摘要
目的探究非球面优化单眼视准分子激光手术在近视合并老视患者中的应用效果。方法22例近视合并老视患者,均采用Custom-Q引导的单眼视准分子激光手术治疗,主视眼屈光度全矫,非主视眼根据患者的年龄和近附加情况,保留-0.5~-1.25 D的球镜度数,目标Q值设置为-1.0,ZemnikeC4值随之变化,继而调整目标球镜度数,保证C4值接近Q值调整前数值。随访3个月,观察患者基本资料及治疗的有效性[治疗前后的远距离单眼、双眼最佳矫正视力(BSCVA)、裸眼视力(UCVA)、近距离单眼和双眼BSCVA和UCVA]、安全性、预测性、双眼视功能。结果①基本资料:患者术前平均等效球镜度为(-4.89±2.12)D,平均柱镜为(-0.50±0.82)D;术后主视眼平均等效球镜度为(-0.48±0.36)D,非主视眼平均等效球镜度为(-0.85±0.35)D。②有效性:主视眼术前平均BSCVA为0.93,术后主视眼平均视远UCVA为1.03,有效率比值(术后平均UC-VA/术前BSCVA)为1.10。22例患者中,59.09%(13/22)双眼UCVA≥1.0,86.36%(19/22)双眼UCVA≥0.8,100.00%(22/22)双眼UCVA≥0.5。22例患者中,54.55%(12/22)非主视眼视近UCVA≥J1,95.45%(21/22)非主视眼视近UCVA≥J2,100.00%(22/22)非主视眼视近UCVA≥J5。68.18%(15/22)双眼视近UCVA≥J1,100.00%(22/22)双眼视近UCVA≥J2。22例患者中,59.09%(13/22)患者视远UCVA≥1.0,同时视近UCVA≥J1;68.18%(15/22)患者视远UCVA≥0.8,同时视近UCVA≥J1。术后3个月内裸眼远视力和近视力均显著呈现上升趋势,差异具有统计学意义(P<0.05)。③安全性:术前双眼平均远视BSCVA为0.75,术后为1.02,远距安全性之术(术后平均视远BSCVA/术前平均视远BSCVA)为1.33。8眼(18.18%)术前术后BSCVA无变化,36眼(81.82%)术后BSCVA提高1行,术后无任何一眼BSCVA下降1行。④预测性:99%术眼实际获得的等效球镜度与预期切削等效球镜度的差值维持在±1.00 D内,65%术眼差值维持在±0.50 D。⑤双眼视功能:Titmus立体视检查,术前立体均<60 n,术后立体视锐度无下降。Bagolini线状镜检查所有患者的术前术后融像功能正常,Worth四点检查近距离和远距融像功能术前与术后无显著改变。结论选择非球面优化单眼视准分子激光手术治疗近视合并老视,可合理恢复双眼远近视力和双眼视功能,值得参考。
Objective To explore effects of applying Q-value-guided non-linear aspherical monocular laser-assisted in situ keratomileusis(LASIK)on patients with myopia and presbyopia.Methods 22 patients with myopia and presbyopia were treated with Custom-Q-guided monocular LASIK,with the refractive error of dominant eye was fully corrected,while for the non-dominant eye,the diopter of spherical power of-0.5--1.25D was reserved according to the age and near additional condition of each patient.The target Q value was set to-1.0,and the Zemnike C4 value changed accordingly.During the follow-up of 3 months,the patients’basic information and effectiveness[long-distance monocular,best spectacle corrected visual acuity(BSCVA),uncorrected visual acuity(UCVA),short-range monocular and binocular BSCVA and UCVA],safety,predictability,binocular visual functions were observed.Results①Basic information:before the operation,the mean spherical equivalent refraction was(-4.89±2.12)D,the mean diopter of cylinder power was(-0.5±0.82)D;after the operation,the mean spherical equivalent refraction of the dominant eye was(-0.48±0.36)D,and the mean spherical equivalent refraction of the non dominant eye was(-0.85±0.35)D.②Effectiveness:for the dominant eye,the mean BSCVA was 0.93 before the operation,and the mean distance UCVA was 1.03 after the operation,with an efficiency(mean UCVA after the operation/BSCVA before the operation)of 1.10.In 22 patients,59.09%(13/22)of patients had binocular UCVA≥1.0,86.36%(19/22)of patients had binocular UCVA≥0.8,100.00%(22/22)of patients had binocular UCVA≥0.5;for the non dominant eye,54.55%(12/22)of patients had short-range UCVA≥J1,95.45%(21/22)of patients had image fusion function UCVA≥J2,100.00%of patients had short-range UCVA≥J5;68.18%(15/22)of patients had binocular short-range UCVA≥J1,100.00%(22/22)of patients had binocular short-range UCVA≥J2.In 22 patients,59.09%(13/22)of patients had long-distance UCVA≥1.0 and short-range UCVA≥J1,68.18%(15/22)of patients had long-distance UCVA≥0.8 and short-range UCVA≥J1.Within three months after operation,the distant vision and near vision of naked eyes showed a significant improved trend,the difference was statistically significant(P<0.05).③Safety:the binocular mean long-distance BSCVA was 0.75 before operation and 1.02 after operation,with the safety ratio for long-distance(mean long-distance BSCVA after the operation/mean long-distance BSCVA before the operation)of 1.33.8 eyes(18.18%)had no change in BSCVA before and after operation,36 eyes(81.82%)had 1 line improved in BSCVA after operation,and none had one line decrease in BSCVA after operation.④Predictability:99%of the eyes after operation had the difference between the actual spherical equivalent refraction and the expected keratectomy spherical equivalent refraction within±1.00 D,65%of the eyes after operation had the difference within±0.50 D.⑤Binocular visual functions:in Titmus stereopsis test,preoperative stereopsis<60 n,postoperative stereopsis sharpness did not decline.Bagolini striated glasses test showed the image fusion function of all patients was normal before and after operation;and Worth four-point test showed there was no significant change in the short-range and long-distance image fusion functions before and after operation.Conclusion Applying non-linear aspherical monocular LASIK in the treatment of myopia and presbyopia can reasonably restore the binocular distant vision and near vision,and binocular visual functions.Thus,it is worth promoting.
作者
宁静
NING Jing(Shenyang He’s Ophthalmic Hospital,Shenyang 110034,China)
出处
《中国实用医药》
2021年第21期55-58,共4页
China Practical Medicine
关键词
非球面优化
单眼视准分子激光手术
近视
老视
Aspheric optimization
Monocular laser-assisted in situ keratomileusis
Myopia
Presbyopia
