[1]季红,熊洁,张辰星,等.飞秒激光辅助LASIK联合快速角膜交联巩固术治疗中高度近视的2年期疗效观察[J].第三军医大学学报,2020,42(19):1957-1964.
 JI Hong,XIONG Jie,ZHANG Chenxing,et al.Two-year outcome of Fs-LASIK combined accelerated corneal cross-linking for moderate and high myopia[J].J Third Mil Med Univ,2020,42(19):1957-1964.
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飞秒激光辅助LASIK联合快速角膜交联巩固术治疗中高度近视的2年期疗效观察(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
42卷
期数:
2020年第19期
页码:
1957-1964
栏目:
临床医学
出版日期:
2020-10-15

文章信息/Info

Title:
Two-year outcome of Fs-LASIK combined accelerated corneal cross-linking for moderate and high myopia
作者:
季红熊洁张辰星罗启惠王科周青青周友惠
陆军军医大学(第三军医大学)第一附属医院眼科
Author(s):
JI Hong XIONG Jie ZHANG Chenxing LUO Qihui WANG Ke ZHOU Qingqing ZHOU Youhui

Department of Ophthalmology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China

关键词:
近视薄角膜角膜胶原交联术飞秒激光辅助准分子激光原位角膜磨镶术近视回退
Keywords:
myopia thin corneal accelerated cross-linking femtosecond laser assisted excimer laser in-situ keratomileusis myopia regression
分类号:
R181.32; R778.11; R779.63
文献标志码:
A
摘要:

目的探讨飞秒激光辅助准分子激光原位角膜磨镶术联合快速角膜胶原交联巩固术(Fs-LASIK Xtra)治疗角膜较薄的中、高度近视患者的有效性、可预测性以及安全性。方法采用回顾性病例对照研究,收集我院2016年3月至2017年3月手术满2年,随访资料完整的Fs-LASIK Xtra及单纯Fs-LASIK手术的患者资料。其中Fs-LASIK Xtra手术患者为联合手术组,共44例88眼,单纯Fs-LASIK手术患者为对照组,共50例100眼。观察两组患者术后1周及1、3、12、24个月裸眼视力(UCVA)、最佳矫正视力(BCVA)、等效球镜、角膜曲率、角膜厚度、眼压、角膜内皮细胞计数、前节OCT交联线深度、术后角膜层间炎性反应及haze等并发症情况。结果两组术前BCVA及术后3、12、24个月UCVA比较,术后UCVA较术前BCVA均显著提高(P<0.05)。两组术前角膜曲率、等效球镜与术后3、12、24个月角膜曲率及等效球镜比较,术后角膜曲率及等效球镜均显著下降(P<0.05)。两组24个月等效球镜达到预测值比较无统计学差异(P>0.05);两组24个月等效球镜分布比较有统计学差异(P<0.05),联合手术组术后24个月正等效球镜分布率较对照组高,负等效球镜分布率较对照组低;两组24个月回退率及过矫率比较有统计学差异(P<0.05),联合手术组术后24个月过矫率较对照组高,回退率较对照组低。联合手术组有32眼术后1个月在角膜基质深度(224.57±62.01)μm可见角膜交联线。联合手术组于术后1~3个月出现0.5级haze共6眼(6.8%),1级haze共2眼(2.3%),给予激素眼液点眼治疗后haze消失,均未影响视力。结论Fs-LASIK Xtra手术能有效治疗角膜较薄的中、高度近视患者,具有安全、有效、预测性好等优点,2年期观察相对单纯Fs-LASIK能有效防止近视回退,但术后需要足量、规则地使用糖皮质激素滴眼液,以减少角膜炎症反应及haze的发生。

Abstract:

ObjectiveTo evaluate the safety, effectiveness and predictability of femtosecond laser assisted excimer laser in-situ keratomileusis combined with accelerated cross-linking (Fs-LASIK Xtra) in moderate and high myopia with thin cornea. MethodsA retrospective case-control study was carried out after the whole clinical data of 2 years’ follow-up from the patients undergoing Fs-LASIK Xtra or single Fs-LASIK in our hospital during March 2016 and March 2017 were collected. Forty-four patients (88 eyes) undergoing Fs-LASIK Xtra surgeries were included in the study group, and 50 patients (100 eyes) Fs-LASIK surgeries in the control group. Changes in uncorrected distance visual acuity (UCVA), correction of best distant vision (BCVA), equivalent spherical mirror (SEQ), corneal curvature, intraocular pressure, endothelium, depth of demarcation line in anterior segmental optical coherence tomography (OCT), and the incidences of postoperative complications, such as interlaminar inflammation reaction and corneal haze in 1 week, and 1, 3, 12 and 24 months after surgery were measured and observed. ResultsThe pre-operative BCVA and post-operative UCVA at 3, 12 and 24 months were all significant improved (P<0.05). The pre-operative corneal curvature and SEQ were also greatly decreased in 3, 12 and 24 months after surgery. The SEQ reached the predicted value in both groups in 24 months, but there was no obvious difference between them (P>0.05). The distribution of positive SEQ was notably higher, while that of negative SEQ was lower in the study group when compared to the control group (P<0.05). Significant differences in the percentages of regression and overcorrection at 24 months were seen between the 2 groups (P<0.05), with the study group having higher percentage of overcorrection, but lower percentage of regression than the control group. In the study group, the depth of demarcation line of 32 eyes was 224.57±62.01 μm. Six eyes (6.8%) with grade 0.5 haze and 2 eyes (2.3%) with grade 1 haze occurred in 1 to 3 months after surgery, and the symptoms were disappeared after topical steroid treatment which had no negative influence in the final visual acuity. ConclusionFs-LASIK Xtra can treat moderate and high myopia with thin cornea with good safety, effectiveness and predictability. Sufficient glucocorticosteroid eye drop should be used regularly to prevent post-operative inflammation reaction and haze.

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更新日期/Last Update: 2020-10-02