LASIK矫治儿童高度远视性屈光参差术后视力、屈光度及角膜地形图分析

目的探讨LASIK矫治儿童高度远视性屈光参差的有效性、稳定性及角膜形态的变化对视力的影响,以便指导手术设计,提高手术疗效。方法对51例6~14岁患儿53只高度远视性屈光参差眼LASIK术后1、3、6和12个月进行视力、屈光度及角膜地形图的随访。结果术后各时间段的平均裸眼远、近视力,平均矫正远、近视力都明显好于术前;术后第1个月模拟角膜镜度数(simulatedkeratoscope reading,Sim k)的等效值较术前平均增加4.89 D,球镜屈光度较术前平均减少5.73 D。术后1~3个月Sim k等效值平均回退量为0.42 D,球镜屈光度的平均回退量为0.45 D;术后3~6个月两者的回退量分别为0.30 D和0.32 D;术后6~12个月两者仍然有0.26 D和0.23 D的回退,在各时间段中两者的回退变化相一致;Sim k的差值与柱镜屈光度的变化相符:术后较术前明显减少,术后各时间段相比较差异无显著意义。结论 LASIK矫治儿童高度远视性屈光参差是有效的,但是稳定性低于成人及儿童高度近视性屈光参差,角膜地形图检查可准确显示术后角膜的形态变化:在成人LASIK术后角膜地形图的形态变化基础上具有一定的自身特点,掌握这些特点对手术设计的改进和手术疗效的预测具有重要的临床意义。

Vision Acuity, Refraction and Corneal Topography after LASIK for Anisometropia of High Hyperopia in Children

Objective To analyze the active changes in vision acuity,refraction and corneal topography after laser in situ keratomileusis（LASIK） for anisometropia of high hyperopia in children.Methods Fifty-one pediatric patients（53 eyes） with anisometropia of high hyperopia were included,who were followed-up at 1,3,6 and 12 months postoperatively with vision acuity,refraction and corneal topography detection.Results The mean distance uncorrected visual acuity（DUCVA）,distance best spectacle-corrected visual acuity（DBSCVA）,reading uncorrected visual acuity（RUCVA） and reading best spectacle-corrected visual acuity（RBSCVA） after surgery were better than those of preoperation.The average addition of equivalent value of simulated keratoscope reading（Sim k） was 4.89 D and average decrease in spherical refraction was 5.73 D 1 month after surgery,decreased 0.42 D and 0.45 D within 3 months,decreased 0.30 D and 0.32 D from 3 to 6 months and still decreased 0.26 D and 0.23 D from 6 to 12 months,the decrease in equivalent value of Sim k accorded with the change in spherical refraction.The margin of Sim k accorded with the change in the cylindrical refraction and decreased significantly after surgery and had no significant change in different periods.Conclusions It is of value to children after LASIK for anisometropia of high hyperopia but it＇s stability is lower than adults and with anisometropia of high myopia in children,the corneal topography could display the modality of cornea accurately,which is similar to adults and has its own characteristic.The corneal topography has clinical importance for the improvement and the predictability of surgery.