LASEK与PRK矫正近视及近视散光的疗效比较

目的 比较LASEK与PRK手术矫正不同程度近视及近视散光的有效性、安全性及稳定性。方法 70名患者(140眼)，分为中低度近视组39人(78眼)、高度近视组31人(62眼)。患者一眼行LASEK手术，对侧眼行PRK手术，术后观察术眼疼痛情况、上皮愈合时问、角膜上皮下雾状混浊(haze)、术后裸眼视力6个月。结果LASEK与PRK术后上皮愈合时间及术眼疼痛指数无明显差异；中低度近视组两种手术后裸眼视力无显著差异；高度近视组裸眼视力及角膜haze程度差异显著。结论 LASEK矫正不同程度近视均能取得较好的临床效果，术后裸眼视力及视力稳定程度优于PRK，特别表现在高度近视组。     

准分子激光治疗高度和超高度近视的远期疗效

目的:比较准分子激光屈光性角膜切削术(PRK)和激光原位角膜磨镶术(LASIK)治疗高度和超高度近视的远期临床效果及其影响疗效的因素。方法:高度近视眼163例(294眼),其中PRK组84例(139眼),平均等效球镜屈光度-8.68±2.08D,LASIK组79例(155眼),平均等效球镜-9.17±2.92D。按术前屈光度分2组,Ⅰ组-6.25～-10.00D,Ⅱ组≥-10.00D,随访2a。结果:2a时,裸眼视力≥0.5者,Ⅰ组中PRK占89.5%,LASIK占96.8%;Ⅱ组中PRK占35.3%,LASIK占83.9%。裸眼视力≥1.0者,Ⅰ组中PRK为51.4%,LASIK为80.6%;Ⅱ组中PRK为2.9%,LASIK为46.8%。术后屈光度在预期矫正屈光度±1.00D范围以内者:Ⅰ组中PRK为62.8%,LASIK为88.2%;Ⅱ组中PRK为17.6%,LASIK为61.3%。角膜上皮下混浊(Haze)发生率,PRK组0级53.2%,0.5级25.3%,1级13.0%,2级8.6%。其中Ⅰ组发生率为39.0%,Ⅱ组发生率为70.5%。LASIK组均无上皮下或层间混浊发生。术后2a的等效球镜屈光度(Y)PRK组与术前等效球镜(X1雪,角膜屈光力(X 2)建立多元回归方程为Y =-8.645 0.444X1 0.265X 2(P <0.001)。LASIK组与术前等效球镜(X 1)、术中角膜切削深度(X 3)建立多元回归方程Y =-0.703 0.52X 1 0.0437X 3(P <0.001)。结论:准分子激光治疗高度和超高度近视眼的临床效果LASIK术式较PRK术式具有明显的优势。     

准分子激光角膜原位磨镶术矫治高度近视准分子激光屈光性角膜切削术后屈光回退的临床观察

目的评价准分子激光角膜原位磨镶术（LASIK）矫治高度近视准分子激光屈光性角膜切削术（PRK）后屈光回退的疗效。方法回顾性临床研究。对PRK术后2年以上、屈光回退且屈光度稳定的患者8例14眼行LASIK,对LASIK术后术眼进行评价。患眼PRK术前屈光度为-6.25～-12.50 D,PRK术后屈光度为-1.50～-6.25 D。随访观察LASIK矫正1年后术眼的裸眼视力、最佳矫正视力、屈光度、上皮下雾状混浊（haze）形成和角膜厚度的变化。结果所有患眼术后主观症状较轻。LASIK术后1年平均球镜度数为（-0.62±0.94）D。LASIK术后0.5≤裸眼视力〈0.8者4眼,≥0.8者9眼,1眼（7.1%）最佳矫正视力下降2行。4眼术后出现不同程度的haze,包括2级haze 3眼、3级haze 1眼。应用氟米龙滴眼液1个月后,haze及屈光回退减轻;术后1年,1级haze 2眼,2级haze 2眼,3级haze 1眼。LASIK术前角膜厚度为（467±38）μm,术后为（422±21）μm。结论高度近视PRK术后屈光回退行LASIK矫治是一种可行的方法,但少数患者术后可出现haze,仍需治疗。     

Long term results of no-alcohol laser epithelial keratomileusis and photorefractive keratectomy for myopia

RESULTS: Twenty-one eyes and 22 eyes completed follow-up of 60mo in LASEK and PRK group respectively. Manifest refraction at 60mo follow-up was -0.01 and 0.26 in LASEK and PRK group respectively. In the LASEK group mean UDVA and mean CDVA after 60mo were 20/22 and 20/20 respectively (P>0.01). In the PRK group mean UDVA and mean CDVA at 60mo follow-up were 20/20 and 20/20 after 60mo (P>0.01). The efficacy indexes were 0.87 and 0.95, and the safety indexes were 1.25 and 1.4 respectively for LASEK group and PRK group.CONCLUSION:Both standard PRK and no-alcohol LASEK offer safe and effective correction of low-moderate myopia in the long term without any statistically significant difference between the two groups.     

PRK治疗高度近视的临床分析

目的探讨准分子激光角膜切削术对高度近视的疗效及其并发症。方法采用UV200型准分子激光机,对183例（330眼）—6．00D以上近视患者施行准分子激光角膜切削术,对随诊1a以上的患者进行观察。术前等值球面镜屈光度为—6．00～—26．00D（—10．27±—3．87D）,按屈光度分为3组：A组—600～—10．00D,199眼;B组—10．00～—15．00D,87眼;C组＞—15．00D,44眼。结果术后1a时裸眼视力＞0．5者276眼,占83．64％,M1．0者144眼,占43．64％;术后类固醇高眼压37眼,占11．21％;23眼（6．97％）的患眼有严重的角膜混浊,发生视网膜脱离3眼,眼底出血2眼。角膜曲率和中央角膜厚度在术后各时期无明显变化。结论PRK手术对高度近视是有效的．安全的。部分患者可获得良好的裸眼视力,大部分患者可明显减轻眼镜度数。     

Single-step transepithelial photorefractive keratectomy in high myopia: qualitative and quantitative visual functions

AIM: To investigate quantitative and qualitative optical outcomes of single-step transepithelial photorefractive keratectomy (TransPRK) in high myopia. METHODS: In a prospective interventional case-series, 30 eyes with high myopia (-6.00 to -8.75 D) with (up to -3.00 D) or without astigmatism were enrolled from Bina Eye Hospital, Tehran, Iran. One-step TransPRK was performed with aberration-free aspherical optimized profile and SCHWIND AMARIS 500 laser. One-year follow-up results for refraction, visual acuities, vector analysis, ocular wave-front (OWF) and corneal wave-front (CWF) higher order aberrations (HOA), contrast sensitivity (CS), and post-operative haze were assessed. RESULTS: After the surgery, both photopic and mesopic CSs significantly improved (both P<0.001). We detected significant induction of OWF coma and trefoil (P<0.001 for both) HOAs; CWF coma (P=0.002), spherical (P<0.001), and tetrafoil (P=0.003) HOAs in 6 mm analysis diameter; and CWF trefoil (P=0.04) HOA in 4 mm analysis diameter. The range of mean induction observed for various HOAs was 0.005-0.11 µm. The 86.7% of eyes reached an uncorrected distance visual acuity of 20/20 or better; 96.7% of eyes were within ±0.5 D of targeted spherical refraction. In vector analysis, mean correction index value was 1.03 and mean index of success was 0.22. By 12mo after the operation, no eye lost any number of corrected distance visual acuity lines. We detected no corneal haze greater than 1+ throughout the follow-up. CONCLUSION: Our findings show promising effects of single-step TransPRK on quality of vision in high myopic eyes. It also improves refraction and visual acuity.     

Corneal curvature,asphericity, and aberrations after transepithelial photorefractive keratectomy and femtosecond laser-assisted in situ keratomileusis for myopia: A prospective comparative study

Purpose:We aimed to compare transepithelial photorefractive keratectomy (TPRK) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for myopia treatment by analyzing corneal curvature, asphericity (Q-value), and corneal aberration.Methods:Corneal topography was measured before and 6 months after the TPRK or FS-LASIK surgery. We measured and compared corneal curvature (sagittal curvature in the 1- to 7-mm zones), change in keratometric measurements (Kmpost – Kmpre, ΔK), Q-values (from the vertex of the 6-, 7-, 8-, and 9-mm zones), higher-order aberration (HOA), vertical and horizontal trefoil (Z3^-3 and Z3³), vertical and horizontal coma (Z3^-1 and Z3¹), and spherical aberration (Z4⁰) between the two surgery groups.Results:The sagittal curvature Δ K in the 1-mm zone after TPRK was significantly higher than after FS-LASIK. The Δ K/ΔSE (ΔSE [spherical equivalent] = SEpre – SEpost) ratio in the 1- to 4-mm diameter zones was significantly higher after TPRK than after FS-LASIK. The preoperative Q-values of the 6- and 7-mm zones did not differ between the treatment groups, but postoperative values were significantly higher following FS-LASIK than following TPRK. HOA, Z4⁰, and Z3^-1 were all significantly higher after surgery in both groups. Postoperative Z3^-3 was significantly higher following TPRK but not following FS-LASIK. There were no postoperative differences in aberrations in either group; however, the change in HOA and Z3^-1 was significantly greater following FS-LASIK.Conclusion:TPRK changes the corneal curvature to a greater extent and the visual quality (Q-value, aberrations) to a lesser extent than FS-LASIK.     

LASEK、PRK和LASIK治疗中低度近视的比较

目的对比分析准分子激光上皮下角膜磨镶术(LASEK)、碰光性角膜切削术(PRK)、激光原位角膜磨镶术(LASIK)治疗中低度近视临床疗效。方法LASEK组58例(112眼)随访3-9月,PRK、LASIK组各120眼随访1a以上,观察分析术后疼痛症状,裸眼视力及角膜混浊情况。结果术后1d出现疼痛症状:LASEK组:81眼(72.3％),PRK组120 眼(100.0％),LASIK组13眼(10.8％);术后3d裸眼视力≥0.8:LASEK组24眼(21.4％),PRK组27眼(22.5％),LASIK组113 眼(94.2％);术后3月存在角膜Haze:LASEK组31眼(27.6％)、PRK组94眼(78.3％),LASIK组0眼。结论LASEK后疼痛症状、角膜Haze明显减轻,疗效优于PRK;LASEK与LASIK相比没有角膜瓣相关并发症,早期视力恢复较慢。     

经上皮准分子激光屈光性角膜切削术(TPRK)及飞秒激光辅助的准分子激光原位角膜磨镶术(FS-LASIK)后眼轴长度及角膜光密度的变化

目的观察经上皮准分子激光屈光性角膜切削术(transepithelial photorefractive keratectomy,TPRK)及飞秒激光辅助的准分子激光原位角膜磨镶术(femtosecond laser-assisted in situ keratomileusis,FS-LASIK)手术前后眼轴长度及角膜光密度(corneal density,CD)的变化,并探讨二者间相关性。方法回顾性分析。使用IOL Master 500测量TPRK组(72眼)和FS-LASIK组(42眼)患者术前及术后3个月的眼轴长度,同时使用Pentacam进行角膜厚度测量及CD分析。对手术前后眼轴差与角膜消融厚度之间的差异性、相关性及一致性进行分析,同时分析IOL Master眼轴测量偏差(眼轴差与角膜消融厚度间差值)与CD变化的相关性。结果 TPRK组及FS-LASIK组手术前后眼轴差分别为(0.09±0.04)mm、(0.11±0.05)mm,角膜消融厚度分别为(0.09±0.02)mm、(0.09±0.03)mm,二者之间显著正相关(r=0.486、0.494,均为P<0.01),...     

智能脉冲技术辅助的经上皮准分子激光角膜切削术（Trans-PRK）矫正中低度近视

目的　研究智能脉冲技术（smart pulse technology,SPT）辅助的经上皮准分子激光角膜切削术（transepithelial photorefractive keratectomy,Trans-PRK）矫正中低度近视的效果。方法　回顾性分析2017年6月至11月在我院使用1050 Hz切削频率和SPT辅助的Trans-PRK手术的中低度近视患者39例(75眼)的临床资料,应用Sirius眼前节分析仪测量6 mm瞳孔直径下角膜波前像差。随访6个月,手术前后数据采用重复测量方差分析检验。结果　术后6个月的最佳矫正视力与术前比较,无一例下降超过一行,46.67％(35/75)的患眼无变化,37.33％(28/75) 的患眼提高一行,16.00％(12/75) 的患眼提高两行。术后6个月的裸眼视力,100.00％(75/75) 的患眼达到20/20或更好,88.00％(66/75) 的患眼达到20/16或更好,60.00％(45/75) 的患眼达到20/13或更好,8.00％(6/75) 的患眼达到20/10。术后6个月,6 mm瞳孔直径下角膜球差、高阶像差、彗差分别为（0.25±0.14）μm、（0.45±0.15）μm和（0.23±0.11）μm,均较术前（0.19±0.07）μm、（0.33±0.07）μm和（0.19±0.09）μm增加（均为P<0.05）。结论　SPT辅助的Trans-PRK矫正中低度近视是安全、有效的,术后角膜高阶像差、球差和彗差均有一定程度增加。     

准分子激光角膜切削术治疗高度、超高度近视眼术后角膜上皮下混浊的远期观察

目的:探讨准分子激光角膜切削术(PRK)治疗高度、超高度近视眼术后角膜上皮下雾状混浊(Haze)的发生情况及影响因素。方法:应用日本NIDEKEC-5000型准分子激光仪治疗高度、超高度近视眼143例(245眼),I组:-6.25～-10.00D,167眼;Ⅱ组-10.25～-24.00D,78眼。观察术后不同时期Haze的发生情况,随访7a以上。结果:术后3mo,0.5,1,4,7a,Haze的发生率,I组分别为74.8%,44.3%,24.5%,11.9%,7.8%;Ⅱ组为80.7%,52.1%,33.3%,24.3%,19.2%。7a时I组屈光度-0.57±1.84D,Ⅱ组-5.02±4.26D。有3级Haze7眼,I组2眼,为RK术后者;Ⅱ组5眼,4眼为年龄>40岁者。≥3级Haze者多出现在Ⅱ组,3～6mo达到高峰,持续时间达1a以上。结论:Haze为高度、超高度近视眼PRK术后的主要并发症。预矫屈光度越高,切削越深,则混浊程度越重;部分患者Haze逐渐减轻,角膜组织创伤修复时间长,部分重度Haze日后可能成为永久性瘢痕。     

准分子激光屈光性角膜切削术治疗高度近视探讨

目的探讨准分子激光角膜切削术(PRK)治疗高度近视的效果.方法应用VISX20/20B型准分子激光仪,采用多光区切削法治疗-15D以上超高度近视.术后随访19～38月,并对结果进行分析.结果术前最佳矫正视力0.69±0.19,术后裸眼视力0.61±0.11.术后3月左右角膜上皮下混浊(haze)明显,1年后最轻,该组haze平均(0.53±0.17)级,屈光度回退平均(3.15±1.56)D.结论对于角膜较薄,不适于准分子激光原位角膜磨削术(LASIK)的超高度近视患者,PRK的多光区切削方式仍不失为一种安全、有效且稳定性较好的方法.     

PRK联合术中丝裂霉素矫正高度近视的临床研究

目的:探讨准分子激光屈光性角膜切削术(photorefractive keratectomy,PRK)联合术中使用0.2g/L丝裂霉素(MMC)矫治高度近视的安全性、有效性、稳定性。方法:对109例201眼高度近视的患者行PRK术,激光切削后使用0.2g/LMMC20s,观察术后角膜上皮愈合时间、观察术后1,3,6,12mo时裸眼视力、矫正远视力、屈光状态、haze形成情况及并发症情况、角膜内皮细胞计数等。结果:角膜上皮愈合时间为3.68±0.35d。术后裸眼视力均有明显提高,术后12mo裸眼视力达到1.0以上的者189眼(94%),等效球镜在±0.5D以内者153眼(76%)。术后矫正远视力下降1行者7眼(3%),无1例矫正远视力下降2行或2行以上。术后3mo与术后12mo相比,屈光度变化≤0.5D者占96%。手术前后角膜内皮细胞计数、变异系数比较均无显著性差异(P1=0.71;P2=0.83)。术后12mo,0～0.5级haze者189眼(94%),1级haze者12眼(6%);未见2级以上haze。术后未见丝裂霉素毒性反应及并发症。结论:准分子激光屈光性角膜切削术联合术中使用0.2g/LMMC20s矫治高度近视安全、有效。     

全激光TransPRK术治疗近视眼的临床观察

目的:探讨全激光TransPRK治疗近视、散光的疗效和安全性的效果分析。方法:采用德国SCHWIND公司生产的AMARIS准分子激光系统,对进行全激光TransPRK术的80例156眼近视患者,进行裸眼远视力、矫正视力、屈光度、眼压、角膜地形图、干眼等随访,观察分析。结果:随访1a,裸眼远视力≥1.0者47例92眼,占58.8%。裸眼远视力0.8者20例40眼,占25%;裸眼远视力0.6者13例24眼,占16.3%。接近或高于最佳矫正视力(BCVA)者63例121眼,占78.8%。稍低于最佳矫正视力(BCVA)1行或2行者17例34眼,占21.2%。术后干眼9例18眼,占11.3%。主诉有眩光,夜间视力差16例32眼,占20%。结论:准分子全激光TransPRK术是治疗近视、散光的安全、有效的理想表层手术方式之一。术后远视力及屈光度稳定,手术安全性好。     

Prognostic factors of visual quality after transepithelial photorefractive keratectomy in patients with low-to-moderate myopia

Purpose:The aim of this study was to evaluate visual quality after high-frequency transepithelial photorefractive keratectomy (t-PRK) by assessing the relationship between the operational parameters and the first-year postoperative corneal higher-order aberrations (HOAs).Methods:This was a retrospective study of low-to-moderate myopic eyes treated with t-PRK. The files of 46 low-to-moderate myopic patients (90 eyes; myopia up to −5D) were included in the study. Eyes having a cylindrical refractive error more than 2D and the patients not having completed a 1-year follow-up were excluded from the study. Factors including age, preoperative mean spherical equivalent (MSE), mean keratometry (Km), central corneal thickness (CCT), scotopic pupil, optical zone (OZ), transition zone (TZ), ablation zone (AZ), central ablation depth (CAD), and static cyclotorsion correction (SCC) were analyzed for association with the first-year postoperative corneal HOAs.Results:Corneal HOAs were found to be increased postoperatively with a 6-mm pupil (P < 0.05). The increased spherical aberration had a positive correlation with patient age, preoperative MSE, Km, TZ, and CAD, whereas it had a negative relationship with OZ and AZ (P < 0.05). The corneal coma had a significantly positive correlation with preoperative MSE and a significantly negative relationship with OZ (P < .05).Conclusion:Postoperatively induced corneal HOAs may affect patients'' scotopic vision (night time driving, cinema) when the pupils get larger. The relationship between patient age, preoperative MSE, Km, CAD, TZ, OZ, AZ, and postoperative corneal HOAs underlines the need to consider the effects of these parameters on the final vision quality.     

Contrast sensitivity after excimer laser photorefractive keratectomy for myopia

AIM: To evaluate contrast sensitivity in patients who had undergone uncomplicated excimer laser photorefractive keratectomy (PRK) for myopia. · METHODS: Monocular contrast sensitivity function was measured with the CSV-I000E chart in 41 patients who had received PRK by the Nidek EC-5000 excimer laser system. Mean preoperative refractive error was -2.62±1.33 D (range, -0.75 to -4.00 D). Contrast sensitivity function was measured preoperatively, 1week, 1, 3 and 6 months after surgery through the CSV-1000E contrast sensitivity unit (VectorVision). · RESULTS: Logarithmic values of contrast sensitivity at each spatial frequency were used for statistical analysis and normalized values were used for graphical representation. Contrast sensitivity decreased 1 week and 1 month postoperatively. Starting from the first month, there was rapid recovery of contrast sensitivity especially at low spatial frequencies, and at the third month, only at 6 and 12 cycles per degree (cpd) statistically significant decrease was seen. Six months after surgery, there was an increase in contrast sensitivity values at all spatial frequencies. · CONCLUSION: Photorefractive keratectomy can induce significant reductions in contrast sensitivity in the first month after surgery; these values returned to the preopereative values at 6 months after surgery.     

近视眼准分子激光角膜切削术后的对比敏感度评价

目的:评价近视患者PRK术后的对比敏感度变化.方法:应用CSV-1000E图表对41例接受Nidek EC-5000型准分子激光仪行PRK手术的患者,行单眼对比敏感度测量.患者术前平均屈光度为-2.62±1.33D(范围从-0.75至-4.00D).应用CSV-1000E对比敏感度仪分别在术前,术后1wk;1,3,6mo行对比敏感度检查.结果:将每个空间频率的对比敏感度对数值进行统计学分析,并应用图表与正常值进行比较.结果显示对比敏感度在术后1wk及术后1 mo时明显降低,从第1 mo开始,对比敏感度尤其是低空间频率的对比敏感度快速恢复,在第3mo,只有6和12cpd两种空间频率的对比敏感度明显降低,在术后6mo时,所有频率的对比敏感度功能都明显增加.结论:PRK术后患者第1 mo对比敏感度功能明显降低,但在术后6mo时对比敏感度功能即恢复至术前水平.     

PRK治疗近视远期疗效分析

目的　评价PRK治疗近视及散光的远期疗效。方法　 1995年 11月～ 1997年 5月PRK手术 3 46例 (619眼 ) ,按术前等值球镜度分为 3组 ,A组 :-1.0 0D～ -6.0 0D ,3 40眼 ;B组 :-6.2 5D～ -10 .0 0D ,189眼 ;C组 :-10 .2 5D～ -2 4.0 0D ,90眼。术后随访 5年。结果　术后 5年屈光度在预定矫正度± 1.0 0D以内者 ,A、B、C组依次为 93 .2 % ;82 .5 % ;2 7.8%。裸眼视力≥0 .5者 ,3组依次为 94 1% ;78 8% ;3 5 6%。最佳矫正视力达到或超过术前最佳矫正视力得依次为 99 1% ;95 2 % ;92 2 %。有3级以上角膜上皮下雾状浑浊 (haze)者依次为 0 .5 9% ;1.0 6% ;6 67%。结论　PRK是治疗近视安全有效的方法 ,其预测性及稳定性与近视度呈负相关     

Effect of mitomycin C on the corneal endothelial cells of Saudi patients with myopia after transepithelial photorefractive keratectomy: a two-armed cohort study

AIM: To study the effect of mitomycin C (MMC) applied during transepithelial photorefractive keratectomy (TPRK) on the corneal endothelium one week (W1) and three months (M3) after surgery and its determinants. METHODS: In this two-armed cohort study conducted in 2022, eyes treated with MMC during TPRK (group 1) were compared with eyes not treated with MMC (group 2). The corneal endothelial cell (EC) count, EC density (ECD; cells/mm2), average (μm2), standard deviation (μm2), coefficient of variation (CV%), ECmax, ECmin, and EC percentage of hexagonality were estimated at W1 and M3. The postoperative changes in the EC count in the two groups were compared and correlated with the other independent variables. RESULTS: Group 1 had 26 eyes, and group 2 had 78 eyes. All TPRK indices were significantly higher for the eyes in group 1 than for those in group 2. The MMC usage was not a significant predictor of the change in ECD (P=0.644), change in CV (P=0.374), and change in the percentage of hexagonality of EC (P=0.164) at W1. However, the use of MMC was a significant predictor of changes in CV (P=0.014) and the change in the percentage of hexagonality of EC (P=0.039) at M3. The duration of laser exposure and the size of the optical zone influenced the correlation of MMC use with the changes in EC indices, postoperatively. CONCLUSION: The use of MMC doesn’t affect ECD, CV, and percentage of hexagonality at W1 if other surgical indices are considered. At M3 after operating myopic eyes by TPRK, MMC significantly influence the CV and percentage of hexagonality. The duration of the laser application and the size of the optical zone should be considered when determining the effect of MMC on the EC indices.     

准分子激光角膜切削术治疗近视和近视散光的临床研究

目的 评价准分子激光角膜切削术矫正近视的结果。方法 我院自１９９６年９月到１９９７年１０月,应用ＳＶＳＡＰＥＸ型（Ｓｕｍｍｉｔ Ｔｅｃｈｎｏｌｏｇｙ Ｉｎｃ．ＵＳＡ）准分子激光治疗仪,对１６８例近视患者（３１６只眼）行ＰＲＫ手术,对其中的１５０例（２６０只眼,占８４％）患者随诊至少３ｍｏ以上,最长１ａ;男６８例（１１６只眼,占４０．１％）,女８２例（１４４只眼,占５９．９％）。１５０例（２６０只眼