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准分子激光表面切削术治疗薄角膜近视的十年随访

Ten-year follow-up of excimer laser surface ablation for myopia in thin corneas.

作者信息

de Benito-Llopis Laura, Alió Jorge L, Ortiz Dolores, Teus Miguel A, Artola Alberto

机构信息

Vissum Madrid, Madrid, Spain.

出版信息

Am J Ophthalmol. 2009 May;147(5):768-73, 773.e1-2. doi: 10.1016/j.ajo.2008.12.022. Epub 2009 Feb 25.

Abstract

PURPOSE

To evaluate the long-term outcomes of excimer laser surface ablation performed on thin corneas.

DESIGN

Retrospective study.

METHODS

We included in the study 75 eyes (49 patients) with a preoperative central corneal thickness (CCT) thinner than 500 mum that had undergone surface ablation to correct their myopia and that had at least 10 years of follow-up. We evaluated the stability of visual acuity (VA) and refraction, the predictability, corneal keratometry, safety, efficacy, and postoperative complications at the examinations 3 months and 1, 2, 5, and 10 years after surgery.

RESULTS

Preoperative CCT was 481.54 +/- 15.7 microm (range, 438 to 499 microm). Preoperative spherical equivalent was -6.12 +/- 2.67 diopters (D) (range, -2 to -14 D). The best spectacle-corrected VA significantly improved (P < .01) during the follow-up. The uncorrected VA showed significant improvement in all visits when compared with the 3-month postoperative visit. Both the sphere and cylinder showed a slight but significant regression (P < .01) only in the comparison between 3 months and 10 years after the surgery. Ten years after the surgery, 30 eyes (40%) were within 0.50 D and 43 eyes (57.33%) were within 1.00 D of emmetropia. The safety index improved over the 10 year period and was always higher than 0.9. The efficacy index remained stable around 0.8. The topography did not show signs of corneal ectasia and the keratometry showed no increase in corneal power. Thirty eyes (40%) needed enhancement.

CONCLUSION

Surface ablation seems to be safe and effective to correct myopia in corneas thinner than 500 microm, with stable visual and refractive outcomes in a 10-year follow-up.

摘要

目的

评估准分子激光表面切削术治疗薄角膜近视的长期疗效。

设计

回顾性研究。

方法

本研究纳入75只眼(49例患者),术前中央角膜厚度(CCT)小于500μm,接受表面切削术矫正近视,且随访至少10年。我们评估了术后3个月、1年、2年、5年和10年时的视力(VA)和屈光稳定性、可预测性、角膜曲率、安全性、有效性及术后并发症。

结果

术前CCT为481.54±15.7μm(范围438至499μm)。术前等效球镜度为-6.12±2.67屈光度(D)(范围-2至-14 D)。随访期间最佳矫正视力显著改善(P<.01)。与术后3个月相比,所有随访时的裸眼视力均显著改善。仅在术后3个月与10年的比较中,球镜度和柱镜度均显示轻微但显著的回退(P<.01)。术后10年,30只眼(40%)的屈光度数在正视眼±0.50 D范围内,43只眼(57.33%)在±1.00 D范围内。安全指数在10年期间有所改善,且始终高于0.9。有效指数稳定在0.8左右。角膜地形图未显示角膜扩张迹象,角膜曲率计显示角膜屈光度未增加。30只眼(40%)需要再次手术。

结论

表面切削术矫正500μm以下薄角膜近视似乎安全有效,10年随访视力和屈光结果稳定。

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