眼散光轴与角膜散光轴对LASIK矫正散光效果的影响

目的研究眼散光轴和角膜散光轴对准分子激光原位磨镶术(laser in situ keratomileusis,LASIK)矫正散光效果的影响。方法对73例(114眼)行LASIK手术的近视散光患者进行回顾性分析,按照眼散光和角膜散光轴的差异分为<15°组(68眼)和≥15°组(46眼),分析2组LASIK术后散光的矫正效果及角膜散光与眼散光之间的关系。结果术前<15°组和≥15°组的眼散光分别为(-0.94±0.36)D和(-0.82±0.34)D,2组间差异无统计学意义(t=-1.02,P>0.05);角膜散光分别为(-1.31±0.41)D和(-1.18±0.49)D,2组间差异无统计学意义(t=1.599,P>0.05)。术前角膜散光与眼散光有统计学相关性(r=0.527,P<0.01),但术后无统计学相关性(r=-0.024,P>0.05)。<15°组术后散光矫正效果较好,2组间有统计学意义(t=-2.017,P<0.05)。术后眼散光量与偏心量有统计学相关性(r=0.395,P<0.01),而角膜散光则与偏心量没有统计学相关性(r=-0.133,P>0.05)。结论眼散光和角膜散光轴的差异影响LASIK矫正散光的效果。LASIK术后角膜形态改变,角膜散光与眼散光之间的关系也发生改变。     

PRK与LASIK矫正近视性散光准确性及预测性的比较

目的：评价对比准分子激光屈光性角膜切削术（PRK）与准分子激光原位角膜磨削术（LASIK）矫治近视性散光的疗效及预测性，进一步分析两种手术在治疗中存在的问题。方法：采用LASIK及PRK，对40例近视散光患者进行了分组治疗。结果：近视球镜矫正的准确性，LASIK组高于PRK组；近视散光度数的矫正及散光轴位矫正的准确性两组无明显改变；术后6个月裸眼视力达到或超过术前最佳矫正视力眼，LASIK组大于PRK组；解膜表面规则性指数（SRI）及角膜表现非规则性指数（SAI）在手术前后的变化，LASIK及PRK组无明显差异。结论：LASIK治疗近视性散光的疗效优于PRK。     

白内障手术切口对角膜原有散光的影响

目的评价小切口常规白内障手术联合角膜缘松解切口矫正散光的效果。方法对角膜散光>1.00D的30例(37眼)老年性白内障患者进行研究,以散光度数≥2.00D为A组,共11例(13眼);散光度数小于2.00D为B组,共19例(24眼)。两组患者均在角膜最大屈光径线上行角膜缘切口白内障囊外摘出联合人工晶状体植入术,A组患者再在白内障手术切口对侧角膜缘处行4mm穿透性切口。检测术前、术后1周、1个月、3个月角膜散光度数和视力变化。采用SPSS17.0统计学软件进行分析。结果术后1周、1个月、3个月,A组平均视力分别为0.57±0.07、0.67±0.07、0.67±0.06,B组分别为0.52±0.07、0.56±0.06、0.59±0.06,A组术后各时间段均优于B组。A组患者术前平均散光度数为(3.06±0.89)D,术后1周、1个月、3个月平均散光度分别为(1.58±0.18)D、(1.18±0.17)D、(1.03±0.22)D,手术前后散光度数差异均有统计学意义(均为P<0.05)。B组患者术前平均散光度数为(1.69±0.17)D,术后1周、1个月、3个月平均散光度数分别为(0.67±0.04)D、(0.47±0.05)D、(0.26±0.13)D,手术前后散光度数差异有统计学意义(均为P<0.05)。术后3个月,A组患者角膜散光平均矫正量为(2.08±0.08)D,B组患者角膜散光平均矫正量为(1.42±0.02)D,A、B两组患者手术散光矫正量差异有统计学意义(P<0.05)。结论小切口常规白内障手术联合对侧角膜缘穿透性松解切口可以更大范围地矫正术前已存在的角膜散光,提高患者裸眼视力和减少患者的不适。     

国人近视人群角膜前表面散光与眼球散光的定量分析

目的:研究国人近视人群角膜前表面散光与眼球散光的关系,为眼屈光手术设计提供参考。方法:连续性资料358眼。采用日本TOMEY公司的TMS-4角膜地形图仪进行角膜前表面地形图检查,获取角膜前表面散光度数及轴向;用日本TOPCON公司的RM8000自动电脑验光仪进行散瞳验光,获取眼球散光度数和轴向。结果:眼球散光与角膜前表面散光的比值为0.811±0.665;眼球散光<0.50D者150眼,散光度数差异、散光轴向差异均有统计学意义;散光度数、散光轴向均正相关;0.50D≤眼球散光<1.00D者122眼,散光度数差异有统计学意义;轴向差异无统计学意义;散光度数无相关性,散光轴向正相关;眼球散光≥1.00D者86眼,散光度数差异无统计学意义;散光轴向差异有统计学意义;散光度数、散光轴向均正相关。结论:角膜后表面及晶状体对角膜前表面散光有一定的补偿作用;角膜前表面散光与眼球散光正相关,散光度数越高,相关程度越高;角膜屈光手术根据眼球散光进行手术设计可能较好,屈光性晶状体置换术及白内障手术可根据角膜前表面散光确定手术切口位置。     

LASIK术后的散光矢量分析

目的采用矢量法分析准分子激光原位角膜磨镶术（LASIK）术后散光产生的规律。方法选取249眼行LASIK矫正近视散光,分成低散光眼组（〈-1.00 D）和相对高散光眼组（-1.00--4.00 D）,术后随访6个月。用标准分析方法对术前和术后的散光进行评估和统计。结果术后71.9%患者仍存在散光,低散光组散光下降了54.6%,相对高散光组下降了78.5%,二者差异有统计学意义（P〈0.05）。轴向改变大部分〉30°,手术矫正散光的量（SIRC）与目标矫正散光（IRC）呈正相关（r=0.93,P〈0.01）,术后残余散光的量（EV）与目标矫正散光（IRC）呈正相关（r=0.60,P〈0.01）。术前散光度越高,手术矫正散光的轴向误差（EA）越小,数量误差的绝对值（EM）也越大。角度误差的绝对值（EA）绝大部分〈15°,尤其是相对高散光眼组。结论为了减少术后散光,需提高术中矫正散光轴向的准确性。     

“T”切口矫正白内障合并角膜高度散光的临床观察

目的评价超声乳化白内障摘出术中"T"形切口矫正术前角膜散光的作用。方法年龄相关性白内障患者39例(46眼),所有患者术前角膜散光度(角膜地形图检查)均>2.00D。随机将患者分为2组:A组18例(23眼),B组21例(23眼)。A组患者行透明角膜3.0mm切口超声乳化白内障摘出联合后房型人工晶状体植入术,B组患者首先完成同A组的手术操作,然后以最陡峭子午线为中心,可调钻石刀作成对横切口,即"T"形切口。观察术后1周、1个月、3个月患者的裸眼视力、角膜散光情况及散光轴向。结果 A组患者术前平均角膜散光度数为(2.43±0.34)D,术后1周、1个月、3个月平均角膜散光度数分别为(2.53±0.31)D、(2.46±0.27)D、(2.41±0.28)D,手术前后散光度数差异均无统计学意义(均为P>0.05)。B组患者术前平均角膜散光度数为(2.44±0.45)D,术后1周、1个月、3个月平均角膜散光度数分别为(1.85±0.58)D、(1.46±0.46)D、(1.36±0.47)D,手术前后散光度数差异均有统计学意义(均为P<0.01)。术后各时间点A组与B组平均角膜散光度数比较,差异均有统计学意义(P<0.05或P<0.01),B组角膜散光低于A组。两组术后各时间点手术源性散光、散光轴向构成比比较,差异均无统计学意义(均为P>0.05)。结论角膜散光>2.00D的患者在行白内障手术时联合角膜"T"切口,矫正了部分术前散光,视力恢复好,提高了患者的视觉质量。     

LASIK治疗近视合并中高度散光临床观察

目的:探讨准分子激光原位角膜磨镶术(LASIK)治疗近视合并中高度散光的安全性和有效性。方法:应用德国Wavelight公司的鹰视准分子激光治疗系统对62例83眼近视合并中高度散光(≥-2.00D)患者进行LASIK治疗。随访6mo,比较手术前后的视力、屈光度、散光及其散光轴位的变化。结果:术后6mo,视力在0.8以上(≥0.8)和1.0以上(≥1.0)者分别为78%和47%,裸眼视力≥术前最佳矫正视力(BCVA)57眼(69%),散光度数在±1.00以内64眼(77%),残留散光平均为-0.80D,散光矫正(±0.50以内)37眼(45%)。结论:LASIK治疗近视合并中高度散光效果明显,患者术后满意度高。     

Epi-LASIK和LASIK治疗近视散光的早期疗效对比观察

目的:探讨分析角膜微型刀上皮瓣下准分子激光原位角膜磨镶术(epipolis laser in situ keratomileusis,Epi-LASIK)和准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)治疗近视散光的疗效。方法:近视散光行Epi-LASIK治疗的患者32例64眼,LASIK治疗的患者63例126眼,将患者根据柱镜度数分为2组:Ⅰ组(柱镜-0.25～-2.75D,Epi-LASIK 20例、LASIK 48例)、Ⅱ组(柱镜-3.00～-5.00D,Epi-LASIK 12例、LASIK 15例)。随访6mo观察两种术式的疗效。对比两组患者的术后裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)、残余散光度、角膜愈合情况、眼压及角膜地形图等。结果:术后6mo,Ⅱ组中UCVA较术前明显提高,EpiLASIK为21眼(87.5%),LASIK为19眼(63.3%),两术式相比较差异有显著性(χ2=4.055,P<0.05);残余散光度Epi-LASIK为-0.41±0.30D,LASIK为-0.74±0.36D,两术式相比较差异有显著性(t=2.672,P<0.05);角膜散光Epi-LASIK为0.63±0.34D,LASIK为0.81±0.52D,两术式相比较差异有显著性(t=2.234,P<0.05)。结论:Epi-LASIK治疗≥-3.00D散光与LASIK相比具有更好的效果和预测性。     

LASIK治疗近视散光的临床观察

目的:观察准分子激光原位角膜磨镶术(laser in situ kera-tomileusis,LASIK)治疗近视散光的临床疗效。方法:应用鹰视准分子激光治疗系统对120例234眼近视散光进行LASIK手术治疗。随访12mo,比较手术前后的视力、屈光度、散光及其散光轴位的变化。结果:术后随访12mo,裸眼视力≥术前最佳矫正视力(BCVA)者108例213眼(91%),屈光度在±1.00D以内者112例222眼(94.8%),散光残留平均为-0.52D。结论:LASIK治疗近视散光效果好,稳定性高,安全可靠。     

实时虹膜识别技术在准分子激光原位角膜磨镶术矫正中高度近视性散光中的应用

目的 评价实时虹膜识别技术在准分子激光原位角膜磨镶术(LASIK)矫正中高度近视性散光中的价值.方法 采用随机对照研究,接受实时虹膜识别引导LASIK手术的近视性散光49例(90眼)作为试验组,接受常规LASIK手术的近视性散光49例(91眼)作为对照组.对两组术后1个月、3个月、6个月的裸眼视力、最佳矫正视力、散光度、散光轴向等进行比较.结果 静态虹膜识别检测出眼球旋转偏移角度为2.83°±2.65°,动态虹膜识别检测眼球旋转变化范围为0°～6°.术后6个月时,试验组裸眼视力≥术前最佳矫正视力86眼(95.6％)多于对照组75眼(82.4％)(P＜0.01);试验组的平均散光(-0.29 ±0.23)D低于对照组(-0.45 ±0.31)D(P ＜0.05).术后6个月,试验组无散光眼40眼(44.4％)多于对照组26眼(28.6％)(P＜0.05);对照组斜轴散光明显增加.结论 实时虹膜识别技术能够有效校正LASIK术前和术中的眼球旋转偏差,使散光度数和轴向的治疗更加精确.     

Effect of refractive and topographic astigmatic axis on LASIK correction of myopic astigmatism

PURPOSE: To evaluate whether agreement or disagreement between the axis of astigmatism as determined by refraction and corneal topography has any influence on the outcome of laser in situ keratomileusis (LASIK) correction of astigmatism. METHODS: Charts of 122 consecutive eyes of 75 patients (46 women and 29 men) who underwent uncomplicated, primary LASIK for myopic astigmatism were reviewed. The series was divided into two groups--group 1, "agreement" (77 eyes) with a difference between refractive and topographic axis of astigmatism < or = 15 degrees, and group 2, "disagreement" (45 eyes) with a difference > 15 degrees. RESULTS: The mean difference in axis of astigmatism was 10 +/- 17.20 degrees (range: 0 degrees to 86 degrees), and 63.11% of eyes were within a 15 degrees difference. A significant negative correlation was found between the percentage of corrected astigmatism and the degree of disagreement. The percentage of corrected astigmatism differed significantly between the two groups (P=.002) with better results in group 1 (agreement). CONCLUSIONS: Disagreement between refractive and topographic astigmatic axis is common. Approximately one third of eyes with astigmatism have > 15 degrees disagreement. Disagreement between refractive and topographic determination of the astigmatic axis can be considered a prognostic factor for LASIK correction of myopic astigmatism.     

Toric与球面人工晶状体临床效果的对比研究

目的:对比植入AcrySof Toric人工晶状体与AcrySof球面人工晶状体术后的临床效果。方法:收集确诊为老年性白内障并伴有规则角膜散光的患者56例63眼,按照患者自愿原则,分别植入AcrySof Toric人工晶状体(实验组)27例30眼;AcrySofNatural球面人工晶状体(对照组)29例33眼。均施行白内障超声乳化摘除联合人工晶状体植入术,随访时间6mo。观察两组患者术后裸眼远视力、最佳矫正远视力、术前术后角膜散光变化情况、术后散光、AcrySofToric人工晶状体轴位稳定性。结果:两组患者术后1wk,6mo裸眼视力,实验组明显优于对照组,比较差异均有统计学意义(P<0.05),两组患者术后1wk,6mo散光比较差异均有统计学意义(P<0.05)。两组患者术前与术后6mo的角膜散光比较,差异均无统计学意义。术后AcrySof Toric IOL的轴位移动度,术后1d;1wk;1,6moIOL平均轴位移动度分别为:(4.22±1·69)°,(4.64±1.97)°,(4.87±1.91)°,(5.39±1·56)°,差异无统计学意义(F=2.259,P>0.05)。术后6mo96.67%的患眼轴位移动度<10°。结论:与普通球面人工晶状体比较,AcrySof Toric人工晶状体能安全、有效、稳定矫正白内障患者的角膜散光,具有良好的轴位移动稳定性。     

实时虹膜识别联合波前引导LASIK治疗中高度近视性散光

目的:评价实时虹膜识别技术应用在波前引导准分子激光原位角膜磨镶术（laser in situkeratomileusis, LASIK）治疗中高度近视性散光中的准确性、稳定性。方法:采用随机对照研究,接受实时虹膜识别联合波前引导LASIK手术的近视性散光患者57例104眼作为试验组,接受常规波前引导LASIK手术的近视性散光患者58例107眼作为对照组,对两组患者术后1,3,6mo的裸眼视力、最佳矫正视力、散光度、散光轴向、波前像差等进行比较。结果:静态虹膜识别检测出眼球旋转偏移角度为2.61°±2.08°,动态虹膜识别检测眼球旋转变化范围为0°～5°。术后6mo时,试验组裸眼视力≥术前最佳矫正视力的患者（96眼,92.3%）多于对照组（78眼,72.9%）,差异有统计学意义(P＜0.01);试验组的平均散光（-0.28±0.26D）低于对照组(-0.44±0.35D),差异有统计学意义(P＜0.05)。术后6mo,试验组无散光眼（49眼,47.1%）多于对照组（31眼,29.0%）, 差异有统计学意义(P＜0.01)。当瞳孔直径为6mm时,试验组彗差的增加少于对照组,差异有统计学意义(P＜0.01)。结论:实时虹膜识别技术能够有效校正LASIK术前和术中的眼球旋转偏差及瞳孔中心移位,使散光度数和轴向的治疗更加精确,同时提高视觉质量。     

Toric工晶状体治疗白内障合并角膜散光疗效观察

目的：应用角膜曲率联合角膜地形图检查测量角膜曲率,采用个性化手术源性散光值,计算人工晶状体型号及轴位,在白内障手术中植入散光型人工晶状体来矫正角膜散光并观察疗效。 方法：收集白内障并伴有角膜规则散光的病例43眼,手术中采用白内障超声乳化术植入AcrySof Toric IOL,并放置IOL于目标轴位,观察术后屈光结果。 结果：术后随访3mo,33眼使用T5以下人工晶状体,85%患者裸眼视力＞0.5,70%患者裸眼视力＞0.8术后角膜散光由术前的1.64±0.53D降至0.63±0.32D,10眼应使用T6,T 7,但使用T5裸眼视力均＞0.5,残余散光接近预测值。术后3mo观察,43眼术后第1d平均轴位偏离465°±4.21°,84% IOL轴位偏离＜10°,3mo平均旋转116°±184°,100% IOL旋转＜10°。 结论：应用角膜曲率联合角膜地形图检查测量角膜曲率,采用个性化手术源性散光值,计算人工晶状体型号及轴位,植入AcrySof Toric IOL能有效地矫正角膜散光,并具有良好的囊袋内稳定性。     

Laser in situ keratomileusis for myopic astigmatism

PURPOSE: To evaluate the refractive results of laser in situ keratomileusis (LASIK) for myopic astigmatic eyes, and to assess the efficacy, accuracy, stability, and safety of the procedure. METHODS: LASIK was performed on 113 eyes of 73 patients for correction of myopic astigmatism ranging from 1.00 to 5.00 D, as measured by manifest refraction, with a mean baseline refractive astigmatism of 2.09 +/- 1.12 D. The Chiron Automated Corneal Shaper was used to create a corneal flap, and laser ablation was performed using the Chiron-Technolas Keracor 116 excimer laser. Follow-up time was 12 months for all eyes. RESULTS: Refractive astigmatism was stable by 3 months after surgery. At 1 year after LASIK, refractive astigmatism was reduced to a mean of 0.25 +/- 0.31 D (range 0 to 1.00 D). Sixty-one eyes (54%) had no residual astigmatism and 98 eyes (86.7%) had 0 to 0.50 D of refractive astigmatism. The mean percent reduction of preoperative astigmatism was 87.9 +/- 14.9%. The mean axis deviation of the surgically induced astigmatism was 2.1 +/- 3.1 degrees, with 96 eyes (84.9%) within 5 degrees of the desired axis. The percent correction of preoperative astigmatism in the proper axis was 97.1 +/- 15.5%. Spectacle-corrected visual acuity improved by 2 lines in 11 eyes (9.7%), and was reduced by 1 line only in 1 eye. There were no other significant complications. CONCLUSION: LASIK with the Chiron-Technolas Keracor 116 excimer laser was effective for correction of myopic astigmatism, with good stability after 3 months. The results were predictable with an acceptable degree of accuracy. LASIK is a safe procedure with very few complications.     

Laser in situ keratomileusis for the correction of myopia and myopic astigmatism

PURPOSE: To evaluate the efficacy, safety, predictability, and surgically induced astigmatism (SIA) of laser in situ keratomileusis (LASIK) for the correction of myopia and myopic astigmatism. SETTING: Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan. METHODS: This retrospective study comprised 69 eyes that had LASIK to correct myopia and 74 eyes that had LASIK to correct myopic astigmatism. The excimer laser keratectomy was performed using a Summit Apex Plus machine. Refraction, visual acuity, and computerized corneal videokeratography data from the preoperative and postoperative examinations were collected. The astigmatic change was calculated by the Alpins vector analysis method. RESULTS: The preoperative spherical equivalent at the glasses plane in the myopia and myopic astigmatism groups was -8.08 diopters (D) and -9.73 D, respectively. At 6 months, the spherical equivalent and residual corneal astigmatism were -0.25 D and 0.85 D, respectively, in the myopia group and -0.71 D and 0.82 D, respectively, in the myopic astigmatism group. In the myopia group, 88% of eyes were within +/-1.0 D of the intended myopia correction and in the myopic astigmatism group, 85% were within +/-1.0 D of the targeted spherical equivalent and 90% were within +/-1.0 D of the intended astigmatism correction. The uncorrected visual acuity was 20/40 or better in 94.1% of eyes in the myopia group and 92.5% of eyes in the myopic astigmatism group. The SIA magnitude was 0.66 D with the axis randomly distributed in the myopia group. The mean astigmatism correction index was 0.97, the mean magnitude of error was 0.13 D +/- 0.62 (SD), and the mean angle of error was -3.70 +/- 13.73 degrees in the myopic astigmatism group. CONCLUSION: Laser in situ keratomileusis had similar predictability, safety, and efficacy in the treatment of myopia and myopic astigmatism. The astigmatism correction was effective, but the results suggest that subjective astigmatism of less than 1.0 D need not be treated with the Summit Apex Plus laser.     

Acrysof Toric人工晶状体植入矫正白内障术前角膜散光的短期观察

目的 评价超声乳化白内障吸除术中Acrysof Tofic人工晶状体(IOL)植入矫正白内障伴术前角膜散光的早期临床效果,及其有效性、安全性和预测性.方法 前瞻性病例系列研究.植入Acrysof Toric IOL的年龄相关性白内障患者60例(71只眼),观察其术前、术后的IogMAR裸眼视力、最佳矫正视力、术前角膜散光、术后残留散光、术后残留球镜、IOL轴位等.术后残留散光根据柱镜轴向分为散光全矫,残留斜轴散光(45°/135°±30°),残留顺规散光(90°±15°),残留逆规散光(180°±15°),并收集各类散光组中散光为0.50～0.75 D者的裸眼远近视力.随访3个月.采用非参数检验秩和检验和Friedman检验等对数据进行统计学分析.结果 裸眼远视力中位数:术前为0.80;术后3个月为0.20.散光中位数:术前为2.02 D,术前预计残留散光为0.34 D,术后3个月为0.67 D.IOL术后1 d定位和预计轴位差值为1.58°±2.30°.3个月时旋转1.63°±1.83°,96%旋转小于5.00°.未发现一例手术并发症.裸眼近视力中位数:散光全矫组0.50,残留顺规散光组0.50,残留逆规散光组0.21,残留斜轴散光组0.30;裸眼远视力中位数:散光全矫组0.10;残留顺规散光组0.26;残留逆规散光组0.15.残留斜轴散光组0.20;非参数统计分析结果提示:裸眼远视力,残留逆规散光组与顺规散光组比较,差异具有统计学意义(t=4.00,P=0.000),而与斜轴散光组,散光全矫组之间的差异无统计学意义(t=0.49,P=0.623;t=2.00,P=0.061);裸眼近视力,逆规散光组最佳,而且与顺规散光组,斜轴散光组,散光全矫组的差异均具有统计学意义(t分别为6.95,2.60,6.52,P分别为0.000,0.011,0.000).结论 超声乳化白内障吸除术中Acrysof Toric IOL植入是一种有效、安全,可预测的矫正年龄相关性白内障伴术前角膜散光的方法.术后残留少量的逆规近视性散光可以在不明显影响裸眼远视力基础上获得较好的裸眼近视力.     

飞秒激光联合对称弧形角膜切口对白内障合并角膜散光患者的治疗效果

目的 评估飞秒激光联合对称弧形角膜切口对白内障合并角膜散光患者的治疗效果。方法 前瞻性研究。收集43例(57眼)白内障合并≥0.75 D角膜规则散光的患者,均行飞秒激光超声乳化白内障手术,术中同时采用对称弧形角膜切口矫正角膜散光。弧形切口设置在角膜直径中央8.0 mm处,深度为角膜厚度的85%,术中开口器分离弧形切口。术前及术后均采用Pentacam三维眼前节分析系统记录角膜散光。采用Alpins矢量法分析术后角膜散光变化,并分析散光类型、年龄与散光矫正效果的相关性。结果 术中及术后所有患者均未出现角膜穿透、上皮损伤、角膜上皮增生、切口感染等并发症。术前患眼角膜散光为(1.23±0.31)D,术后3个月患眼角膜散光下降到(0.85±0.34)D,差异有统计学意义(t=4.645,P=0.000)。对患者手术前后角膜散光的变化进行矢量分析,结果显示,目标诱导散光为0.80～2.10(1.23±0.31)D,手术诱导散光为0.00～1.80(0.68±0.45)D,差异向量为0.26～1.70(0.89±0.42)D,矫正指数为0.00～1.01(0.55±0.27),理想值为1,提示总体...