Immediate changes in pupil size following Laser in situ keratomileusis (LASIK): Pupillometry study

Purpose

To investigate the impact of laser in situ keratomileusis (LASIK) on the change in pupil size immediately after the procedure.

Methods

In a prospective study, measurement of pupil size was assessed in 70 eyes of 35 consecutive patients using a hand-held pupillometer before and immediately after LASIK in mesopic condition at the refractive eye center, Riyadh, Saudi Arabia.

Results

The pupil showed mild dilation immediate after LASIK. Mean pupil size before LASIK was 4.10 ± 0.74 and immediate after was 4.74 ± 0.82, P value <0.0001. No association was found with age, sex, central corneal thickness or pre-operative refractive measurements (CCT).

Conclusion

There is a change in pupil size that immerses immediately after LASIK; postulations suggested for pupillary dilation include the effect of suction ring, post-operative steroid eye drops, dark room, pain and anxiety.     

应用飞秒激光制作角膜瓣的准分子激光角膜原位磨镶术的初步临床研究

目的 评价应用飞秒激光制作角膜瓣的准分子激光角膜原位磨镶术（LASIK）的安全性、有效性和可预测性。方法 应用VISX Star S4准分子激光设备和Intra Lase飞秒激光仪，对屈光不正患者109例209眼施行飞秒激光制作角膜瓣的LASIK手术。术前检查包括最佳矫正视力（BCVA）、验光、角膜厚度、角膜地形图，术后第1天、1w、1m和3m检查裸眼视力和验光。对其中20眼在术中测量角膜床厚度，计算角膜瓣厚度。对20眼在术前和术后1w、1m、3m和6m进行角膜共聚焦显微镜检查。对19眼在术前和术后1w进行角膜内皮显微镜检查。结果 术后3m的平均等效球镜为-0．35±0．66D（-2．75D～＋1．25D），196眼（93．8％）的裸眼视力大于或等于1．0，178眼（85．2％）的裸眼视力等于或超过术前BCVA。术中并发症包括结膜下出血、切口出血、前房气泡、角膜基质内微小气泡和掀瓣困难。手术前后角膜内皮显微镜检查未见明显差异。角膜共聚焦显微镜可观察角膜基质细胞和神经纤维愈合。结论 应用飞秒激光制作角膜瓣的LASIK手术是矫正屈光不正的安全和有效的方法，其可预测性好，但也具有一些不同于微型角膜刀的独特并发症。     

角膜地形图引导的准分子激光治疗LASIK术后不规则散光

目的：评价角膜地形图引导的准分子激光个性化切削治疗准分子激光原位角膜磨镶术（ LASIK）术后不规则散光的临床疗效。方法选取2013年2月至2015年8月在我院就诊的患者9例（10只眼）,均为LASIK术后存在一定程度的偏中心或不规则散光。在角膜地形图引导下行准分子激光切削,比较手术前后视力、散光度、角膜不规则指数（ CIM）及高阶像差均方根（ High RMS）。结果患者术后裸眼视力由平均0.50±0.13变为术后3个月平均0.98±0.11,差异具有统计学意义（ P ＝0.00）。手术前散光绝度值1．00 D～2．50 D,平均为（1．78±0.39）D,术后3个月平均（0.62±0.22）D,手术前后差异具有统计学意义。术后CIM及High RMS均较术前下降,差异均具有统计学意义（ P ＝0.00）。结论 CRS-MASTER平台角膜地形图引导的准分子激光治疗LASIK术后不规则散光安全、有效。     

Retinal colour duplex scanning during LASIK-ring suction with different keratomes

PURPOSE: The purpose was to measure the blood flow velocity during the suction phase of LASIK. SETTING: University Eye Hospital, Martin-Luther-University Halle-Wittenberg, Halle, Germany. METHODS: Papillary blood flow velocity was measured by colour Doppler sonography. Suction rings of four different manufacturers were applied in 30 healthy volunteers without eye diseases all of normal blood and eye pressure. The velocity of the blood flow in the central retinal artery was measured before, during and after suction. RESULTS: When Hansatome (Bausch & Lomb) and M2 (Moria) rings were used, no blood flow velocity was detected during suction in 90% of all cases. These rings were compared to the SKBM standard suction ring (Alcon) and the Krumeich non-IOP ring, in which no blood was present in only 56.67% (p < 0.05) and 10% (p < 0.001) of cases respectively. Moria, Alcon and Krumeich Lasitome rings performed equally well during the recovery phase compared with the original values. An exception is the Hansatome ring (Bausch & Lomb), with lower velocities when evaluated after 30 minutes (p < 0.01). CONCLUSIONS: During the ring suction phase of LASIK, the rings tested reduce velocity differently.     

超薄型角膜瓣在LASIK屈光矫正中的临床效果观察

目的探讨在LASIK屈光矫正中应用超薄型角膜瓣的临床效果。方法对115例（230眼）中高度近视患者LASIK中应用超薄型角膜瓣,对比术前术后患者的视力及角膜地形图变化情况,观察术后并发症的发生情况。结果术后患者的视力较术前明显提高（p0.05）;术后角膜地形图图形以平滑型（64.5%）为主;中央岛和偏心切削发生率分别为6.29%、5.03%;SimK值较术前显著降低（P0.05）;SRI和SAI值较术前显著增高（P0.05）;术中无游离瓣、纽扣瓣及角膜瓣破裂出现,术后角膜瓣对位良好,无角膜瓣融解、上皮植入现象发生。结论 LASIK中应用超薄型角膜瓣疗效好,安全性高,值得临床推广。     

Evaluación de las modificaciones biométricas del ojo durante la succión del LASIK

PurposeTo study the biometric modifications of the eyeball during suction in laser assisted in situ keratomileusis (LASIK).MethodsObservational and cross-sectional study. We studied 43 patients who underwent surgery for myopia and myopic astigmatism. Mean age was 38.3±11.5 years, and 19 were female (44.2%). Conventional LASIK surgery with a manual microkeratome was performed. Before and during the suction maneuvre the following parameters were measured using an 11 MHz biometric probe: aqueous depth (AQD), lens thickness (LT), vitreous cavity length (VCL) and axial length (AXL). Paired t-test was used to compare the biometric measurements before and during suction.ResultsThe mean spherical equivalent refractive error was −4.5±2.3 diopters. During suction, the AQD did not change significantly (p = 0.231). However, AXL and VCL increased by 0.12 mm and 0.22 mm respectively (p = 0.039 and <0.01) and LT decreased by 0.20 mm (p<0.01). AXL increased in 42% of the eyes and decreased in 16%, VCL increased in 70% of the eyes and decreased in 9%, and the LT was reduced in 67% of the eyes.ConclusionsSuction maneuvres during LASIK surgery produce changes of little magnitude in the eye globe, mainly a decrease in LT and an increase in VCL and AXL. Therefore, these modifications are expected to produce minimal anatomic alterations.     

LASIK前后非接触眼压计测量结果的研究

目的：研究激光原位角膜磨镶术（LASIK）手术前后非接触眼压计（NCT）测量值的改变,及其与屈光度矫正值和术中角膜切削厚度之间的关系,方法：随机选择112眼接受LASIK治疗的高度近视患者,排除青光眼或高眼压症,于术前、术后3、6、12个月作非接触眼压测量,对术前、术后的非接触眼压测量值作u检验,并对眼压改变值与预期屈光度矫正值和术中角膜切削厚度作相关性分析,结果：①手术前后非接触眼压测量值的改变差异有显著性意义（P＜0.001）,术后一年平均眼压测量值下降0.931±0.293kPa;③术后一年眼压下降值与预期屈光度矫正值存在统计学上的相关性(r=0.1942,P＜0．05);术后一年眼压下降值与术中角膜切削厚度亦存在统计学上的相关性(r=0.2577,P＜0.001）,结论：LASIK术后不能按传统正常值衡量非接触眼压计测量结果,否则可能延误类固醇性青光眼的早期诊断,激光切削石角膜厚度变薄是导致手术后非接触眼压计测量结果下降的直接原因。     

有晶状体眼后房型人工晶状体植入术与飞秒激光制瓣LASIK治疗中高度近视患者的早期临床效果对比分析

目的　对比分析有晶状体眼后房型人工晶状体植入术与飞秒激光制瓣LASIK（FS-LASIK）治疗中高度近视患者的早期临床效果。方法　选取2016年8月至2017年3月于我院接受有晶状体眼后房型人工晶状体植入术的中高度近视患者35例（69眼）为人工晶状体组,选择同期接受FS-LASIK的中高度近视患者38例（76眼）为LASIK组,两组患者性别构成和年龄差异均无统计学意义（均为P＞0.05）。此外,术前两组患者对比敏感度（contrast sensitivity function,CSF）、眩光对比敏感度（glare CSF,GCSF）差异均无统计学意义（P＞0.05）。术后随访6个月检查患者裸眼视力、最佳矫正视力、等效球镜度数,计算有效性系数和安全性系数,同时进行CSF和GCSF检查;观察患者并发症发生情况。结果　术前两组患者裸眼视力和最佳矫正视力差异均无统计学意义（均为P＞0.05）;术前人工晶状体组等效球镜度数为-4.00~-12.00（-8.86±3.70）D,LASIK组为-4.00~-11.75 （-8.51±4.20）D,差异无统计学意义（P＞0.05）。术后两组患者裸眼视力、最佳矫正视力和等效球镜度数差异亦均无统计学意义（均为P＞0.05）;术后6个月人工晶状体组有效性系数和安全性系数均优于LASIK组,差异均有统计学意义（均为P＜0.05）。术后人工晶状体组CSF在1.5 c·d^-1、3.0 c·d^-1"、6.0 c·d"^-1、12.0 c·d^-1和18.0 c·d^-1等空间频率,均优于LASIK组,差异均有统计学意义（均为P＜0.05）;人工晶状体组GCSF在1.5 c·d^-1、3.0 c·d^-1、6.0 c·d^-1和18.0 c·d^-1等空间频率,均优于LASIK组,差异均有统计学意义（均为P＜0.05）。术后4 h有4例（7眼）患者出现眼压升高,给予前房穿刺放液后眼压得到控制,未见晶状体混浊患者。结论　有晶状体眼后房型人工晶状体植入术和FS-LASIK均可安全有效地治疗中高度近视,但是人工晶状体植入术治疗效果更好,术后患者有效性指数、安全性指数、CSF和GCSF均优于FS-LASIK。     

LASIK术后角膜损伤修复过程中干眼症的影响因素及防治

准分子激光原位角膜磨镶术后干眼症较为普遍,严重影响患者术后舒适度和视觉质量。我们就准分子激光原位角膜磨镶术后角膜损伤修复对术后干眼症的影响因素进行综述,为临床相关研究提供一定的的参考依据。