Gavin Herbert Department of Ophthalmology, University of California, Irvine, CA, USA.
J Refract Surg. 2010 Apr;26(4):241-50. doi: 10.3928/1081597X-20100212-02.
To assess a previously published risk score system for predicting postoperative LASIK ectasia in eyes with normal preoperative topography.
A retrospective review of one surgeon's LASIK database was performed for eyes with Randleman ectasia risk scores based on patient age <30 years, preoperative central corneal thickness <510 microm, residual stromal bed thickness <300 microm, and/or a preoperative manifest refraction spherical equivalent >-8.00 diopters that had a minimum follow-up of 1 year. RESULTS Of 1702 eyes with myopic errors and normal topographies, 35 (2.0%) eyes had a combined risk score between 5 and 9 points, 92 (5.4%) eyes had a combined risk score of 4 or higher, and 208 (12.2%) eyes had a combined score of 3 or higher. None of these eyes developed ectasia, whereas 3 eyes with preoperative topographic keratoconus with no other risk factors developed ectasia.
The current risk score system would have eliminated 5.4% of eyes with 4 or more points from LASIK surgery, and would have also required the surgeon to advise an additional 6.8% of eyes with a score of 3 that they were at "moderate risk" and should "proceed with caution." In eyes with normal preoperative topographies, the scoring system may not accurately predict whether patients are at increased risk for developing postoperative LASIK ectasia.
评估先前发表的一种预测 LASIK 术后角膜扩张风险评分系统，该系统适用于术前角膜形态正常的患者。
对一位医生的 LASIK 数据库进行回顾性分析，纳入 Randleman 角膜扩张风险评分≥5 分的患者，评分标准为：患者年龄<30 岁、术前中央角膜厚度<510μm、剩余基质床厚度<300μm 和/或术前等效球镜值>-8.00 屈光度，且术后至少随访 1 年。
在 1702 例近视且术前角膜形态正常的患者中，有 35 只眼（2.0%）的综合风险评分为 5~9 分，92 只眼（5.4%）的综合风险评分为 4 分或更高，208 只眼（12.2%）的综合风险评分为 3 分或更高。这些患者均未发生角膜扩张，而术前有角膜地形图提示圆锥角膜但无其他危险因素的 3 只眼发生了角膜扩张。
目前的风险评分系统可以排除 5.4%的 Randleman 评分≥4 分的患者接受 LASIK 手术，还需要告知 6.8%的 Randleman 评分≥3 分的患者存在中度风险，应“谨慎操作”。在术前角膜形态正常的患者中，该评分系统可能无法准确预测患者术后发生 LASIK 角膜扩张的风险。
