主塑堂堂查201L笙月第1曼卷第1期ChinJOptomOphthalmolVisSci,February2011,Vo1.13,No.1准分子激光角膜表层切削术矫治疑似圆锥角膜的长期临床观察张钰陈跃国夏英杰【摘要】目的探讨准分子激光上皮瓣下角膜磨镶术(LASEK)及机械法准分子激光上皮瓣下角膜磨镶术(Epi—LASIK)矫治疑似圆锥角膜引起的近视及散光的长期安全性、有效性和稳定性。方法回顾性病例系列研究。疑似圆锥角膜患者38例(55眼),年龄19~44岁,男7例,女31例。近视度一3.25—7.75D,平均(一5.54~2.18)D;散光度0~3D,平均(0.80~0.75)D;中央角膜厚度479—605m,平均(541.8~30.0)m。角膜地形图均提示l期圆锥角膜,近视及散光度、角膜地形图形态稳定至少2年。55眼均成功接受了LASEK(38眼)或Epi—LASIK(17眼)。术后6个月及2年以上(2~5年)随访,检查患者的视力、屈光度及角膜地形图。对手术前后的数据进行配对t检验(正态分布)或WilcoxonSignedRanks检验(非正态分布)。结果术后2年以上,48眼(87_3%1的裸眼视力≥1.0,有效指数为1.002;51眼(92.7%)的最佳矫正视力较术前不变或提高,仅4眼(7_3%)下降1行,安全指数为1.053;等效球镜度为(一0.11~0.45)D,在±0.50D范围内为49眼(89.1%),在±1.0HDD范围内为53眼(96.4%);近视度和散光度分别为(一0.01~0.45)D和(0.25~0.33)D。术后2年以上的近视及散光度与术后6个月比较,差异均无统计学意义(P>0.05)。术后2年以上的角膜地形图圆锥角膜指数KI值为1.02~0.04,较术前(1.08+0.叭)降低,差异有统计学意义(z=一6.098,P<0.01)。随访期间未见明显haze及圆锥角膜进展。结论疑似圆锥角膜患者的年龄、近视屈光度、角膜厚度及屈光度和角膜地形图的稳定性是其能否接受LASEK或Epi—LASIK治疗的关键。LASEK和Epi—LASIK对于矫治屈光及角膜地形图形态稳定的疑似圆锥角膜的近视及散光,可能是一种安全、有效的方法,但更长期的安全性有待于进一步的观察。【关键词】圆锥角膜;屈光性角膜切削术;近视;散光;角膜地形图Long—termresultsofexcimerlasercornealsurfaceablationforcorrectionofmyopiaandastigmatisminsuspectedkeratoconusZHANGYu.CHENYue-guo.XIAYing-jie.Department0phthalmology,theThirdHospitalofPekingUniversity,Beijing100191,ChinaCorrespondingauthor:CHENYue-guo,Email:chenyueguo@263.net【Abstract】0bjectiveToexplorethelong-termsafety,eficacyandstabilityoflaserepithelialkeratomileusis(LASEK)andepipolislaserinsitukeratomileusis(Epi—LASIK)forthecorrectionofmyopiaandastigmatisminsuspectedkeratoconus.MethodsThiswasaretrospectiveclinicalstudy.Thi~y——eightpatientswith55eyessuspectedtohavekeratoconuswereenrolledinthestudy.Alleyesweremyopic,rangingfrom-3.25to一7.75D[(-5.54+2.18)D】,cylinder0to3D[(0.80~0.75)D】,withacentralcornealthicknessof479to605m,andstageonekeratoconus(KC1)detectedbykeratography.Refractionandkeratographwerestableforatleast2yearsinalleyes.Fifty—fiveeyessuccessfullyunderwenteitherLASEK(38eyes)orEpi-LASIK(17eyes).Visualacuity,refraction,andkeratographwerecheckedpostoperativelyfrom6monthstomorethan2years(2to5years).Apairedsamplesttestnormaldistribution)andaWilcoxonSignedRankstestnon-normaldistribution)wereusedtocomparethedatabeforeandaftersurgery.ResultsMorethan2yearspostoperatively,uncorrectedvisualacuitywas1.0orbetterin48eyes(87_3%),theeficacyindexwas1.002;bestspectacle—correctedvisualacuityremainedunchangedorimprovedin51eyes(92.7%),andonelinewaslostin4eyes(7.3%),thesafetyindexwas1.053.Meansphericalequivalentrefractionwas(-0.11~0.45)D;sphericalequivalentrefractionwaswithin±0.50Din49eyes(89.1%)andwithinDOI:10.3760/cma.j.issn.1674—845X.2011.01.012作者单位:100191北京,北京大学第三医院眼科通信作者:陈跃国,Email:c...