准分子激光原位角膜磨镶术治疗视觉敏感期后远视性屈光参差性弱视

目的评价准分子激光原位角膜磨镶术（laser in situ kemtomileusis，LASIK）治疗视觉敏感期后远视性屈光参差性弱视1年后的作用和安全性。方法对25例（25眼）年龄为12—16岁的远视性屈光参差性弱视患儿行角膜中央最薄处厚度和中央2．5mm外四个方位厚度检测、1％阿托品散瞳验光、角膜直径测量、wavefront或OPD—scan波前像差仪进行坐位时的虹膜识别后行LASIK治疗。弱视眼屈光度远视1．50—7．50DS，散光为1．00-5．00DC，激光仪使用visxstarS4或NidekEC5000 CX—Ⅱ激光仪，两种激光均具有眼球主动追踪和虹膜识别技术。术后辅助弱视训练，随访12个月以上。结果弱视眼远视切削均值达（3．75±1．20）D，最高限度为6，75DS，术中术后无角膜瓣相关并发症发生。术后第12个月随访时，术眼残余屈光度均值（1.09±1．13）D（P〈0．01），最佳矫正视力由0．24±0．17提高至0．67±0．37（P〈0．01），无最佳矫正视力下降或丢失。结论视觉敏感期后的弱视仍具有可塑性，术后1年的随防表明LASIK治疗远视性屈光参差性弱视安全、有效。

The effectiveness of laser in situ keratomileusis for anisometropic amblyopia in children past the sensitive period for visual development based on clinical observation

Objective To determine whether laser in situ keratomileusis （LASIK） is effective for correcting amblyopiogenic refractive errors after the sensitive period for visual development based on a clinical observation period of at least one year. Methods Twenty-five eyes in 25 amblyopic children, who ranged in age from 12 to 16 years （mean, 13.4 years）, all had a neurobehavioral disorder and/or were noncompliant with spectacle or contact lens wear. Measurements were taken for corneal thickness at the center and perimeter, mydriatic refraction, corneal diameter and wavefront aberrations before surgery. Hyperopia ranged from 1.50 to 7.50 D mean, （4.15±1.40）D]. VISX Star S4 or Nidek EC5000 CX-Ⅱ excimer lasers were used in auto-tracking modes. Mean follow-up was more than 12 months （range, 12-25 months）. Results Hyperopic correction averaged （3.75±1.20）diopters （D） （range, 2.75 to 6.25 D）. No eye was treated if the spherical equivalent measurement was more than 6.75 diopters. No complications from corneal flap were found. At 1 year after surgery, the mean spherical refraction was within （1.09±1.13）D of the targeted correction; mean best corrected visual acuity improved from 0.24±0.17 to 0.67±0.37, and acuity improved postoperatively in 100% of the children. No child lost acuity. All of the eyes had clear corneas with no haze. The results of a functional vision survey showed a positive effect on the patients＇ ability to function in their environments after LASIK. Conclusion Laser in situ keratomileusis is effective for correcting anisemetropic amblyopia in children past the sensitive period for visual development. The observation period of one year or more indicates the surgery is safe and effective for the treatment of anisometropic amblyopia.