LASIK术后主导眼及其视力变化对视觉舒适度影响的研究

目的:评价LASIK术前近视眼患者主导眼分布、术后主导眼及其视力变化对视觉舒适度的影响。方法:选择拟行LASIK手术的近视眼患者118例(236眼),术前用卡洞法行主导眼检查,全部患者分别在术后2,4wk;2,3mo检查主导眼眼别及主导眼和非主导眼的视力;术后2mo按主导眼和非主导眼的视力情况分4组,接受近距离工作主觉症状及远距离视疲劳症状调查表的调查。结果:LASIK术前近视眼患者主导眼分布以右眼为主(70.3%);术前主导眼眼别与最佳裸眼视力眼别一致性差(n=67,kappa值=0.148,P=0.140),两者符合率为55.2%;术前主导眼眼别与最高屈光度眼眼别一致性差(n=109,kappa值=-0.16,P=0.007),两者符合率为42.2%;118例近视眼患者LASIK术后第2,4wk;2,3mo均未出现主导眼眼别的调换;4组比较而言,LASIK术后主导眼视力变化对视觉舒适度未产生显著影响。结论:近视人群主导眼分布以右眼为主,且主导眼与性别、最佳裸眼视力眼眼别、屈光度高低无显著相关;近视眼患者LASIK术后3mo主导眼眼别未发生改变;LASIK术后部分患者主导眼与非主导眼视力发生变化,这种变化对视觉舒适度未产生影响。     

近视性屈光参差主导眼的屈光状态及其调节功能

目的 研究近视性屈光参差主导眼与近视程度的关系以及主导眼与非主导眼调节功能分析,探讨屈光参差的成因及其发展原因。设计 回顾性病例系列。研究对象 8～35岁近视性屈光参差患者59例,根据屈光参差程度,将其分为低度屈光参差（1.00 D≤双眼等效球镜度差≤2.50 D）和高度屈光参差（双眼等效球镜度差>2.50 D）两组。方法 对各组别患者应用简化双手卡洞法测定双眼中的主导眼眼别。使用综合验光仪测定患者单、双眼正/负相对调节及其比值（PRA/NRA）。采用改良移近法及正负球镜翻转法分别测量单、双眼的调节幅度和调节灵活度。主要指标 主导眼眼别与屈光度大的眼别的相关性。单、双眼正/负相对调节及其比值（PRA/NRA）,单、双眼的调节幅度和调节灵活度。结果 低度屈光参差患者26例,主导眼为右眼者22例（84.5%）;主导眼平均屈光度为（-4.01±1.96）D,非主导眼为（-3.19±1.80）D,平均参差程度（1.76±0.21）D。主导眼屈光度高于非主导眼（z=-2.37,P=0.02）。高度屈光参差患者33例,主导眼为右眼者21例（63.6%）;主导眼平均屈光度为（-3.90±2.84）D,非主导眼平均屈光度为（-3.47±2.20）D,平均参差程度（3.40±0.81）D。主导眼与非主导眼屈光度比较无统计学差异（z=-0.57,P=0.57）。低度屈光参差组主导眼平均正相对调节为（-2.68±1.44）D,非主导眼为（-3.29±1.31）D,差异有统计学意义（z=-2.27,P=0.02）;高度屈光参差组主导眼平均正相对调节为（-3.14±1.84）D,非主导眼为（-4.10±1.59） D,差异有统计学意义（z=-3.54,P=0.00）。低度屈光参差组主导眼平均PRA/NRA绝对值为（1.15±0.58）,非主导眼为（1.36±0.52）,差异无统计学意义（z=-1.89,P=0.06）;高度屈光参差组主导眼平均PRA/NRA绝对值为（1.34±1.57）,非主导眼为（1.74±0.62）,差异有统计学意义（z=-3.03,P=0.00）。结论 低度近视性屈光参差患者主导眼屈光度较非主导眼高;不同程度的屈光参差患者主导眼PRA及PRA/NRA低于非主导眼。（眼科,2016, 25： 102-105）     

学龄儿童握笔姿势与双眼屈光度差异的关系

目的 通过临床观察儿童握笔姿势,探讨儿童不正确握笔与双眼近视性屈光度差异的相关性.方法 横断面研究.排除在南京市中西医结合医院眼科建立屈光档案的儿童中患弱视、斜视及散光大于1.0 D者,按男女比1:1随机抽取经确认握笔姿势正确和不正确的儿童各100例.通过睫状肌麻痹验光数据比较左右眼屈光度差值,以左眼等效球镜度减去右眼等效球镜度的代数值进行统计.对两组左右眼屈光度差值是否存在差异进行Wilcoxon秩和检验.结果 握笔错误组右眼近视度偏高,与握笔正确组相比差异有统计学意义(Z=-10.33,P＜0.01),且握笔错误组右眼屈光度比左眼高.结论 儿童不正确的握笔姿势可能是导致双眼屈光度差异的原因之一,可导致右眼近视度数偏高.     

形觉剥夺在儿童近视中的表达

目的:通过调查处于生长发育期的儿童由于各种原因的形觉剥夺会否造成双眼在近视发生、发展中的不一致,从临床层面上证实形觉剥夺性近视,揭示近视发病的环境因素和机制,从而采取有效措施进行防治。方法:抽取门诊近视患儿114例,均常规行视力、眼位、主导眼、眼底、裂隙灯、规范的散瞳检影等检查,并通过问诊了解家族史及是否存在剥夺因素。比较双眼的视力、屈光度,并就形觉剥夺眼与屈光度的高低进行相关性统计分析。结果:双眼视力(P=0.000)及屈光度(P=0.006)均存在显著性差异,即形觉剥夺眼与双眼屈光度高者相关(P=0.005)。结论:处于生长发育期的儿童由于各种原因的单眼形觉剥夺可以造成双眼近视发生不一致,剥夺眼近视发生早,屈光度高。应引起重视并积极采取有效措施进行早期干预。     

近视回归镜控制青少年近视发展的临床观察

目的:临床观察近视回归镜对青少年近视发展的防治作用。方法:随机选取52例在我院视光中心就诊的年龄在9~18岁近视患者配戴近视回归镜作为治疗组,观察裸眼视力变化,屈光度变化,眼轴长度及角膜曲率变化情况.并与52例年龄及屈光度相似的近视患者配戴框架眼镜作为对照组,观察时间12mo。结果:治疗组屈光度增加<0.50D者38例(76眼)有效率73.1%,对照组屈光度增加<0.50D者18例(36眼)有效率34.6%,两组间有显著差异(P<0.01);治疗组裸眼视力下降<2行者39例(78眼)有效率73.6%,对照组裸眼视力下降<2行者10例(20眼)有效率19.2%,两组间差异有显著性(P<0.05);眼轴长度及角膜曲率值变化治疗组与对照组之间无明显差别。结论:近视回归镜对青少年近视发展有延缓作用。     

手术矫治近视性屈光参差后双眼视觉的远期效果观察

目的 探讨LASIK手术矫治近视性屈光参差对视功能的远期影响,从双眼视觉方面评价其临床应用价值.设计回顾性病例系列.研究对象接受LASIK手术的近视性屈光参差(两眼屈光参差≥2.50D)患者30例(57眼).方法 应用VISXSTAR-S4型准分子激光机行LASIK手术,随访24～44个月,平均(31.1±6.2)个月.主要指标手术前后裸眼视力(UCVA)、最佳矫正视力(BSCVA)以及双眼视功能.结果 术后2年时的裸眼视力达到0.8以上者54眼(94.74%).手术后双眼屈光参差度数(0.69±0.77 D)较手术前(5.17±2.50 D)明显降低(P=0.041).手术前、后存在同时视、融合、远立体视者分别为24例、29例(P=0.059),8例、29例(P=0.000),1例、16例(p=0.000).术前戴框架眼镜矫正与LASIK手术后比较,近立体视正常者分别为4例、11例,近立体视异常者分别为15例、15例,立体视缺失者分别为11例、4例,差异有统计学意义(P=0.038).结论 LASIK治疗近视性屈光参差的远期疗效稳定,不仅可以提高患者的裸眼视力,对其双眼视功能的恢复也有促进作用.     

准分子激光角膜切削术治疗近视及近视散光远期疗效观察

目的:评价准分子激光角膜切削术治疗近视、近视散光的远期疗效,分析术后远期视力回退的相关因素。方法:测量、比较79例(137眼)不同程度的近视及近视散光患者PRK术后1和7a的视力、屈光度、角膜屈光力、角膜厚度、角膜Haze变化,并对术后视力回退的影响因素进行分析及回归分析。结果:术后7a视力、屈光度与术后1a比较差异均有显著意义(P <0.05);术后不同时期屈光度低组与高组比较视力及屈光度差异均有非常显著意义(P <0.01)。角膜厚度术后7a较术后1a差异有非常显著意义(P <0.01),角膜屈光力差异无显著意义(P >0.05)。术后裸眼视力回退(Y)与术后等效球镜屈光度变化(X)呈正相关(r =0.49,P <0.01),与术前球镜屈光度呈负相关(r =-0.20,P <0.05),建立多元逐步回归方程为:Y =0.08 0.12X。结论:PRK术后远期视力及屈光度均有轻度回退,以高度近视眼明显,影响术后远期视力回退的主要因素是术后屈光度的变化。     

单眼视设计的人工晶状体眼视功能临床研究

目的 探讨应用单眼视原理设计双眼白内障超声乳化联合植入单焦点人工晶状体术后的视功能情况.方法 对双眼年龄相关性白内障患者42例(84只眼),分为常规组21例(42只眼)及单眼视组21例(42只眼).常规行白内障超声乳化联合折叠式人工晶状体植入术.分别记录术前最佳矫正视力及术后1周单眼裸眼远、近视力及双眼裸眼远、近视力.采用SAS8.2统计软件对结果进行统计学分析.结果 (1)术前平均最佳矫正视力常规组4.44,单眼视组4.47(P ＞0.05),患者平均年龄常规组71岁,单眼视组69.5岁(P ＞0.05),差异无统计学意义.(2)术后1周单眼裸眼远视力常规组4.90,单眼视组:优势眼4.94(P ＞0.05),与常规组比较差异无统计学意义;非优势眼4.71(P < 0.05),与常规组比较差异有统计学意义.术后1周单眼近视力常规组4.36,单眼视组:优势眼4.37(P＞0.05),与常规组比较差异无统计学意义;非优势眼4.78(P < 0.05),与常规组比较差异有统计学意义.(3)术后1周双眼裸眼远视力常规组4.91,单眼视组4.91(P ＞0.05),与常规组比较差异无统计学意义;术后1周双眼近视力常规组4.42,单眼视组4.78(P < 0.05),与常规组比较差异有统计学意义.结论 单眼视设计的人工晶状体眼术后双眼远视力与常规设计人工晶状体眼相同,但近视力明显好于常规设计.按照单眼视原理设计人工晶状体可以较好的临床应用.     

植入ReSTOR阶梯渐进衍射型人工晶状体的临床效果

目的 研究3种不同屈光状态白内障眼植入ReSTOR阶梯渐进衍射型多焦点人工晶状体（MIOL）的临床效果。方法 前瞻性临床研究。白内障患者28例（42眼）,按眼轴长度将这42眼分为近视（17眼）、正视（15眼）、远视（10眼）3组。所有患者均在白内障超声乳化术中植入ReSTOR MIOL,术后6个月比较3组患者的裸眼远视力、最佳矫正远视力、裸眼近视力、最佳矫正近视力、高对比度及低对比度下的裸眼及最佳矫正中间距离视力;结合患者术后的残留屈光度,分析常用的3种人工晶状体计算公式对术后屈光度的预测性;对患者术后满意度、脱镜率及术后视觉不良症状进行问卷调查。采用单因素方差分析及卡方检验对结果进行分析。结果 3组患者术后裸眼及矫正远、中、近视力差异均无统计学意义,所有患者平均裸眼及矫正中间距离视力稍低于远、近视力,尤其是低对比度中间距离视力。术后3组的残留屈光度中,近视组与正视组、近视组与远视组之间差异有统计学意义（F=8.33,P＜0.05）。在近视组,Haigis公式及Holladay I公式计算的术后预期屈光度与实际残留屈光度比较差异有统计学意义（P＜0.05）,SRK-T计算的术后预期屈光度与实际残留屈光度比较差异无统计学意义。3组患者对远、近距离的视力满意度差异无统计学意义,但远视组对中间距离视力的满意度要低于其他2组,差异有统计学意义（P＜0.05）。3组患者术后脱镜率、眩光及光晕等不良视觉症状的比较差异无统计学意义。结论 正视、远视及近视白内障患者植入ReSTOR MIOL后均能获得较好的术后视力、较高的脱镜率及较少的视觉不良症状。     

多焦点人工晶状体植入术后远期临床表现

目的:探讨多焦点人工晶状体Array植入术后远期的临床表现。方法:行超声乳化白内障吸除术的33例白内障患者,植入多焦点人工晶状体(试验组)19例25眼,植入单焦点人工晶状体(对照组)14例20眼。观察患者的术后远,中,近视力、立体视觉、不同距离下脱镜率。结果:裸眼近视力≥0.5者,试验组为17眼,占68%(17/25),对照组为6眼,占30%(6/20),两组比较差异有统计学意义(P<0.05);裸眼远视力≥0.5者,试验组为23眼,占92%(23/25),对照组为20眼,占100%(20/20),两组比较差异均无统计学意义(P>0.05)。中间视力:40cm:试验组得分为54.64±10.80,对照组得分为47.05±6.39,两组比较差异有统计学意义(P<0.05);63cm:试验组得分为50.36±10.32,对照组得分为46.50±8.32,两组比较差异无统计学意义(P>0.05);100cm:试验组得分为43.44±8.08,对照组得分为42.05±6.63,两组比较差异无统计学意义(P>0.05)。立体视觉:试验组6例双眼手术,6例立体视锐度均≤60″;对照组6例双眼手术,1例立体视锐度≤60″,两组比较差异有统计学意义(P<0.05)。视近如读书、看报时的戴镜率:试验组19例中有6例需要眼镜,对照组14例中有11例需要眼镜,两组比较差异有统计学意义(P<0.05)。结论:多焦点人工晶状体Array在术后很长时间内使患者拥有良好的全程视力,为双眼手术者提供良好的立体视觉,减少术后患者对眼镜的依赖,提高患者的生活质量。     

LASIK治疗近视性屈光参差性弱视

目的 评价准分子激光原位角膜磨镶术(laser in situ keratomileusis;LASIK)治疗近视性屈光参差性弱视的临床疗效.方法 用LASIK手术矫正8位近视性屈光参差性弱视患者,比较手术前后屈光不正的度数和立体视锐度的改变,并将术前的最佳矫正视力和术后第1天,第3天,第10天的裸眼视力以及6～9个月随访的裸眼视力和最佳矫正视力进行比较和分析.结果 术前屈光度数高眼的屈光不正的等效球镜平均为(-10.06±1.50)D,术后该眼屈光不正的等效球镜平均为(0.19±0.32)D.手术前后立体视锐度差别有统计学意义(z=-2.207,P=0.027).术前屈光度数高眼矫正视力和术后该眼矫正视力相比,差别有统计学意义(F=11.431;P=0.000).结论 LASIK手术能安全,有效地减少近视性屈光参差,提高患者的视力和立体视功能.     

Near vision after implantation of monofocal versus multifocal intraocular lenses

AIM: Object of this study was to compare the near visual acuity between eyes with monofocal intraocular lens (MONO) and myopic target refraction in comparison with eyes after refractive multifocal intraocular lens (MIOL) implantation and emmetropic to slight hyperopic target refraction. PATIENTS AND METHOD: 89 eyes of 83 patients underwent cataract surgery, in 49 eyes a MONO (SI-40NB, Allergan) was implanted, in 40 eyes a refractive MIOL (SA-40N, Allergan). At day 2 after surgery and after 5 months the uncorrected near visual acuity, the near visual aculty with distance correction and with an addition of +3 diopters (D) were determined. The refractive outcome targeted in case of MIOL implantation was emmetropia to slight hyperopia and myopia for the MONO subjects. The eyes with MONO were classified in 4 categories depending on their postoperative refractive error (spherical equivalent, SE): category 1 with SE +1 to > 0 D, category 2 with SE 0 to > -1 D, category 3 with SE -1 to > -2 D and category 4 with a SE -2 to > -3 D. RESULTS: We found a statistically significant better uncorrected near visual acuity in eyes with MIOL than in MONO subjects for category 1-3. In category 4 there was no statistically significant difference between MONO and MIOL. With best distance correction near visual acuity in MIOL was statistically significant better than in all 4 MONO categories. After adding 3 D, there was no statistically significant difference between the groups. CONCLUSION: Even in case of a myopic target refraction near visual acuity in eyes of the MONO group was statistically significant worse than in the eyes of the MIOL group. Only in case of postoperative SE of < or = -2 D eyes of the MONO group had a near visual acuity similar to the eyes of the MIOL group. This advantage is accomplished with a decrease in the uncorrected distance visual acuity.     

Bilateral comparison of photorefractive keratectomy for myopia using two excimer lasers.

PURPOSE: The aim of this study was to compare the results of excimer laser photorefractive keratectomy (PRK) in patients who underwent PRK using the Summit Apex (Omnimed) excimer laser in one eye and the Nidek EC-5000 excimer laser in the other. METHODS: All consecutive patients who underwent PRK with the Summit Apex laser (Omnimed) in one eye and the Nidek laser (EC-5000) in the second and had at least 12 months of follow-up were included in this retrospective study (n=30). Uncorrected and spectacle-corrected visual acuity, final spherical equivalent refraction, and grade of subepithelial haze were compared. The average preoperative spherical equivalent refraction of eyes treated with the Summit laser was -6.00 D (range, -2.50 to -8.75 D), and for Nidek-treated eyes it was -5.57 D (range, -2.50 to -8.80 D). RESULTS: Forty-seven percent of Summit-treated eyes and 53% of Nidek-treated eyes had uncorrected visual acuity of 6/6 or better; 61% of Summit-treated eyes and 63% of Nidek-treated eyes had uncorrected visual acuity of 6/7.5 or better; 95% of Summit-treated eyes and 95% of Nidek-treated eyes had uncorrected visual acuity of 6/12 or better (difference not statistically significant). Seventy-three percent of eyes treated with the Summit laser and 80% of eyes treated with the Nidek laser had a postoperative refraction within +/-0.50 D of emmetropia; 97% of Summit-treated eyes and 87% of Nidek-treated eyes had a postoperative spherical equivalent refraction within +/-1.00 D of emmetropia; the difference between the two lasers was not statistically significant. However, the percent of eyes with persistent hyperopia was smaller in the Nidek group after 3 months (P=.0062) and after 6 months (P=.07) than in the Summit group. Videokeratography was not done. CONCLUSION: Both lasers were effective with relatively low side effects. No significant difference was found between the two lasers in postoperative uncorrected visual acuity or refractive outcome. Eyes operated with the Nidek laser had less persistent hyperopia and stabilized earlier.     

Comparative analysis of visual quality between unilateral implantation of a trifocal intraocular lens and a rotationally asymmetric refractive multifocal intraocular lens

AIM: To compare visual quality after unilateral cataract surgery with implantation of trifocal intraocular lens (IOL) and asymmetric refractive multifocal IOL. METHODS: The prospective nonrandom, comparative study consisted of 60 eyes of 60 patients suffering unilateral cataract surgery with implantation of two different IOLs: AT LISA tri 839MP (30 eyes; Carl Zeiss Meditec, Germany) and LS-313 MF30 (30 eyes; Oculentis GmbH, Germany). Visual acuity, refractive outcome, contrast sensitivity, defocus curves, quality of vision, and optical phenomena were evaluated at 3mo postoperatively. RESULTS: There were no statistical differences between groups in uncorrected distance visual acuity (P=0.13) and uncorrected near visual acuity (P=0.54). In contrast, uncorrected intermediate visual acuity was better in trifocal group compared to the refractive multifocal group (P=0.02). No significant statistical between-group difference was detected in cylinder (P=0.43). Compared to trifocal group, spherical refraction and spherical equivalent in refractive multi focal group were more myopic (P<0.01). Under photopic conditions, no significant statistical differences were found between groups in contrast sensitivity at 3 and 6 cycles per degree (cpd). The refractive multifocal group performed better at 12 and 18 cpd than the trifocal group (P=0.01, P=0.034, respectively). The questionnaires of quality of vision and optical phenomena showed no differences between groups. CONCLUSION: Trifocal IOL is superior to refractive multifocal IOL in intermediate visual acuity. Rotationally asymmetric refractive multifocal IOL is more myopic in automated refraction and significantly better for the photopic contrast sensitivity at high frequency.     

Combined refractive lensectomy and laser in situ keratomileusis to correct extreme myopia

Refractive lensectomy followed by laser in situ keratomileusis (LASIK) was performed in both eyes of a severely myopic patient. An uncorrected visual acuity of 20/20 was achieved in the right eye with a manifest refraction of plano -0.25 x 65. Intentional monovision correction of the left eye left a manifest refraction of -0.75 diopter. Best corrected visual acuity improved by 1 Snellen line to 20/20 in both eyes. Follow-up evaluation will be required to assess the long-term refractive stability and the incidence of retinal detachment after combined refractive lensectomy and LASIK.     

Correlation of visual and refractive outcomes between eyes after same-session bilateral laser in situ keratomileusis surgery

PURPOSE: To determine whether between-eye refractive and visual outcomes after same-session laser in situ keratomileusis (LASIK) surgery are correlated, and to determine whether suboptimal visual and refractive outcomes in one eye are predictive of poor results in the fellow eye. DESIGN: Observational case series. METHODS: Retrospective chart review. A total of 484 eyes of 242 patients met inclusion criteria of having undergone same-day LASIK surgery and having 3-month refractive and visual acuity outcomes. Statistical comparisons of outcomes were performed, including between-eye Pearson correlation analysis and logistic regression models for predicting second-eye outcome. Main outcome measures were 1-month, 3-month, and 6-month uncorrected visual acuity and manifest refraction. RESULTS: Refractive outcomes at 1, 3, and 6 months between first (right) and second eyes were not found to be significantly different. No difference in uncorrected or best spectacle-corrected visual acuity was observed between first and second eyes Refractive outcomes of spherical equivalent, sphere, and cylinder and visual outcomes of uncorrected and best spectacle-corrected visual acuity were highly correlated between the two eyes. Analysis of cases with suboptimal outcomes (> or =1 diopter from intended correction or uncorrected acuity equal to or worse than 20/40) suggests that a poor refractive or visual outcome in the first eye increases the risk of a poor outcome in the second eye by approximately 20-fold. CONCLUSIONS: Retrospective analysis of refractive and visual outcomes from patients undergoing same-session bilateral LASIK demonstrates a high correlation of refractive and visual outcome between the eyes.     

大龄近视患者LASIK疗效分析

目的：探讨大龄近视患者LASIK特点及采用Monovision矫正方法设计的LASIK术后疗效。

方法：对104例186眼大龄近视患者(年龄≥40岁)采用Monovision矫正方法设计并进行LASIK手术,并对术前后视力、屈光度、手术疗效等进行统计分析。

结果：术后1mo,所有术眼的裸眼视力均明显提高(P<0.01),达到1.0的百分率分别为非主导眼83.7%(87/104),主导眼91.5%(75/82); 术后裸眼视力与术前最佳矫正视力比较,非主导眼差异不显著(P>0.05),而主导眼提高明显(P<0.01); 术后屈光度非主导眼为-0.70±0.12D,与术前欠矫设计量基本一致(P>0.05),主导眼为-0.04±0.28D,两组差异显著(P<0.01); 患者对远视力满意度100%、近视力满意度82.7%。

结论：大龄近视患者行LASIK治疗以高度、超高度近视患者为主,大屈光参差(>2.50D)患者占比例较高; 采用Monovision矫正方法设计的LASIK术对改善大龄患者术后视近功能、缓解视疲劳以及提高其视觉满意度是切实有效的,将这一临床经验用于个体化手术方案的设计可以使其更为完善。     

Refractive surgery for unilateral high myopia in children

PURPOSE: To evaluate the safety and efficacy of refractive surgery in children. METHODS: Pediatric patients with unilateral high myopia who were 9 years of age or older were offered refractive surgery to supplement optical correction. The patients and families were informed that the operation may not improve their best-corrected visual acuity. Photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK) was performed on the more myopic eye with the use of topical anesthesia. Cycloplegic refraction, stereopsis, motility, and best-corrected visual acuity were measured before the procedure and at 2 months and 20 months after the procedure. All patients had completed amblyopia therapy before surgery. RESULTS: Fourteen eyes of 14 patients aged 9 to 14 years received refractive surgery. Average age at the time of surgery was 11.9 years (+/-1,6). Average corrected preoperative visual acuity was 20/147 (+/-0.065 in decimals). Average preoperative refraction was -7.96 D (+/-2,16) spherical equivalent. Twenty months after refractive surgery, the uncorrected visual acuity averaged 20/129 (+/-0.08 in decimals) and best-corrected vision averaged 20/121 (+/-0.08 in decimals). Average refraction was -0.46 D (+/-0,58) at 2 months and -0.67 D (+/-0,68) D at 20 months. An average myopic shift in refraction of -0.22 D was found in treated eyes during the 20 months of follow-up; this was not statistically significant (P =.69). Three patients had LASIK and 11 patients had PRK. LASIK patients averaged -0.875 D of myopic shift over 20 months of follow-up. Those with PRK averaged -0.025 D. This difference was not statistically significant (P =.10). The vision of 5 of 14 patients improved 1 or 2 lines after refractive surgery. Two patients who had 20/80 vision preoperatively improved to 20/60. No patients lost any lines of vision. Only 4 patients demonstrated stereopsis preoperatively, and all retained stereopsis postoperatively. No patient gained stereopsis. CONCLUSIONS: LASIK and PRK can be performed safely and effectively in children who are cooperative enough to undergo the procedures with topical anesthesia. Refractive surgery does not improve vision in densely amblyopic eyes but may give modest improvement in those that are mildly amblyopic. No significant complications were encountered aside from a myopic shift over time.     

有晶状体眼散光矫治型后房型人工晶状体植入矫治超高度近视并散光的临床观察

背景近年来随着屈光手术的不断进步,有晶状体眼人工晶状体植入手术在矫治超高度近视、散光、远视等方面逐步体现出其特有的优越性,其安全性、有效性在临床上越来越受到关注。目的观察有晶状体眼散光矫治型后房型人工晶状体（TICL）植入治疗超高度近视并散光的有效性、稳定性及安全性。方法回顾性系列病例研究。观察分析2008年5月-2009年2月经手术治疗的超高度近视并散光患者27例33眼的病例资料,均在眼球周围阻滞麻醉下经3mm颞侧透明角膜切口植入TICL,随访18个月,随访内容包括术前及术后1d,1周,2周,1、3、6、12、18个月的裸眼远近视力、最佳矫正视力、裂隙灯显微镜检查、TICL轴向、屈光度数、眼压、角膜内皮细胞分析等。结果术后96．97％眼裸眼视力等于或高于术前最佳矫正视力,术后球镜度数均在一1．00～＋0．25D,柱镜度数均在-1．00～0D,TICL轴向偏差在10°以内者占93．94％（31／33）,手术前后眼压及角膜内皮细胞计数的差异均无统计学意义（眼压：F=3．350,P=5．490;角膜内皮细胞计数：t=1．835,P=0．082）,术后1眼出现须手术调整的散光轴向旋转,1眼因TICL直径较大,发生术后高眼压,行TICL置换后眼压恢复正常,目前尚无白内障发生。结论TICL植入矫治超高度近视并散光具有有效性、安全性及稳定性。