Bower K S, Weichel E D, Kim T J
Walter Reed Army Medical Center, Washington, DC, USA.
Am Fam Physician. 2001 Oct 1;64(7):1183-90.
Patients with myopia, hyperopia and astigmatism can now reduce or eliminate their dependence on contact lenses and eyeglasses through refractive surgery that includes radial keratotomy (RK), photorefractive keratectomy (PRK), laser-assisted in situ keratomileusis (LASIK), laser thermal keratoplasty (LTK) and intrastromal corneal rings (ICR). Since the approval of the excimer laser in 1995, the popularity of RK has declined because of the superior outcomes from PRK and LASIK. In patients with low-to-moderate myopia, PRK produces stable and predictable results with an excellent safety profile. LASIK is also efficacious, predictable and safe, with the additional advantages of rapid vision recovery and minimal pain. LASIK has rapidly become the most widely performed refractive surgery, with high patient and surgeon satisfaction. Noncontact Holium: YAG LTK provides satisfactory correction in patients with low hyperopia. ICR offers patients with low myopia the potential advantage of removal if the vision outcome is unsatisfactory. Despite the current widespread advertising and media attention about laser refractive surgery, not all patients are good candidates for this surgery. Family physicians should be familiar with the different refractive surgeries and their potential complications.
近视、远视和散光患者现在可以通过包括放射状角膜切开术（RK）、准分子激光角膜切削术（PRK）、准分子原位角膜磨镶术（LASIK）、激光热角膜成形术（LTK）和角膜基质内环状植片（ICR）在内的屈光手术来减少或消除对隐形眼镜和眼镜的依赖。自1995年准分子激光获批以来，由于PRK和LASIK的效果更佳，RK的受欢迎程度有所下降。对于中低度近视患者，PRK能产生稳定且可预测的结果，安全性极佳。LASIK同样有效、可预测且安全，还具有视力恢复快和疼痛轻微的额外优势。LASIK迅速成为实施最为广泛的屈光手术，患者和外科医生满意度都很高。非接触式钬激光：YAG LTK为低度远视患者提供了令人满意的矫正效果。如果视力结果不理想，ICR为低度近视患者提供了可取出的潜在优势。尽管目前激光屈光手术在广告宣传和媒体上备受关注，但并非所有患者都适合这种手术。家庭医生应该熟悉不同的屈光手术及其潜在并发症。
