Choi R Y, Wilson S E
Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington 98195-6485, U.S.A.
Cornea. 2001 May;20(4):388-93. doi: 10.1097/00003226-200105000-00010.
To retrospectively analyze the safety and efficacy of hyperopic laser in situ keratomileusis (LASIK) treatment of eyes with primary hyperopia and consecutive hyperopia after initial myopic treatment.
Thirty-two eyes of 19 patients with primary hyperopia (group 1) and 37 eyes of 26 patients with consecutive hyperopia after initial myopic LASIK overcorrection (group 2) that had LASIK for hyperopia with the Hansatome microkeratome and VISX S2 Smoothscan excimer laser with 6 months' follow-up after surgery were analyzed. Uncorrected visual acuity, best spectacle-corrected visual acuity, fogged manifest refraction, and corneal topography with corneal irregularity measurement (CIM) were evaluated 1 month, 3 months, and 6 months after surgery.
In group 1, the mean preoperative cycloplegic spherical equivalent was +4.0 +/- 4.5 diopters (D) (range, +1.5 to + 8.75 D) and the 6-month postoperative cycloplegic spherical equivalent was +0.26 +/- 1.74 D (range, -3.00 to +2.75 D). Fifty-three percent of eyes (n= 17) in group 1 were within 1 D of emmetropia. Sixty-six percent of eyes (n= 21) had uncorrected visual acuity of at least 20/40. Three eyes (9%) lost two lines of best spectacle-corrected visual acuity. Changes in uncorrected visual acuity, best spectacle-corrected visual acuity, spherical equivalent, and the CIM topographic index 6 months after surgery were statistically significant compared with the preoperative values. In group 2, the mean preoperative cycloplegic spherical equivalent was +1.58 +/- 0.35 D (range, +0.125 to +2.75 D), and the mean postoperative cycloplegic spherical equivalent was -0.48 +/- 0.46 (range, -2.75 to +0.38 D). Eighty-six percent of eyes (n= 32) were within 1 D of emmetropia. Eighty-four percent of eyes (n= 31) in group 2 had uncorrected visual acuity of at least 20/40. One eye (2.7%) lost two lines of best spectacle-corrected visual acuity. Complications included an epithelial nest that resolved 3 months after surgery in one eye in group 2.
LASIK is a relatively safe treatment of primary hyperopia and hyperopia resulting from overcorrection after initial LASIK treatment of myopia (consecutive hyperopia). Patients with high hyperopia (>5 D) are at risk for loss of two lines of best spectacle-corrected visual acuity. A reduction in the level of attempted correction appears to be necessary in the treatment of consecutive hyperopia.
回顾性分析准分子激光原位角膜磨镶术（LASIK）治疗原发性远视及初次近视治疗后发生的继发性远视的安全性和有效性。
分析19例原发性远视患者的32只眼（第1组）和26例初次近视LASIK术后过矫导致继发性远视患者的37只眼（第2组），这些患者均使用Hansatome微型角膜刀及VISX S2 Smoothscan准分子激光行远视LASIK手术，术后随访6个月。分别于术后1个月、3个月和6个月评估裸眼视力、最佳矫正视力、雾视验光及角膜地形图并测量角膜不规则度（CIM）。
第1组患者术前平均睫状肌麻痹等效球镜度为+4.0±4.5屈光度（D）（范围为+1.5至+8.75 D），术后6个月睫状肌麻痹等效球镜度为+0.26±1.74 D（范围为-3.00至+2.75 D）。第1组53%（n = 17）的眼等效球镜度在正视眼1 D范围内。66%（n = 21）的眼裸眼视力至少为20/40。3只眼（9%）最佳矫正视力下降两行。术后6个月时，裸眼视力、最佳矫正视力、等效球镜度及CIM地形图指数与术前相比差异有统计学意义。第2组患者术前平均睫状肌麻痹等效球镜度为+1.58±0.35 D（范围为+0.125至+2.75 D），术后平均睫状肌麻痹等效球镜度为-0.48±0.46（范围为-2.75至+0.38 D）。第2组86%（n = 32）的眼等效球镜度在正视眼1 D范围内。第2组84%（n = 31）的眼裸眼视力至少为20/40。1只眼（2.7%）最佳矫正视力下降两行。并发症包括第2组1只眼中出现的上皮植入物，术后3个月自行消退。
LASIK是治疗原发性远视及初次近视LASIK术后过矫所致继发性远视（连续远视）的一种相对安全的方法。高度远视（>5 D）患者有最佳矫正视力下降两行的风险。在治疗连续远视时，似乎有必要降低预期矫正量。
