必须加强视疲劳诊治的研究

随着信息社会的发展,视疲劳对社会生产和生活的影响越来越大.视疲劳的表现多种多样,原因复杂.有些临床症状与其他疾病相似或者本身相关,因此视疲劳的诊断往往被忽视.在治疗上只是简单笼统的对症,忽视病因的查找和纠正,治疗效果十分有限.鉴于该病诊疗的情况,我们必须从全面的视角审视问题,加强该病的诊治研究.在研究中我们应以建立标准验光室和提高验光水平为基础,加强该病的流行病学调查,加强病因和药物治疗的研究.     

国产改良负压吸引环在LASIK中的应用

目的：评价国产改良负压吸引环在特殊眼球患者中的应用效果。方法：选择经常规负压吸引环不少于3次吸引未成功的眼球,改用国产改良负压吸引环进行手术,并分析这些眼球结构特点。结果：患者共9例15眼,采用改良负压吸引环均1次吸引固定成功,顺利完成角膜瓣的制作。其中5例8眼角膜屈光度较小,平均角膜屈光度＜42．7D,周边膜最小屈光度值尤其小,其中7眼＜41D;1例角膜直径偏小,为9．5mm手术中整个负压环吸引固定的部位均位于巩膜上;3例6眼为睑裂偏小患者,结论：国产改良负压吸引环对于较平的角膜,角膜直径偏小以及睑裂偏小等特殊患者是一种安全有效的负压吸引固定环。     

KN-5000A LASIK微型角膜成形系统临床研究

目的:探讨KN-5000A型LASIK微型角膜成形系统在大样本LASIK病例中的临床制瓣效果、安全性、预测性和稳定性.方法:回顾分析2组LASIK病例,A组应用KN-5000A型LASIK微型角膜成形系统,602例1 171眼.B组应用KN-5000 LASIK微型角膜刀,103例192眼;随访至少1月,最长45个月.比较术中瓣成形、术后瓣愈合、瓣下及瓣缘痕迹,比较微型角膜刀相关的并发症.结果:两组术中完全瓣比率的差异无统计意义(P＞0.05),游离瓣比率的差异无统计意义(P＞0.05).A组的瓣缘痕迹计分大于Ⅱ级的发生率小于B组(P＜0.05),瓣下混浊比率少于对照组(P＜0.05).5000A型LASIK微型角膜成形系统组1眼发生Sahara综合征,无其他严重并发症发生.随访视力与屈光度显示两组的差异无显著意义(P＞0.05).结论:KN-5000A型LASIK微型角膜成形系统制瓣的安全性、预测性及稳定性与KN-5000微型角膜刀一致,所制角膜瓣瓣缘及瓣面的临床愈合后混浊少于KN-5000微型角膜刀.LASIK微型角膜刀的不断更新,将促进LASIK手术更好地发展.     

要视力，更要视觉质量

近来，借英国某刊物载有准分子激光矫治近视有10％的并发症的信息，告戒慎用这种手术之际，我国的一些媒体也借用某专家谈话，认为英国手术仅为我国上世纪90年代水平，不必为此担忧。准分子激光近视手术是否需要慎用？我国的水平究竟如何？我的回答是“准分子激光近视矫正切不可滥用，要视力，更要视觉质量。”     

正常角膜及圆锥角膜的生物力学特性比较研究

Objective To compare the corneal hysteresis (CH) and corneal resistance factor (CRF) measured with the Ocular Response Analyzer (ORA) in normal and keratoconic eyes. Methods It was a case-control study. Random selected 96 normal eyes and 46 keratoconic eyes in the same period were included in this study. Normal eyes were divided into 2 groups: high corneal astigmatism (≥3.00 D) and low-to-moderate corneal astigmatism (<3.00 D). Keratoconic eyes were also divided into 3 groups based on Amsler-Krumeich classification: mild (stage Ⅰ), moderate (stage Ⅱ) and severe (stage Ⅲ/Ⅳ). CH and CRF were compared between groups and the areas under ROC curves of the CH and CRF were calculated. Results The mean CH and CRF were (7.1±1.6) mm Hg and (6.3±1.5) mm Hg in keratoconic eyes compared with (10.1±1.3) mm Hg and (10.5±1.6) mm Hg in normal eyes. The difference were statistically significant(t=-11.813, -14.943 ;P<0.001). In normal eyes, there was no difference of CH or CRF between the high corneal astigmatism and low-to- moderate corneal astigmatism (t=0.373,0.095; P>0.05). In keratoconic eyes, there was a significant negative correlation between CH and the keratoconus grade (r=-0.627, P<0.001) and the same relationship was found between CRF and the keratoconus grade (r=-0.587, P<0.001). In multiple linear regression analysis, CH was correlated with central corneal thickness (CCT) and corneal curvature (r=0.320, -0.375;P<0.05) and CRF was correlated with corneal curvature in keratoconic eyes (r=-0.441 ,P<0.01), while they were only correlated with CCT in normal eyes (r=0.367,0.459;P<0.001). The areas under ROC curves of the CH and CRF were 0.9282 and 0.9731 (Z=20.462,38.305 ;P<0.0001), the difference between them was significant (Z =7.134,P=0.008). Conclusions The CH and CRF were significantly lower in keratoconic eyes than in normal eyes, especially on CRF. The long-term follow-up of CH and CRF may provide information for evaluation of progression of keratoconus. They may be included as indicators for detecting keratoconus.     

正常角膜及圆锥角膜的生物力学特性比较研究

Objective To compare the corneal hysteresis (CH) and corneal resistance factor (CRF) measured with the Ocular Response Analyzer (ORA) in normal and keratoconic eyes. Methods It was a case-control study. Random selected 96 normal eyes and 46 keratoconic eyes in the same period were included in this study. Normal eyes were divided into 2 groups: high corneal astigmatism (≥3.00 D) and low-to-moderate corneal astigmatism (<3.00 D). Keratoconic eyes were also divided into 3 groups based on Amsler-Krumeich classification: mild (stage Ⅰ), moderate (stage Ⅱ) and severe (stage Ⅲ/Ⅳ). CH and CRF were compared between groups and the areas under ROC curves of the CH and CRF were calculated. Results The mean CH and CRF were (7.1±1.6) mm Hg and (6.3±1.5) mm Hg in keratoconic eyes compared with (10.1±1.3) mm Hg and (10.5±1.6) mm Hg in normal eyes. The difference were statistically significant(t=-11.813, -14.943 ;P<0.001). In normal eyes, there was no difference of CH or CRF between the high corneal astigmatism and low-to- moderate corneal astigmatism (t=0.373,0.095; P>0.05). In keratoconic eyes, there was a significant negative correlation between CH and the keratoconus grade (r=-0.627, P<0.001) and the same relationship was found between CRF and the keratoconus grade (r=-0.587, P<0.001). In multiple linear regression analysis, CH was correlated with central corneal thickness (CCT) and corneal curvature (r=0.320, -0.375;P<0.05) and CRF was correlated with corneal curvature in keratoconic eyes (r=-0.441 ,P<0.01), while they were only correlated with CCT in normal eyes (r=0.367,0.459;P<0.001). The areas under ROC curves of the CH and CRF were 0.9282 and 0.9731 (Z=20.462,38.305 ;P<0.0001), the difference between them was significant (Z =7.134,P=0.008). Conclusions The CH and CRF were significantly lower in keratoconic eyes than in normal eyes, especially on CRF. The long-term follow-up of CH and CRF may provide information for evaluation of progression of keratoconus. They may be included as indicators for detecting keratoconus.     

正常角膜及圆锥角膜的生物力学特性比较研究

Objective To compare the corneal hysteresis (CH) and corneal resistance factor (CRF) measured with the Ocular Response Analyzer (ORA) in normal and keratoconic eyes. Methods It was a case-control study. Random selected 96 normal eyes and 46 keratoconic eyes in the same period were included in this study. Normal eyes were divided into 2 groups: high corneal astigmatism (≥3.00 D) and low-to-moderate corneal astigmatism (<3.00 D). Keratoconic eyes were also divided into 3 groups based on Amsler-Krumeich classification: mild (stage Ⅰ), moderate (stage Ⅱ) and severe (stage Ⅲ/Ⅳ). CH and CRF were compared between groups and the areas under ROC curves of the CH and CRF were calculated. Results The mean CH and CRF were (7.1±1.6) mm Hg and (6.3±1.5) mm Hg in keratoconic eyes compared with (10.1±1.3) mm Hg and (10.5±1.6) mm Hg in normal eyes. The difference were statistically significant(t=-11.813, -14.943 ;P<0.001). In normal eyes, there was no difference of CH or CRF between the high corneal astigmatism and low-to- moderate corneal astigmatism (t=0.373,0.095; P>0.05). In keratoconic eyes, there was a significant negative correlation between CH and the keratoconus grade (r=-0.627, P<0.001) and the same relationship was found between CRF and the keratoconus grade (r=-0.587, P<0.001). In multiple linear regression analysis, CH was correlated with central corneal thickness (CCT) and corneal curvature (r=0.320, -0.375;P<0.05) and CRF was correlated with corneal curvature in keratoconic eyes (r=-0.441 ,P<0.01), while they were only correlated with CCT in normal eyes (r=0.367,0.459;P<0.001). The areas under ROC curves of the CH and CRF were 0.9282 and 0.9731 (Z=20.462,38.305 ;P<0.0001), the difference between them was significant (Z =7.134,P=0.008). Conclusions The CH and CRF were significantly lower in keratoconic eyes than in normal eyes, especially on CRF. The long-term follow-up of CH and CRF may provide information for evaluation of progression of keratoconus. They may be included as indicators for detecting keratoconus.     

像差仪在主观验光中的应用价值

目的评估像差仪检测结果在主观验光中的作用。方法选择2004年5月至2004年11月于本院行近视屈光手术患者129例,252眼。根据患者在睫状肌麻痹前的电脑验光的球镜度数,分成<-6.0D、-6.0～9.0D、>9.0D三组,分别称为一般度数组、高度数组和超高度数组。患者被随机选择先行电脑验光或像差检查,再经综合验光仪(Nidek)行主观验光。对同一眼的球镜量、散光量、轴向在电脑验光、像差测量和综合验光仪检查(均未予睫状肌麻痹)等三种检查方法之间的相关性情况进行分析。结果①一般度数组:综合主观验光、电脑验光、像差仪三种方法球镜度数分别为(-3.28±2.52)D、(-3.18±2.93)D、(-2.86±2.89)D;散光度数分别为(-1.24±1.86)D、(-1.99±1.56)D、(-1.35±1.28)D;散光轴向分别为81.68±73.26、70.11±58.99、89.14±78.90,所有参数各种方法之间无明显差异(P>0.05),有很好的相关性(P<0.05)。②高度数组:综合主观验光、电脑验光、像差仪三种方法球镜度数分别为(-7.43±1.27)D、(-7.38±1.03)D、(-7.81±1.19)D;散光度数分别为(-1.16±1.02)D、(-1.12±0.75)D、(-1.41±1.64)D;散光轴向分别为86.50±71.24、94.71±65.03、100.62±74.07,所有参数各种方法之间无明显差异(P>0.05),有很好的相关性(P<0.05)。③超高度数组:综合主观验光、电脑验光、像差仪三种方法球镜度数分别为(-14.07±4.09)D、(-12.12±3.66)D、(-11.75±3.19)D,各种方法之间无明显差异(P>0.05),有很好的相关性(P<0.05);散光度数分别为(-2.02±1.59)D、(-0.74±0.71)D、(-1.05±0.77)D,各种方法之间有明显差异(P<0.05);散光轴向分别为86.27±63.87、77.68±57.85、110.36±70.83,各种方法之间无明显差异(P>0.05),有很好的相关性(P<0.05)。结论在一般近视中,像差仪检查可替代电脑验光作为客观验光的方法,但在超高度近视中偏差则较大。     

角膜瓣的种类对准分子激光屈光矫正手术的影响

角膜瓣的制作是影响准分子激光屈光手术疗效较关键的一步,角膜瓣包括基质瓣和上皮瓣,普通基质瓣术后视力恢复快,但存在瓣厚薄不匀、厚度预测性差、制瓣后可诱导像差增大.飞秒激光基质瓣厚薄均匀,对像差影响小,术后视觉质量优于普通基质瓣,但设备昂贵,制瓣时间长.乙醇浸泡制作的上皮瓣操作安全,术后视觉质量优于普通基质瓣LASIK术,微型角膜刀法的上皮瓣无乙醇对角膜上皮的毒副作用,较乙醇浸泡法LASEK术刺激症状和角膜上皮下雾状混浊轻.角膜基质瓣的蒂位于上方时,术后角膜知觉下降较蒂位于鼻侧时明显且恢复慢,干眼症状更重.在手术安全性和术后视觉质量方面,制作上皮瓣优于基质瓣,上皮瓣存在的刺激症状较明显与角膜上皮下雾状混浊是进一步需要研究解决的问题.     

握笔姿势对学龄儿童近视病情影响的初步研究

目的研究不同的握笔姿势对学龄儿童近视的发病及近视严重程度的影响.方法在上海市2所定点中学中进行视力普查,收集300名正视学生的资料.记录其握笔姿势.同时收集300名于2003.7.1～2003.8.15至我院门诊就诊的学龄近视患儿的资料.根据屈光度(＜-3.00D,-3.00D～-6.00D,＞-6.00D)分为3组,每组100人,分别记录握笔姿势.对所得资料进行统计分析.结果握笔姿势分为三种:拇指于食指不相碰(姿势1),拇指与食指相碰(姿势2),拇指与食指交叉(姿势3).正视组儿童握尾姿势为姿势1者68人,屈光不正组儿童握笔姿势为姿势1者37人,x2=11.09＞x2(0.01)P＜0.01差异有显著意义.分别比较3组不同屈光度的儿童的握笔姿势.其差别的x2=19.2＞x20.01P＜0.01.结论近视的发病与采用不同的握笔姿势有关.屈光度的加深与采用不同的握笔姿势也有关.从本次调查结果来看,姿势1,即拇指与食指不相碰,有利于学龄儿童防治近视,保护视力.