Vuori Elisa, Tervo Timo M T, Holopainen Martti V A, Holopainen Juha M
Department of Ophthalmology, University of Helsinki, Helsinki, Finland.
J Refract Surg. 2007 May;23(5):447-55. doi: 10.3928/1081-597X-20070501-05.
To test the hypothesis that anisometropic adults without significant amblyopia suffer from mild visual impairment probably due to aniseikonia, which might be improved by corneal refractive surgery.
Fifty-seven patients presenting with myopic anisometropia > or = 3.25 diopters (D) and 174 myopic controls appropriate for refractive surgery were included. Photorefractive keratectomy (PRK) or LASIK was performed on 57 anisometropic eyes. As 43 of the 174 myopic control patients had bilateral surgery, PRK or LASIK was performed on 217 myopic control eyes. Best spectacle-corrected visual acuity (BSCVA), refraction, and refractive correction were measured preoperatively and at 1, 3, 5 to 7, 8 to 13, and 25 months following surgery.
Preoperative mean spherical equivalent was -7.20 +/- 2.40 D for anisometropic patients and -6.40 +/- 1.90 D for myopic patients. At 8 to 13 months postoperatively, when 23 (40%) anisometropic eyes and 94 (43%) myopic eyes were examined, the mean spherical equivalent refractions were -0.80 +/- 1.60 D and -0.30 +/- 0.60 D, respectively. Preoperatively, the mean BSCVA on a logMAR scale was -0.0143 +/- 0.0572 (Snellen 0.98 +/- 0.12) in the anisometropic group and 0.0136 +/- 0.0361 (Snellen 1.04 +/- 0.09) in the control group (P = .001). Eight to 13 months postoperatively, these values were 0.0076 +/- 0.0659 (Snellen 1.03 +/- 0.15) and 0.0495 +/- 0.0692 (Snellen 1.13 +/- 0.18) and this difference remained statistically significant (P = .012). For the myopic patients, the improvement in BSCVA reached almost maximum at 3 months, and this improvement was found to be highly significant 3 months after surgery (P = .001). The improvement in BSCVA was significantly slower for anisometropic patients and became statistically significant only after 8 to 13 months postoperatively (P = .041).
Anisometropia reduces visual acuity in the more myopic eye and can be at least partially reversed by refractive correction. The slower improvement in BSCVA for anisometropic patients suggests plastic changes in the visual cortex following refractive surgery.
验证以下假说，即无明显弱视的屈光参差性成年患者存在轻度视力损害，可能是由于像不等造成的，而角膜屈光手术或许能改善这种情况。
纳入57例近视性屈光参差≥3.25屈光度（D）的患者以及174例适合屈光手术的近视对照者。对57只屈光参差性眼实施了准分子激光原位角膜磨镶术（LASIK）或准分子激光屈光性角膜切削术（PRK）。由于174例近视对照患者中有43例接受了双眼手术，因此对217只近视对照眼实施了PRK或LASIK。术前以及术后1个月、3个月、5至7个月、8至13个月和25个月测量最佳矫正视力（BSCVA）、验光和屈光矫正情况。
屈光参差性患者术前平均等效球镜度为-7.20±2.40 D，近视患者为-6.40±1.90 D。术后8至13个月，检查了23只（40%）屈光参差性眼和94只（43%）近视性眼，平均等效球镜度屈光分别为-0.80±1.60 D和-0.30±0.60 D。术前，屈光参差性组以logMAR视力表测量的平均BSCVA为-0.0143±0.0572（Snellen视力0.98±0.12），对照组为0.0136±0.0361（Snellen视力1.04±0.09）（P = 0.001）。术后8至13个月，这些值分别为0.0076±0.0659（Snellen视力1.03±0.15）和0.0495±0.0692（Snellen视力1.13±0.18），这种差异仍具有统计学意义（P = 0.012）。对于近视患者，BSCVA的改善在术后3个月几乎达到最大值，且在术后3个月时这种改善具有高度统计学意义（P = 0.001）。屈光参差性患者BSCVA的改善明显较慢，仅在术后8至13个月才具有统计学意义（P = 0.041）。
屈光参差会降低近视程度较重眼的视力，屈光矫正至少可部分逆转这种情况。屈光参差性患者BSCVA改善较慢表明屈光手术后视皮层发生了可塑性变化。
