正,而对传统LASIK术后高阶像差影响不明显。术前配戴软性角膜接触镜者行波前引导LASIK应慎重。     

Do-it-yourself adapter for fundus examination with 90D and 78D lens

The COVID-19 pandemic has brought a radical change in safety measures in outpatient clinics. The use of face masks by patients and healthcare workers has become a mandatory norm. Exhaled air with a face mask often follows an upward route. The warm exhaled air leads to fogging of 90/78D lens during fundus examination, hampering visualization. This can be prevented by the use of a simple yet innovative DIY adapter for a 90/78D lens, which can be made using simple household items such as PVC pipes or water hose pipes.