白内障超声乳化吸除联合对称性角膜切开矫正高度散光临床分析

目的评估白内障超声乳化吸除人工晶状体植入联合对称性角膜切开术(AK)治疗伴有高度散光患者的安全、有效、可预测性。方法对27例(38只眼)散光>2.00 D伴随老年性白内障患者行白内障超声乳化吸除人工晶状体植入术联合AK。分别记录患者术前与术后6个月时的裸眼远视力、最佳矫正远视力、角膜散光、角膜地形图和IOL-Master。结果术前和术后曲率性散光的平均度数为(3.30±1.52)D和(1.59±1.20)D(P<0.01),差异有统计学意义;术前与术后平均裸眼视力为0.28±0.23和0.55±0.28(P<0.01),平均最佳矫正视力为0.61±0.32和0.75±0.28(P<0.01),差异均有统计学意义;未发现严重并发症。结论 AK角膜散光切开联合白内障超声乳化摘除术是一种安全、有效、简单矫正曲率性高度散光的方法。     

准分子激光角膜切削术致角膜并发症二例分析

报告两例屈光不正患者接受准分子激光角膜切削术后出现角膜并发症。一例为术后出现细菌性感染，经抗生素治疗，后遗角膜斑翳；一例为术后出现大泡性角膜病变。对出现并发症的原因进行了分析，认为应用ＰＲＫ技术矫正屈光不正要重视术后继发感染的预防，其远期疗效及对角膜内皮细胞可能产生的影响有待进一步研究。     

Eleven-year Experience with Radial Keratotomy

1 900 consecutive eyes that underwent radial keratotomy by the senior author were evaluated retrospectively. 3 months after surgery, minimum reduction in mean spherical equivalent of 0. 67D was achieved with 1 incision and maximum 7. 250 with 24 incisions. Unconnected visual acuity of 20/40 or better was obtained in 99. 4% of eyes with low myopia, 64. 2% with moderate myopia and 32. 4% with high myopia. For anisometropia, bilateral RK reduced refractive error from -12. 12D to -5. 22D in more myopic eyes and -8. 18D to -3. 4D in less myopic eyes and unilateral surgeries reduced refractive error from -9. 45D to -3. 85D. Anisometropia after surgery became clinically and physically acceptable and aniseikonia was significantly improved. No vision threatening complications occurred. Our results indicate that radial keratotomy is a relatively safe and effective surgical procedure for myopia. Eye Science 1994;10: 6-12.     

LASIK治疗RK后的近视回退

目的探讨准分子激光原位角膜磨镶术（Laser Assisted In-situ Keratomi Leusis，LASIK）矫治放射状角膜切开术（RK）后近视回退患者的安全性和有效性。方法采用LASIK小光斑飞点扫描技术治疗RK术后10年以上近视回退的患者12例23眼，平均随访15月。结果23眼术前远视力≤0．15，术后1年≥1．0，2眼术后半年为1．0，平均近视度数由术前的-6．15DS下降为术后的0．35DS，平均散光度数由术前的-0．71DC下降为术后的0．33DC，无并发症。结论对RK术后近视回退的患者施行LASIK手术是安全、有效的。     

不同人工晶状体计算公式计算眼轴大于28mm的RK术后白内障患眼的准确性比较

目的：比较不同人工晶状体(IOL)计算公式计算眼轴大于28mm的既往接受过放射状角膜切开术(RK)的白内障患者的准确性。方法：回顾性研究。分析2011-01/2020-07在首都医科大学附属北京同仁医院接受白内障手术的眼轴长度大于28mm的RK术后患者19例29眼的病历资料。分别使用Barrett True-K、Haigis、Holladay 1(D-K)公式计算白内障术后实际等效球镜和IOL公式预测的等效球镜之间差值的绝对值(AE)。比较三种IOL公式的AE值及AE值≤0.5、0.75、1.0和2.0D的患眼百分比。结果：三种公式的AE值有显著差异(χ2=8.759,P=0.013),Barrett True-K公式的AE中位数最小,仅为0.62(0.20,1.15)D,Haigis公式次之,为0.76(0.34,1.26)D, Holladay 1(D-K)公式最大,为1.01(0.49,1.62)D。使用Barrett True-K公式,AE值≤0.5、0.75、1.0和2.0D的患眼百分比分别为48%、59%、69%和93%,均等于或高于另外两种公式。结论：对于眼轴长度大于28mm的RK术后白内障患者,在Barrett True-K、Holladay 1(D-K)和Haigis三种公式中,我们更推荐使用Barrett True-K公式。     

放射状角膜切开术后残留屈光不正患者的LASIK手术治疗

目的:研究放射状角膜切开术后LASIK手术的效果和并发症。方法:本描述性研究在伊朗亚兹德LASIK手术中心进行,研究对象包括2003-04/2006-09的LASIK手术患者。数据通过特殊的量表收集,并采用SPSS软件和配对t检验进行分析。结果:患者23例33眼,其中女11例(48%),男12例(52%)。年龄介于28 ～49(平均31.6)岁。制上皮瓣时发现2例(6%)患者有放射状角膜开口和1例(3%)患者有中度非传染性角膜炎出现。术前等效球差为-2.17±0.94D,而术后等效球差为-0.17±0.19D,两者在统计学上具有显著性差异(P=0.0001)。术前平均裸眼视力(裸眼视力)为0.07±0.02,术后则为0.88±0.16,两者在统计学上具有显著性差异(P=0.0001)。手术前平均最佳矫正视力为0.93±0.08,而手术后为0.92±0.08,两者在统计学上不具有显著性差异(P=0.268)。结论:LASIK手术能改善放射状角膜切开术后残留的近视,术中和术后观察发现没有发生明显的并发症,但必须认真思考二次手术的必要性,同时小心选择和评估相关病例。     

A preliminary investigation into the direct measurement of intra-ocular light scatter after radial keratotomy

A glare score based on intra-ocular light scatter and a questionnaire-based subjective assessment of glare were determined for 18 patients who had undergone radial keratotomy (RK) two weeks to 27 months previously. Results were compared to those of 15 control subjects. T-tests showed no significant difference in glare experienced under photopic conditions by RK patients and control subjects. There was no systematic relationship between glare scores and the subjective assessment of glare, nor between glare scores or subjective assessment of glare and the time which had elapsed since surgery. However, a weak relationship (r²=0.36) was found between glare scores and absolute refractive error. It was concluded that RK did not produce significant levels of intra-ocular light scatter under photopic conditions (155 lux).     

Effect of hinged lamellar keratotomy on post-keratoplasty astigmatism and vision

Purpose: To show that hinged lamellar keratotomy alone affects refraction and vision in post‐keratoplasty eyes. Methods: A retrospective, non‐comparative, interventional case series was conducted on 28 eyes of 26 patients who had two‐stage laser in situ keratomileusis (LASIK) after penetrating keratoplasty. Records were reviewed with respect to the hinged lamellar keratotomy component of the procedure. The interval between keratoplasty and keratotomy was at least 1 year, and the follow‐up period averaged 29 ± 10 days. The Automated Corneal Shaper with nasal hinge was used. In addition to basic empirical astigmatism calculations, the Alpins method of astigmatism analysis was also employed to ensure that the influence of changes in cylinder axis were correctly taken into account when calculating the refractive change. Results: Surgically induced astigmatism from hinged lamellar keratotomy was not statistically significant in this series; however, the range in values (?9.06 to +7.57 D) has potential clinical ramifications. Nearly 70% of cases studied experienced surgically induced astigmatism of at least 2 D. Mean preoperative uncorrected vision was logMAR 1.06 ± 0.41, which improved marginally postoperatively to logMAR 1.03 ± 0.44 (P = 0.36). Best spectacle‐corrected visual acuity averaged logMAR 0.21 ± 0.16 preoperatively, improving to logMAR 0.09 ± 0.15 (range ?0.18 to 0.42) postoperatively, which was a statistically significant improvement (P < 0.01). No difference in refractive or visual outcomes was identified when those with keratoconus were compared to those with other underlying corneal disease processes. Conclusion: Although mean surgically induced astigmatism was not statistically significant, hinged lamellar keratotomy caused considerable changes in astigmatism in nearly 70% of post‐keratoplasty eyes studied. This suggests that clinically significant inaccuracies may result if a one‐stage LASIK procedure is performed on such patients. The authors suggest that reassessment of refraction after keratotomy may improve refractive outcomes.     

Repeat Radial Keratotomy in Monkeys

Six adult rhesus monkey eyes underwent a repeat radial keratotomy consisting of eight additional incisions one year following the initial procedure. An additional 1.07 diopters (63%) flattening of the corneal curvature and +0.82 diopters (33%) of refractive error change was produced when compared with the control eyes.