远视的屈光手术。

Refractive surgery for hyperopia.

出版信息

J Refract Surg. 2000 Mar 2;16(2 Suppl):S242-6. doi: 10.3928/1081-597X-20000302-09.

DOI:10.3928/1081-597X-20000302-09

Abstract

PURPOSE

To determine the efficacy, stability, and predictability of refractive surgery for hyperopia using four different procedures: photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK), implantation of a phakic intraocular lens (PIOL), and removing the transparent lens with IOL implantation.

METHODS

We operated on 184 eyes with hyperopia; 56 eyes had less than +2.00 D (low hyperopia), 62 eyes had +2.00 to +5.00 D (moderate hyperopia), and 66 eyes had greater than +5.00 D (high hyperopia). In the low hyperopia group, PRK was used in 22 eyes and LASIK in 34 eyes. In the moderate hyperopia group, PRK was used in 12 eyes and LASIK in 33 eyes, PIOL implantation in 12 eyes, and transparent lens extraction with IOL implantation in 5 eyes. In the high hyperopia group, PRK was used in 7 eyes, LASIK in 12 eyes, PIOL implantation in 21 eyes, and extraction of transparent lens with IOL implantation in 26 eyes. We used the Nidek EC5000 excimer laser and with the Moria LASIK Evolution microkeratome. The transparent lens was removed by phacoemulsification, and the Phacoprofile Storz IOL with optical power from 28.00 to 36.00 D was implanted. The PIOLs were made of a collagen copolymer with a focal power from +6.00 to +12.00 D.

RESULTS AND CONCLUSION

Refraction and visual results depended on amount of baseline hyperopia and age of the patient. For young patients (35 years old or less) with normal accommodation and low or moderate hyperopia, PRK and LASIK were our methods of choice. However, after LASHL stabilization of refraction occurred faster (3 to 12 weeks) compared to PRK, where changes in refraction were noted from 8 to 12 months after surgery. In patients with hyperopia more than +5.00 D, we prefer intraocular methods of correction: phakic IOL implantation for young patients and removing the transparent lens with IOL implantation in patients with presbyopia or anatomical tendency for development of closedangle glaucoma. [J Refract Surg 2000;16(suppl): S242-S246].

摘要

目的

评估使用 4 种不同手术方法治疗远视的疗效、稳定性和可预测性：准分子激光屈光性角膜切削术（PRK）、准分子激光原位角膜磨镶术（LASIK）、有晶状体眼人工晶状体植入术（PIOL）和晶状体摘除联合人工晶状体植入术。

方法

对 184 只远视眼进行了手术，其中低度远视（<+2.00 D）56 只眼，中度远视（+2.00～+5.00 D）62 只眼，高度远视（>+5.00 D）66 只眼。在低度远视组中，22 只眼接受 PRK 治疗，34 只眼接受 LASIK 治疗。在中度远视组中，12 只眼接受 PRK 治疗，33 只眼接受 LASIK 治疗，12 只眼接受 PIOL 植入，5 只眼接受晶状体摘除联合人工晶状体植入。在高度远视组中，7 只眼接受 PRK 治疗，12 只眼接受 LASIK 治疗，21 只眼接受 PIOL 植入，26 只眼接受晶状体摘除联合人工晶状体植入。使用 Nidek EC5000 准分子激光系统和 Moria LASIK Evolution 微型角膜刀。采用超声乳化技术摘除晶状体，植入光学度数为 28.00～36.00 D 的 Phacoprofile Storz IOL。PIOL 由胶原共聚物制成，焦度从+6.00～+12.00 D 不等。

结果和结论

视力恢复情况取决于远视的基线程度和患者年龄。对于有正常调节能力且低度或中度远视的年轻患者（35 岁以下），PRK 和 LASIK 是我们的首选方法。然而，与 PRK 相比，LASIK 术后屈光度更稳定（3～12 周），PRK 术后 8～12 个月才能观察到屈光度的变化。对于远视超过+5.00 D 的患者，我们更倾向于采用眼内矫正方法：年轻患者采用有晶状体眼人工晶状体植入术，远视伴老视或解剖学上有闭角型青光眼发展倾向的患者采用晶状体摘除联合人工晶状体植入术。[J Refract Surg 2000;16(suppl): S242-S246]