放射状角膜切开术后切口严重破裂的临床病理观察

目的探讨放射状角膜切开术(RK)后不同时期切口破裂的临床表现、组织病理学改变和切口破裂的原因。方法收集3例RK后因钝挫伤发生切口严重破裂而摘除的眼球,100g     

白内障术中飞秒激光弧形角膜切开术矫正角膜散光的疗效

目的：研究白内障术中飞秒激光弧形角膜切开术（FSAK）矫正术前角膜散光的临床疗效。方法：回顾性病例对照研究。连续纳入北京爱尔英智眼科医院2017年3月至2021年12月术前规则角膜散光为0.75~2.00 D且接受飞秒激光辅助白内障手术的患者89例（89眼）。所有患者按照术前角膜散光轴位分为顺规散光组（90°±30°）、逆规散光组（180°±30°）及斜轴散光组（45°±15°、135°±15°）。飞秒激光辅助白内障手术及弧形角膜切开术使用Lensx平台。观察患者总体和顺规、逆规散光组术前及术后3个月角膜散光的变化及分布情况。使用配对样本t检验或Wilcoxon符号秩检验比较总体及各亚组术前、术后的散光差异;使用独立样本t检验或Mann-Whitney U检验比较顺规散光组及逆规散光组的差异;散光变化的分析采用Alpins矢量分析法。结果：纳入的89例（89眼）患者中,顺规散光组38例,逆规散光组44例,斜轴散光组7例。所有患者角膜水平径为（11.48±0.57）mm,垂直径为（10.66±0.60）mm。患者总体术后裸眼远视力、最佳矫正远视力相比术前有显著改善（Z=8.01、-7.49,P<0.001）。总体术前角膜散光为（1.28±0.33）D,术后3个月残余散光（0.67±0.37）D,散光矫正量为（0.61±0.33）D。顺规及逆规散光组角膜散光矫正量分别为（0.48±0.27）D、（0.74±0.34）D。总体及顺规、逆规散光组术后平坦轴角膜曲率均有明显升高,而陡峭轴角膜曲率则出现明显下降。矢量分析法显示总体散光矫正指数为0.63±0.30,平坦指数为0.58±0.30,成功指数为0.51±0.25,误差角为-1.83°±12.59°。逆规散光组矫正效果最佳,矫正指数为0.81±0.25,平坦指数为0.75±0.26,成功指数为0.40±0.24;顺规散光组次之,矫正指数为0.42±0.21,平坦指数为0.39±0.21,成功指数为0.63±0.21。结论：白内障术中FSAK矫正术前角膜散光具有良好的有效性和安全性,相同的弧形切口设计方式在逆规散光中取得了更好的疗效,角膜直径可能是产生影响的重要因素。     

兔眼准分子激光角膜切削术联合羊膜移植术的初步实验研究

目的：以准人子角膜切削（PTK）术后的兔眼为模型,探讨保存人羊膜移植对角膜伤口早期愈合的影响,方法：新西兰西兔12只,双眼行PTK术,一眼术后立于角膜表面移植保存的人羊膜,术后,每日进行临床观察,并分别于第3,5,7天处死动物,取角膜行光镜和电镜检查,结果：在术后3,5,7天,羊膜移植侧角膜中央上皮增生厚度均明显小于对照后角膜上皮下雾状混浊（haze)的形成中发挥作用。     

放射状角膜切开术后的散光分析

对50例(98眼)放射状角膜切开术(RK)后散光状况进行了总结分析。结果显示;RK后出现散光,是比较常见的术后并发症,且术后散光轴位非常不规则,占61.5％,非常显著地多于术前(10.2％),P<0.001。多为残余性散光。引起散光的原因,概括起来有两个方面,一是角膜因素,二是手术因素。     

周边加深与不加深的放射状角膜切开术疗效对比

为对比周边加深与不加深的放射状角膜切开术 (radialkeratotomy ,RA)矫正近视的效果 ,对 2组 2 9例 39眼进行回顾分析。结果显示 ,术后 2年同一深度组等效球镜下降 ( 4 .7± 0 .7)D ,角膜屈光力下降 ( 4 .5± 0 .8)D ;周边加深组等效球镜下降 ( 5 .0± 1 .2 )D ,角膜屈光力下降 ( 4 .4± 1 .3)D。 2组病人等效球镜及角膜屈光力下降平均值无明显差异 (P >0 .0 5 )。提示 :角膜周边加深与不加深RK的术后效果无明显差异。     

Combined astigmatic keratotomy with corneal valvular incision in the treatment of high surgical astigmatism

Background: Astigmatic keratotomy is used conventionally to correct moderate surgical astigmatism. However, cases with very high surgical astigmatism due to wound compression can show a dramatic response to relaxing keratotomies made in the steeper meridian. The effect obtained cannot be predicted pre-operatively by using standard nomograms. Methods: Coupled arcuate keratotomies combined with corneal valvular incisions were performed in a case of high astigmatism post-cataract surgery. Results/Conclusion: Coupled arcuate keratotomies were combined with a corneal valvular incision enabled a surgical correction of nearly 9 D of astigmatism.     

Practical astigmatism analysis for refractive outcomes in cataract and refractive surgery

The fundamental concepts underpinning the vectorial analysis of astigmatism are straightforward and intuitive, easily understood by employing a simple golf-putting analogy. The Alpins methodology utilizes three principal vectors and the various ratios between them to provide an aggregate analysis for astigmatic change with parallel indices for spherical correction. A comparative analysis employing both arithmetic and vectorial means together with necessary nomogram adjustments for refining both spherical and astigmatic treatments can also be derived. These advanced techniques, together with their suitability for statistical analysis, comprehensively address the outcome analysis requirements of the entire cornea and the eye's refractive correction, for the purpose of examining success in cataract and refractive surgery.     

改良准分子激光上皮瓣下角膜磨镶术治疗放射状角膜切开术后残余近视和散光的临床观察

目的评价改良LASEK治疗RK术后残余近视和散光的有效性和安全性。方法对15例26眼RK术后5～7年残留近视及散光的患者进行LASEK治疗,并用改良上皮瓣的制作办法(撕囊法),所有术眼术前裸眼视力≤0.3,术后随访2年。结果平均屈光度由术前(-4.37±1.24)D下降至术后的(-0.43±0.24)D,平均散光度由术前的(-1.57±1.34)D下降至术后的(-0.32±0.30)D。24眼术后裸眼视力≥术前的最佳矫正视力,22眼术后裸眼视力≥1.0,2眼≥0.8,有2眼回退,回退度数<-1.25D。结论改良LASEK是一种安全有效的矫正RK术后残留近视散光的方法。