准分子激光上皮瓣下角膜磨镶术的角膜上皮瓣异常

目的　探讨准分子激光上皮瓣下角膜镶术 (ｌａｓｅｒｅｐｉｔｈｅｌｉａｌｋｅｒａｔｏｍｉｌｅｕｓｉｓ,ＬＡＳＥＫ)角膜上皮瓣异常的类型和相关原因 ,总结保护角膜上皮瓣完好的技术和重要性。方法　在行ＬＡＳＥＫ的 16 7例 (30 9只眼 )患者中 ,对在术中和术后出现不同类型角     

Comparison of Efficacy and Visual Outcomes after SMILE and FS-LSIK for the correction of high myopia

Objective:Compare efficacy and visual outcomes after femtosecond laser small incision lenticule extraction(SMILE)and femtosecond laser-assisted laser in situ keratomileusis(FSLASIK)in correcting high myopia.Methods:This prospective,randomized study included patients who underwent SMILE or FS-LASIK for the correction of high myopia[the sum of spherical and cylindrical error from-10.00 to-14.00 diopters(D)].Pre-operative,1 month(P1m),3 months(P3m)and 6 months(P6m)post-operative outcomes were analyzed and compared between the two procedures.Results:93 right eyes of 93 patients(SMILE:n=51,FSLASIK:n=42)were included.Both the(Attempted-achieved)sphere and the(attempted-achieved)SEQ were greater in the FS-LASIK group at all three post-operative time-points(P0.001).The post-operative vector means of astigmatism were smaller in the SMILE group than in the FS-LASIK.The differences between the optical zone of tissue removal(ROZ)during surgery and the post-operative functional optical zone(FOZ;ROZ-FOZ)were smaller in the SMILE group than in the FSLASIK group.No significant difference was found between the two procedures in the delta-root mean square(RMS)of aberrations,except for delta-spherical aberration(SA)at P3m.Conclusions:Both SMILE and FS-LASIK are effective in correcting high myopia.SMILE resulted in less under-correction,less regression,a smaller decrease in the FOZ and a smaller increase in SA when compared to FS-LASIK,which illustrated the better visual outcomes following SMILE.     

SMILE术后远期角膜共聚焦显微镜观察

目的:对比观察全飞秒小切口基质透镜取出术(SMILE)与飞秒LASIK术后两年角膜基底膜下神经纤维、角膜基质细胞、角膜切削面、角膜切口愈合的改变。方法:前瞻性、非随机对照研究,连续收集2010年6月至2012年3月接受SMILE或飞秒LASIK的患者。分别在术前,术后1周,1、3和6个月、5年利用角膜共聚焦显微镜测量角膜中央区、帽缘和瓣缘的角膜基底膜下神经纤维、角膜基质,角膜帽、角膜瓣缘切口改变。术后半年的结果已经发表报道,本研究仅报告术后5年的观察结果。结果:术后5年时SMILE组、飞秒LASIK组角膜中央区均可见再生的、粗大的、有分支角膜基底膜下神经纤维。与术前比较,神经纤维形态较扭曲。SMILE、飞秒LASIK术后角膜切削面仅可见少量的高反光样颗粒状物质,伴有轻度的纤维增殖反应,切削面角膜基质细胞数量减少。SMILE、飞秒LASIK术后角膜切口均可见上皮栓,伴切口纤维性愈合。结论:SMILE、飞秒LASIK术后5年,角膜基底膜下可见再生的、粗大的、有分支角膜基底膜下神经纤维。切削界面见少量的高反光样颗粒状物质,伴有轻度的纤维增殖反应,切削面角膜基质细胞数量减少。     

正常人亮暗背景下不同对比度的视力变化

目的:观察正常人眼在亮、暗背景下不同对比度的视力变化.方法:54例(108眼)正常视力的成年男性,用多功能电子视力测量仪(MFVA-100)比较亮、暗背景下不同对比度(100%、25%、10%、5%)的logMAR视力,并分析亮、暗背景下视力的相关性.结果:背景亮度相同时,随对比度的下降各组视力呈下降趋势,低对比度组视力明显低于高对比度组(P＜0.001);对比度相同时,暗背景组视力明显低于亮背景组(P＜0.001).亮背景100%对比度组视力与暗背景各组视力之间均无线性相关,与亮背景25%、10%、5%对比度组视力呈正线性相关(P＜0.001);暗背景100%对比度组与暗背景25%、10%、5%对比度组视力呈正线性相关(P＜0.001).随着对比度的降低,各组视力的波动幅度增加,暗背景下对比度5%时差异最大.结论:正常人眼亮背景下的视力优于暗背景,随着对比度降低,视力渐趋下降,个体差异增加,亮、暗背景之间的视力变化无线性相关.     

影响老视眼视觉质量的关键因素

老视是与年龄相关的进行性眼调节力下降,老视的矫正不仅重视视力,而且要注重视觉质量。研究影响老视眼视觉质量的关键因素有利于寻求矫正老视的有效手段,达到提高视觉质量的目的。本文就人眼视觉质量的评价、非手术因素、人工晶状体植入、传导性角膜成形术及准分子激光手术等对老视眼视觉质量的影响进行综述。     

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.     

准分子激光原位角膜磨镶术与角膜上皮下磨镶术对中高度近视高阶像差影响的对比研究

目的 比较准分子激光原位角膜磨镶术（LASIK）和准分子激光上皮下磨镶术（LASEK）对中高度近视眼高阶像差的影响。方法 选择中高度近视行准分子激光屈光手术的连续病例27例（41眼）,其中LASIK14例（23眼）、LASEK13例（18眼）。使用Zeiss-WASCA客观像差仪在术前和术后6月测量患眼暗室自然瞳孔下的波前像差。结果 术后6月两组总高阶像差均方根（RMSh）以及3～5阶高阶像差均方根（RMS3～5）均明显高于术前,以RMS4最明显。LASIK组术后RMSh的增幅高于LASEIK组（P=0.042）。LASIK组术后Y轴彗差（Z8）与球差（Z12）明显增高（均P〈0.01）。LASEK组术后Z12明显增高（P〈0.01）。LASIK组术后Z8大于LASEK组（P=0.021）。结论 对于中高度近视矫正,LASEK对高阶像差的影响比LASIK小。     

主觉波前像差仪引导准分子激光角膜原位磨镶术

目的前瞻研究主觉式像差仪引导的准分子激光角膜原位磨镶术的临床效果。方法对主觉像差仪检查与术前验光结果一致的患者随机分成2组,实验组以主觉波前像差仪引导LASIK手术,对照组进行传统LASIK手术。前瞻分析2组术后1周、3月屈光状况、裸眼视力,以及3月高阶波前像差总的均方根RMS。结果符合研究标准的共有86例,实验组为43例85眼,男∶女为22∶21;对照组共43例84眼。术后1周和3月2组视力和屈光状况无差异(P>0.05)。但实验组RMS增加较对照组明显小(P<0.05)。结论波前像差引导的个体化切削可以减少LASIK术后像差增加,改善视觉质量。     

大鼠角膜移植术后植片内γ干扰素mRNA的表达及血清白介素2的变化

目的观察大鼠角膜移植术后植片内干扰素(IFNγ)mRNA的表达及血清白细胞介素2(IL2)的变化。方法以Wistar大鼠为供体,SD大鼠为受体,按常规行穿透性角膜移植,用裂隙灯观察移植排斥情况。角膜移植术后第7天取角膜植片,用RTPCR方法检测IFNγ的表达。分别于移植术后第3天、第7天、第14天、第21天取角膜植片,行HE染色,同时采血清,检测IL2的变化。结果角膜移植术后(7.63±0.74)d出现排斥反应。移植术后第7天角膜植片内可见IFNγmRNA的表达,正常角膜无表达。正常SD大鼠血清IL2浓度为(35.18±2.59)pg/ml,移植术后第3天见IL2浓度略有升高,第7天时明显升高,第14天时血清IL2的水平达高峰(105.52±20.66)pg/ml,第21天时IL2水平有所下降。结论IFNγ、IL2在角膜移植排斥中起着重要作用。     

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.