Mesopic vision after LASIK for myopia

Fragestellung: Bisher liegen keine Erfahrungen über das D?mmerungssehverm?gen nach LASIK vor. Wir untersuchten daher das D?mmerungssehen vor und nach LASIK zur Korrektur der Myopie.     

Mesopic vision after LASIK for myopia

Fragestellung: Bisher liegen keine Erfahrungen über das D?mmerungssehverm?gen nach LASIK vor. Wir untersuchten daher das D?mmerungssehen vor und nach LASIK zur Korrektur der Myopie. Patienten und Methode: 34 Patienten (67 Augen), die mit dem Automatic Corneal Shaper und dem Keracor 117CT Excimer Laser operiert wurden und pr?operativ einen korrigierten Visus von 0,8 erreichten. Wir untersuchten pr?operativ und 1 Jahr postoperativ die Refraktion, den Visus und das D?mmerungssehverm?gen ohne und mit Blendung (Nyktometer, Fa. Rodenstock) in Abh?ngigkeit von der Ausgangsrefraktion in drei Gruppen und verglichen den Anteil der Patienten, die einen Kontrast von 1 : 5 oder geringer erkannten. Ergebnisse: Myopie −1 bis −5 dpt (Gruppe 1; n = 26): Pr?operativ (postoperativ) erkannten ohne Blendung 89 % (96 %) (nur hier signifikanter Unterschied; p = 0,03) und mit Blendung 65 % (73 %) die Kontraststufe 1 : 5. Myopie −5,1 bis −10 dpt (Gruppe 2; n = 24): Pr?operativ (postoperativ) erkannten ohne Blendung 83 % (75 %) und mit Blendung 50 % (21 %) die Kontraststufe 1 : 5. Myopie −10,1 bis −15 dpt (Gruppe 3; n = 11): Pr?operativ (postoperativ) erkannten ohne Blendung 73 % (55 %) und mit Blendung 46 % (27 %) die Kontraststufe 1 : 5. Schlu?folgerung: Nach LASIK scheint es für Korrekturen von mehr als −5 Dioptrien zu einer Verschlechterung des D?mmerungssehverm?gens unter Blendung zu kommen. Bei Korrekturen ab −10 dpt verschlechtert sich auch das D?mmerungssehen ohne Blendung. Allerdings waren die Unterschiede nicht statistisch signifikant. Zudem ist das D?mmerungssehen bereits pr?operativ bei h?herer Myopie erheblich reduziert.      

飞秒激光制瓣再次LASIK治疗LASIK术后近视的临床疗效观察

目的 探讨飞秒激光辅助制作角膜瓣再次LASIK治疗LASIK术后近视患者的临床疗效.方法 选择因LASIK术后近视患者40例(80眼),进行飞秒激光辅助制作角膜瓣再次行LASIK,术后予以药物治疗.观察并记录术后6个月患者的裸眼视力、屈光度、波前像差和对比敏感度(contrast sensitivity function,CSF)、眩光CSF,并与术前相比较.结果 术后6个月裸眼视力为1.07 ±0.11较术前0.10 ±0.05显著提高(P＜0.05).术后6个月屈光度为(-0.23 ±0.54)D较术前(-2.37±0.77)D显著改善(P＜0.05).术后6个月高阶像差为0.52±0.18与术前0.50±0.18相比差异无统计学意义(P＞0.05).术后6个月CSF在6.0c·d-1对数为1.80±0.11比术前1.62 ±0.12显著改善(P＜0.05);在18.0 c·d-1对数为1.25±0.08,比术前0.91±0.09显著改善(P＜0.05).术后6个月眩光CSF在18.0 c·d-1对数为1.02±0.09,较术前(0.55±0.08)显著改善(P＜0.05).结论 飞秒激光辅助制作角膜瓣再次LASIK可安全有效地治疗LASIK术后近视.     

Rhegmatogenous retinal detachment after LASIK for myopia

PURPOSE: To report the characteristics and incidence of rhegmatogenous retinal detachment in myopic eyes after LASIK. METHODS: The medical records of 49 patients with rhegmatogenous retinal detachment after LASIK were reviewed. The incidence of rhegmatogenous retinal detachment after LASIK was determined and potential risk factors were evaluated. RESULTS: LASIK was performed on 59,424 eyes with spherical equivalent refraction (SE) ranging from -0.75 to -26.50 diopters (D) (mean: -6.10 +/- 3.5 D). Forty-nine eyes developed rhegmatogenous retinal detachment between 1.5 and 76 months (mean: 27.3 +/- 21.7 months) after LASIK. The mean preoperative refractive error in these eyes was -8.6 +/- 3.9 D. Mean age of these patients was 38.2 +/- 11.2 years. Thirty-five (71.4%) patients were male. The cumulative incidence of rhegmatogenous retinal detachment was 0.082% (95% confidence interval [CI]: 0.061-0.109), and the yearly incidence was 0.032% (95% CI: 0.023-0.042) after LASIK. The most frequent location of the retinal breaks was the superior temporal quadrant (22.7%). Male sex, older age, and higher preoperative myopia were significantly related to the incidence of rhegmatogenous retinal detachment after LASIK (P<.001). CONCLUSIONS: Based on the results of this study, following the treatment of high-risk peripheral retinal lesions, LASIK did not appear to be an additional risk factor for the development of rhegmatogenous retinal detachment after LASIK in our patients; however, patients should be informed of the possibility of this complication as a consequence of myopia. Patients who are male, older in age, and have high myopia preoperatively may be at increased risk.     

Ocular aberrations after wavefront optimized LASIK for myopia

Purpose:

To study the change in ocular aberrations after wavefront optimized (WFO) laser in situ keratomileusis (LASIK) for correction of myopia and to analyze causative factors that may influence them.

Materials and Methods:

This was a prospective case series. WFO LASIK was performed for the correction of myopia, using the hansatome (Bausch and Lomb) microkeratome to create the flap and the Allegretto laser (Wavelight Technologie) to perform the ablation. The Allegretto wave analyser (Tscherning-type) measured the ocular aberrations prior to LASIK , one month and six months postoperatively.

Results:

The mean age of the 59 patients included in the study was 25±5.64 years and the mean spherical equivalent of the 117 eyes that underwent LASIK was ‒5.33±1.22 preoperatively and ‒0.21±0.38 postoperatively. Hundred and two eyes of 117 (87%) achieved uncorrected visual acuity (UCVA) of 20/20 or better after WFO LASIK and 104 of 117 eyes (89%) were within ±0.5D of the attempted refractive correction. There was a 1.96-fold increase in total root-mean-square of higher order aberrations. Induced changes in seven of the 22 higher order Zernike terms showed a significant linear correlation with the refractive correction attempted. Larger ablation zones induced less spherical aberration.

Conclusion:

In spite of an excellent visual outcome, WFO LASIK induces significant higher order aberrations. Large ablation zones reduce the induction of spherical aberration.     

近视患者LASIK术后夜间眩光的相关因素

目的:探讨近视患者LASIK术后发生夜间眩光的术前相关因素。方法:将665例(1257眼)近视患者按屈光度分为两组:组Ⅰ(低、中度近视)-1.00～-6.00D;组Ⅱ(高度近视)-6.25～-14.25D。以ObscanⅡ眼前节分析系统测量术前暗光下瞳孔直径,所有手术均为标准的LASIK手术,术后3mo调查患者夜间眩光情况。结果:低、中度近视组术前暗光下瞳孔直径6.81±0.50mm,高度近视组6.98±0.57mm,两组差异有显著性(P=0.001)。低、中度近视组58眼(7.9%)发生夜间眩光,高度近视组为137眼(26.2%),两组差异有显著性(P=0.000)。低、中度近视组发生眩光眼和无眩光眼在术前暗光下瞳孔直径上差异有显著性(P=0.000),拟矫正屈光度上差异无显著性(P=0.104);高度近视组在暗光下瞳孔直径和拟矫正屈光度上差异均具有显著性(P=0.001,0.002)。结论:LASIK术后夜间眩光与术前暗光下瞳孔直径有关,高度近视患者也与拟矫正屈光度有关。     

近视LASIK手术后高阶像差的改变

目的分析LASIK手术对高阶像差的影响，分析IASIK术的近视屈光度与LASIK术后眼的高阶像差的关系。方法采用WASCA波前像差仪测量150眼LASIK术前及术后1月及3月瞳孔直径分别为小瞳孔（3mm）及人瞳孔（6．25mm）时的总高阶像差的均方根及第三和第四阶像差的Zemike系数，并计算出球差、慧差、第三及第四阶像差的均方根。对结果进行方差分析和直线相关分析。结果LASIK术后，大瞳孔直径和小瞳孔直径下高阶像差均明显增高。无论瞳孔人小．术后3月较1月时高阶像差均轻微下降。人瞳孔直径下，光区直径为6．25mm时，术后球差、第四阶像差和总高阶像差与术前屈光度存在正相关。结论IASIK术后，高阶像差明显增高，尤以球差最明显。术前屈光度越高，手术所导致的高阶像差也越大，屈光度过高的近视眼不宜采用波前像差引导的个体化屈光手术。     

准分子激光原位角膜磨镶术后角膜后表面Diff值的变化

目的 探讨近视患者准分子激光原位角膜磨镶术（LASIK）术后角膜后表面Diff值变化规律及其对术后视力的影响.方法 对62例（123眼）近视患者于LASIK术前、术后1 d、1周、1个月行角膜地形图检查.分别按照残余基质床厚度、残余基质床厚度占术前角膜厚度的比例及术前屈光度的不同分组,分析各组间及同一组不同时期角膜地形图后表面Diff值的改变及其与术后视力的关系.结果 术后后表面Diff值较术前增大,且随原屈光度增大而增加,随基质床厚度增大而减小.当残余基质床厚度〉300μm或残余基质床厚度占术前角膜厚度的比例≥55%时,后表面Diff值明显减小.术后后表面Diff值与视力呈一定程度负相关.结论 LASIK术后角膜后表面前凸是影响术后视力的原因之一.后表面前凸的主要影响因素包括术前屈光度的高低、残余基质床厚度等,残余基质床厚度在300 μm以上或残余基质床厚度占术前角膜厚度的比例≥55%也许更安全.     

近视LASIK术后角膜膨隆的研究进展

角膜膨隆是近视LASIK术后少见而严重的并发症之一。它严重损害视功能,是对公众健康的潜在危胁。本文从近视LASIK术后角膜膨隆的一般概况、发病的危险因素、病理变化、发病机制、临床特征及诊断、处理等方面总结了近年来对其研究现状及进展。     

近视眼LASIK术后屈光度客观评价的研究

目的:试图找一种简便、准确且不受调节影响的屈光状态判定方法,以佐证LASIK术后患者的视力表视力.方法:回顾分析400只接受LASIK手术的近视眼的资料.按照术前屈光不正等值镜度分4组(≤-3.00D,≤-6.00D,≤-9.00D,≤-12.00D).按照角膜光区直径分4组(5.5,6.0,6.5,7.0 mm).分别用角膜屈光度、全眼屈光不正度和角膜地形图3种方法评价.结果:屈光不正度-6.00D以下和光区直径6.5 mm以上者3方法的预期值和实测值的符合率在80%～95%.全眼屈光不正度检测法预期值和实测值的符合率较低,差异有显著性(χ2检验,P＜0.05).屈光不正度-9.00D以上和光区直径6.0 mm以下3方法的预期值和实测值的符合率在70%～80%,组间差异无显著性(χ2检验,P＞0.05).结论:LASIK术后,-6.00D以下的近视眼用角膜屈光度预期值评估是简便可靠的,-9.00D以下的近视眼可用角膜地形图BFS预期值评价,电脑验光仪所得的屈光不正度受调节影响,有些眼偏差较大.     

Risk factors for night vision complaints after LASIK for myopia

PURPOSE: To study the preoperative risk factors for night vision complaints (NVCs) after LASIK in a clinical setting. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Seven hundred ninety-five patients (1488 eyes) who underwent LASIK for myopia up to -9.75 diopters (D) (from January 1 to December 31, 1999). SETTING: Private clinic. METHODS: A complete preoperative examination was performed. Patients had bilateral LASIK surgery using the Nidek EC-5000 non-wavefront guided slit-scanning excimer laser and the Moria LSK One microkeratome. Patients were observed postoperatively for 12 months. MAIN OUTCOME MEASURES: The reported NVCs for each eye were rated on a subjective scale based on functional visual comfort. Clinically important NVC odds ratios (ORs) were calculated. RESULTS: Reports of NVCs decreased considerably from 25.6% at 1 month to 4.7% at 12 months postoperatively, at which time all patients reported similar NVCs in both eyes. Stratification of risk factors at 12 months postoperatively showed a 2.8-times increase in NVCs for initial myopia of >5 D, a 2.5-times increase for an optical zone of 相似文献   

LASIK治疗PRK术后近视残留

的 :探讨LASIK治疗PRK术后屈光回退 ,屈光欠矫的疗效。方法 :用波长 193nm的ArF准分子激光对曾行PRK后屈光回退或欠矫的 14例 (2 2只 )患眼 ,再行LASIK术。结果 :手术后 1年 ,裸眼视力≥ 0 .5 ,≥1.0者分别为 81.8% (18眼 ) ,5 4.5 % (12眼 ) ,屈光度≤± 1.0 0者为 72 .73% (16眼 )。一例Haze加重。结论 :LASIK是治疗PRK术后屈光回退和欠矫的一种安全、有效方法     

Patient satisfaction and visual symptoms after wavefront-guided and wavefront-optimized LASIK with the WaveLight platform

PURPOSE: To investigate patient satisfaction and visual symptoms after wavefront-guided LASIK. METHODS: A prospective, randomized, double-masked, controlled study comprised 200 eyes of 100 young patients who underwent LASIK for myopia and astigmatism. Patients were randomly divided into two different treatment groups: standard ablation using wavefront-optimized profiles (wavefront-optimized group) and aberration customized aspheric treatment ablation (customized group) using the WaveLight ALLEGRETTO platform. Patients were asked to complete questionnaires regarding reasons for surgery, satisfaction, and visual symptoms. Patients were followed for 6 months. RESULTS: The most frequent motivating factor for surgery was to improve uncorrected visual acuity (UCVA) in the wavefront-optimized and customized groups (both 100%), followed by freedom from spectacles (86.9% vs 96.3%). At 6 months postoperatively, over 95% of patients in both groups reported their UCVA was as good as anticipated and they were satisfied with the surgery and would recommend the operation to a friend or family member. Satisfaction was not correlated with age, attempted refractive error, residual refractive error, postoperative UCVA, or root-mean-square higher order aberration. The rate of postoperative overall visual symptoms was reduced and the mean analog scores of the symptoms in both groups did not change significantly postoperatively (P > .05). The rate of visual symptoms such as glare (8.7% vs 7.4%), halo (0% vs 7.4%), and night driving difficulty (8.7% vs 3.7%) decreased after LASIK at 6 months postoperatively in the wavefront-optimized and customized groups, respectively. CONCLUSIONS: Patient satisfaction was achieved in young myopic patients who underwent wavefront-guided and standard ("wavefront-optimized") LASIK. The rate of visual symptoms such as glare, halo, and night driving difficulty decreased postoperatively after both treatment protocols.     

Laser in situ keratomileusis for residual myopia after primary LASIK

PURPOSE: To analyze the results of secondary laser in situ keratomileusis (LASIK) for residual myopia after primary LASIK. SETTING: Dr. Agarwal's Eye Hospital, Chennai, India. METHODS: A retrospective study of 50 eyes of 29 patients who had a secondary LASIK procedure was carried out. After a mean follow-up of 5.84 months +/- 3.24 (SD) after the primary procedure, the mean myopic residual refraction was -4.30 +/- 1.83 diopters (D). In 10 eyes, the primary corneal flap was lifted by blunt dissection. In 40 eyes, the flap was made with a second cut. The secondary LASIK was performed using the Chiron Technolas Keracor 217 excimer laser and the Automated Corneal Shaper microkeratome (Bausch & Lomb). RESULTS: The mean follow-up was 16.58 +/- 3.06 months. At 12 months, the mean spherical equivalent was -0.45 +/- 0.68 D (P <.05). Thirty-one eyes were emmetropic, 13 eyes were within +/-1.00 D of emmetropia, and 5 eyes were within +/-2.00 D. The mean uncorrected visual acuity improved from 20/80 (range 20/60 to 20/200) to 20/40 (range 20/20 to 20/200) (P <.005). Seventeen eyes gained 1 line of best spectacle-corrected visual acuity; 1 eye lost 1 line because of a decentered ablation with an induced postoperative astigmatism of -3.50 D cylinder. No sight-threatening complications such as a free cap, flap irregularity, corneal ectasia, or retinal complication occurred postoperatively. Epithelial ingrowth developed in 5 eyes and corneal thinning, in 1 eye. Three eyes had night glare. CONCLUSION: Secondary LASIK was a safe, stable, and effective method for the treatment of residual myopia after primary LASIK.     

马来酸噻吗洛尔滴眼液对高度近视眼LASIK术后近视回退的影响

目的探讨马来酸噻吗洛尔滴眼液在防治高度近视眼准分子激光原位角膜磨镶术(1aser in situ keratomileusis,LASIK)后屈光回退中的作用。方法选取接受LASIK治疗的高度近视眼患者术后第1天主觉验光等效球镜屈光度在0～-0.75D患者78例(78眼),随机分为研究组39例(39眼)和对照组39例(39眼)。对照组术后常规应用抗生素滴眼液滴眼10d和皮质类固醇滴眼液滴眼1个月。研究组术后除常规用药外,术后第1天增加使用马来酸噻吗洛尔滴眼液每天2次滴眼1个月。术前、术后10d、1个月、3个月进行眼压和主觉验光检查,OrbscanⅡ测量角膜后表面前移量(Diff差值)。结果研究组术后10d、1个月、3个月眼压分别为(9.61±2.90)mmHg(1kPa=7.5mmHg)、(9.97±2.50)mmHg、(10.61±2.90)mmHg,与对照组比较[(11.69±2.60)mmHg、(11.99±3.07)mmHg、(10.92±2.65)mmHg],术后10d、1个月差异均有统计学意义(均为P<0.05),术后3个月差异无统计学意义(P>0.05)。研究组术后10d、1个月和3个月角膜后表面Diff差值分别是(9.56±6.66)μm、(10.72±6.70)μm和(14.11±4.66)μm,对照组分别为(19.57±7.76)μm、(20.24±7.37)μm和(20.10±6.98)μm,两组比较差异有显著统计学意义(F=34.236,P=0.000);两组术后同时间点Diff差值比较,差异均有统计学意义(均为P<0.05)。研究组术后10d、1个月和3个月时等效球镜屈光度分别为(-0.46±0.28)D、(-0.61±0.34)D和(-0.75±0.21)D,对照组分别为(-0.67±0.23)D、(-0.93±0.23)D和(-1.05±0.29)D,两组术后同时间点比较差异均有统计学意义(均为P<0.05)。结论高度近视眼LASIK术后早期应用马来酸噻吗洛尔滴眼液能阻滞角膜后表面前移,降低近视屈光度,是预防高度近视眼LASIK术后屈光回退的一种有效方法。     

LASIK术中术后并发症及相关因素探讨

目的 探讨准分子激光原位角膜磨镶术(LASIK)术中术后并发症的最佳处理方法.方法 选择我院3年间接受LASIK术受术者1877例(3740眼)资料,对术中及术后并发症的资料进行统计,并分析其相关因素.受术者随访期均为3月余.结果 术中并发症主要为角膜瓣破损3眼(0.08%),角膜瓣游离1眼(0.03%).术后影响视力的主要并发症为角膜瓣皱褶5眼(0.14%),角膜瓣"反卷"2眼(0.05%),屈光回退201眼(5.374%).结论 避免上述有关因素,同时给予及时恰当的处理,在很大程度上可减少LASIK术中及术后相应并发症的发生.