Laser in situ keratomileusis for moderate and high myopia and myopic astigmatism
Laser in situ keratomileusis for moderate and high myopia and myopic astigmatism
复制标题
DOI：
10.1016/s0161-6420(98)95040-0
复制
发表时间：
1998-05-01
期刊：
影响因子：
13.7
通讯作者：
Liesenhoff, H
中科院分区：
文献类型：
--
作者：
Knorz, MC;Wiesinger, B;Liesenhoff, H
目的：评价准分子激光原位角膜磨镶术(LASIK)治疗近视和近视散光的可预测性、稳定性和安全性。设计：采用前瞻性、无掩蔽性、非随机化的临床试验。参与者：散光度小于1.00度的近视患者25例(37眼)，分为3组(-5.00~-9.90D，8眼；-10.00~-14.90D，10眼；角膜散光度1.00~4.50D的近视患者37例(56眼)，分为-5.00~-9.90D组12眼，-10.00~-14.90D组24眼；干预：使用全自动角膜塑形仪和Keracor 116准分子激光进行LASIK手术。主要观察指标：视力、明显屈光度、中央角膜岛、切削偏心和患者满意度。结果：在12个月时，报道了球形(TORIC)组的可预测性、1-12个月的回归、裸眼视力(UCVA)、两行或两行以上矫正视力的丧失以及患者满意度。-5.00~-9.90D亚组：100%(75%)+/-1.00D，屈光度小于或等于1.00D者100%(91.7%)，裸眼视力大于或等于20/40者87.5%(70%)，无一例丢失两行或以上；100%(84%)患者高度满意。-10.00~-14.90D亚组：60%(78.3%)+/-1.00D，屈光度小于或等于1.00D者100%(87%)，裸眼视力大于或等于20/40者77.8%(86.4%)，失去两行者10%(4.3%)，高度满意者90%(91%)。-15.00~-29.00D亚组：38.9%(21.4%)+/-1.00D，屈光度小于或等于1.00D者72.2%(64.3%)，裸眼视力大于或等于20/40者33.3%(40%)，失去两条线者5.6%(7.1%)，高度满意者78%(50%)。-5.00~-9.90D和-15.00~-29.00D亚组之间的预测性和显性屈光度变化差异有统计学意义。17%(5.6%)的球形眼和16%(4.1%)的环形眼出现中心岛(偏心)。总体而言，8.2%的患者可以看到角膜界面。结论：本研究中使用的LASIK方法显示出明显的屈光稳定性和足够的裸眼中心视力，大部分近视患者的角膜稳定性不均匀。尽管进行了治疗，仍有相当数量的少数患者观察到中央角膜岛。对于大于15.00D的近视，准确性和患者满意度都很差，建议不要在这些组中使用作者的治疗技术。在较小比例的患者中发现了视觉上显著的微角膜刀和激光相关的问题。接受散光矫正的患者对结果的满意度低于接受球镜矫正的患者。
Objective: This study evaluated the predictability, stability, and safety of laser in situ keratomileusis (LASIK) in myopia and myopic astigmatism.Design: The study design was a prospective, unmasked, nonrandomized clinical trial.Participants: Participating were 25 patients with myopia (37 eyes) with astigmatism of less than 1.00 diopter (D), divided into 3 subgroups (-5.00 to -9.90 D, 8 eyes; -10.00 to -14.90 D, 10 eyes; -15.00 to -29.00 D, 19 eyes), and 37 patients with myopia (56 eyes) with corneal astigmatism of 1.00 to 4.50 D, divided into 3 subgroups (-5.00 to -9.90 D, 12 eyes; -10.00 to -14.90 D, 24 eyes; -15.00 to -29.00 D, 20 eyes).Intervention: LASIK was performed using the Automatic Corneal Shaper and the Keracor 116 excimer laser.Main Outcome Measures: Visual acuity, manifest refraction, central corneal islands, ablation decentration, and patient satisfaction were measured.Results: At 12 months, predictability, regression between 1 and 12 months, uncorrected visual acuity (UCVA), loss of two or more lines of corrected visual acuity, and patient satisfaction of the spherical (toric) groups are reported. Subgroups -5.00 to -9.90 D: 100% (75%) +/-1.00 D; regression less than or equal to 1.00 D in 100% (91.7%); UCVA greater than or equal to 20/40 in 87.5% (70%); none lost two or more lines; 100% (84%) highly satisfied. Subgroups -10.00 to -14.90 D: 60% (78.3%) +/-1.00 D; regression less than or equal to 1.00 D in 100% (87%); UCVA greater than or equal to 20/40 in 77.8% (86.4%); 10% (4.3%) lost two lines; 90% (91%) highly satisfied. Subgroups -15.00 to -29.00 D: 38.9% (21.4%) +/-1.00 D; regression less than or equal to 1.00 D in 72.2% (64.3%); UCVA greater than or equal to 20/40 in 33.3% (40%); 5.6% (7.1%) lost two lines; 78% (50%) highly satisfied. Differences of predictability and change of manifest refraction between subgroups of -5.00 to -9.90 D and -15.00 to -29.00 D were statistically significant. Central islands (decentrations) were observed in 17% (5.6%) of eyes of the spherical and in 16% (4.1%) of the toric group. Overall, the corneal interface was visible in 8.2%.Conclusions: The LASIK method used in this study showed stability of manifest refraction and adequate uncorrected central visual acuity in a large percentage of patients with myopia up to -15.00 D. Corneal stability was not as uniform. Central corneal islands were observed in a sizable minority of patients despite pretreatment. For myopia greater than 15.00 D, accuracy and patient satisfaction were sufficiently poor to advise against using the authors' treatment technique in these groups. Visually significant microkeratome and laser-related problems were noted in a smaller percentage of patients. Patients with astigmatism correction were less pleased with results than were patients who received spherical corrections.