通过监测上皮厚度进行准分子原位角膜磨镶术治疗高度远视散光

LASIK for the Correction of High Hyperopic Astigmatism With Epithelial Thickness Monitoring.

作者信息

Reinstein Dan Z, Carp Glenn I, Archer Timothy J, Buick Tim, Gobbe Marine, Rowe Elizabeth L, Jukic Mario, Brandon Emma, Moore Johnny, Moore Tara

出版信息

J Refract Surg. 2017 May 1;33(5):314-321. doi: 10.3928/1081597X-20170111-04.

DOI:10.3928/1081597X-20170111-04

PMID:28486722

Abstract

PURPOSE

To evaluate outcomes of high hyperopic LASIK using the MEL 80 excimer laser (Carl Zeiss Meditec, Jena, Germany).

METHODS

Retrospective analysis of 830 consecutive high hyperopic LASIK procedures using the MEL 80 excimer laser and either the VisuMax femtosecond laser (Carl Zeiss Meditec) or zero compression Hansatome microkeratome (Bausch & Lomb, Rochester, NY). Inclusion criteria were attempted hyperopic correction of +4.00 diopters [D] or higher in one axis and corrected distance visual acuity (CDVA) of 20/20 or better. Patients were observed for a minimum of 1 year. Epithelial thickness monitoring by Artemis very high-frequency (VHF) digital ultrasound (ArcScan Inc., Morrison, CO) was used to evaluate potential for further steepening as a re-treatment.

RESULTS

One-year data were available for 785 eyes. Mean attempted spherical equivalent refraction (SEQ) was +4.52 ± 0.84 D (range: +2.00 to +6.96 D) for the primary treatment and mean cylinder was 1.05 ± 0.86 D (range: 0.00 to 5.25 D). Mean age was 50 ± 12 years (range: 18 to 70 years) and 61% were women. Postoperative SEQ was ±0.50 D in 50% and ±1.00 D in 77% of eyes after primary treatment. After re-treatment, 67% of eyes were within ±0.50 D and 89% were within ±1.00 D. Uncorrected distance visual acuity was 20/20 or better in 76% of eyes after final treatment. One line of CDVA was lost in 25% of eyes and two lines were lost in 0.4%. There was a clinically insignificant but statistically significant decrease (P < .05) in contrast sensitivity (CSV-1000) by less than 1 log unit at 3 and 6 cycles per degree (cpd) and by 1 log unit at 12 and 18 cpd. Diurnal fluctuation in refraction was identified in 2 eyes, proven by VHF digital ultrasound to be due to diurnal epithelial remodeling overnight and unrelated to maximum postoperative keratometry induced.

CONCLUSIONS

LASIK for hyperopia by cumulative treatment of up to +8.33 D with the MEL 80 excimer laser was found to satisfy accepted criteria for safety, efficacy, and stability when applying specialized protocols, including epithelial monitoring. [J Refract Surg. 2017;33(5):314-321.].

摘要

目的

评估使用MEL 80准分子激光（德国耶拿卡尔蔡司医疗技术公司）进行高度远视性准分子原位角膜磨镶术（LASIK）的效果。

方法

回顾性分析连续830例使用MEL 80准分子激光以及VisuMax飞秒激光（德国耶拿卡尔蔡司医疗技术公司）或零压缩Hansatome微型角膜刀（美国纽约罗切斯特博士伦公司）进行的高度远视性LASIK手术。纳入标准为单眼尝试矫正远视度数为+4.00屈光度（D）或更高，且矫正远视力（CDVA）为20/20或更好。对患者进行至少1年的观察。使用Artemis超高频（VHF）数字超声（美国科罗拉多州莫里森ArcScan公司）监测上皮厚度，以评估再次治疗时进一步变陡的可能性。

结果

785只眼有1年的数据。初次治疗时平均尝试等效球镜度（SEQ）为+4.52±0.84 D（范围：+2.00至+6.96 D），平均柱镜度为1.05±0.86 D（范围：0.00至5.25 D）。平均年龄为50±12岁（范围：18至70岁），61%为女性。初次治疗后，50%的眼术后SEQ在±0.50 D以内，77%的眼在±1.00 D以内。再次治疗后，67%的眼在±0.50 D以内，89%的眼在±1.00 D以内。最终治疗后，76%的眼未矫正远视力为20/20或更好。25%的眼CDVA下降1行，0.4%的眼下降2行。在每度3和6周波（cpd）时，对比敏感度（CSV - 1000）有临床意义不显著但统计学上显著的下降（P <.05），下降幅度小于1 log单位，在12和18 cpd时下降1 log单位。在2只眼中发现屈光的日波动，经VHF数字超声证实是由于夜间上皮的昼夜重塑，与术后最大角膜曲率计测量值无关。