近视性屈光参差患者LASIK术后双眼视功能评估

目的 观察近视性屈光参差患者接受准分子激光原位角膜磨镶术（LASIK）后双眼视功能的变化，探讨LASIK手术矫治近视性屈光参差对三级视功能的影响，从双眼视觉的变化评价其临床应用价值。设计 前瞻性病例系列。 研究对象 36例（72眼）行LASIK手术的近视性屈光参差患者（双眼屈光参差 ≥ 2.50 D）。 方法 对36例行LASIK手术的近视性屈光参差患者分别于手术前和手术后3个月进行裸眼视力、最佳矫正视力、屈光状态和同视机双眼视功能的检测，并对双眼视功能的变化进行随访研究。 主要指标 手术前后裸眼视力、最佳矫正视力、屈光度、同时视、融合功能、远立体视和近立体视。 结果 术前72眼的裸眼视力在0.01~0.2之间，术后3个月时均达到1.0。双眼屈光参差由术前的（5.01±1.96）D（ 2.50~9.00 D），降低到术后3个月的（0.28±0.22）D（0.00~0.75 D）。手术前后的屈光参差度的改变，差异均有显著统计学意义（P＜0.01）。26例屈光参差量≥2.50 D且≤6.00 D的高度屈光参差者术前戴框架眼镜下近立体视正常的12例，术后3个月增至22例，差异有统计学意义（P＜0.05）；16例屈光参差量>6.0 D的重度屈光参差者手术前后均没有正常近立体视。术前戴框架眼镜下三级视功能（同时视、融合功能、远立体视）正常的分别为33例、18例、13例，LASIK术后3个月三级视功能正常的分别为34例、33例、23例，手术后获得融合功能和远立体视者较术前明显增加（P均＜0.05）。结论 LASIK矫治近视性屈光参差，不仅可提高患者裸眼视力，而且可通过减小患者双眼间的屈光差异，增加双眼物像的融合，改善立体视功能。

Clinal effects of LASIK on binocular vision in myopic anisometropia

Objective To analyze the clinical effects on binocular vision after LASIK for myopic anisometropia, and evaluate its clinical value in the view of vision quality. Design Prospective case series. Participants 36 cases （72 eyes） with myopic anisometropia who received LASIK. Methods All the cases were followed-up for at least 3 months. The uncorrected visual acuity（UCVA）, best corrected visual acuity （BCVA）, refraction and binocular vision were analyzed before and 3 months after surgery. Main Outcome Measures UCVA, BCVA, refraction, simultaneous binocular visions, combined, short and long distance stereopsis visions before and after LASIK. Results The UCVA was 0.01-0.2 before LASIK, while the UCVA reached 1.0 after LASIK. The amount of myopic anisometropia before LASIK was （5.01±1.96） D（ 2.50-9.00 D）, and the amount was （0.28±0.22） D（0.00-0.75 D） after LASIK（P〈0.01 ）. In 26 cases with high degree anisometropia （2.50 D ≤ anisometropia degree ≤6.00 D）, 12 cases of glasses-corrected patients got normal short distance stereopsis vision and 22 cases of LASIK-treated patients got normal short distance stereopsis vision （P〈0.05）; in the 10 cases with severe anisometropia （anisometropia degree 〉6.00 D）, there was no patients who got normal short distance stereopsis vision at both the pre-operation and post-operation. 33 cases of glasses-corrected patients and 34 cases of LASIK-treated patients got simultaneous binocular visions （P〉0.05）. 18 cases of glasses-corrected patients and 33 cases of LASIK-treated patients got combined visions. 13 cases of glasses-corrected patients and 23 cases of LASIK-treated patients got long distance stereopsis visions （P〈0.05）. There was no significant difference in simultaneous binocular visions, but of great significance among combined, and long distance stereopsis visions （P〈0.05）. Conclusions LASIK for myopic anisometropia can improve the visual acuity, reduce the refractive difference, and increase combined and stereopsis vision. LASIK was effective for myopic anisometropia.