López-Montemayor Paloma, Valdez-García Jorge E, Loya-García Denise, Hernandez-Camarena Julio C
Servicio de Córnea y Cirugía Refractiva, Instituto de Oftalmología y Ciencias Visuales, Escuela de Medicina, Tecnológico de Monterrey, Monterrey, Mexico.
Instituto de Oftalmología y Ciencias Visuales, Centro Medico Zambrano Hellion, Batallón de San Patricio 112, Piso 1 Ote, C.P. 66278, San Pedro Garza García, Nuevo Leon, Mexico.
Int Ophthalmol. 2018 Aug;38(4):1515-1520. doi: 10.1007/s10792-017-0614-3. Epub 2017 Jun 23.
Report on the safety, efficiency and refractive outcomes of LASIK surgery in patients aged 65 or older.
This study includes a case series of patients ≥65 years that underwent corneal refractive surgery during the period June 2010 to June 2015 at Hospital Zambrano Hellion, Monterrey, Mexico. Inclusion criteria were normal topography, central corneal thickness >500 μm, preoperative manifest refraction spherical equivalent (MRSE) up to -8.5 D and +6.0 D, cylinder up to -6.0 D, CDVA of 20/25 or better and with no other ocular pathology.
A total of 44 eyes (24 patients) were included. Mean age was 67.2 ± 2.1 years (range 65-80), with mean follow-up of 12.2 ± 1.3 months. Conventional LASIK was performed in 20 patients (group 1, 36 eyes) to improve UDVA (10 eyes myopic LASIK and 26 eyes hyperopic LASIK) and presbyopic LASIK (monovision) in 4 patients (group 2, 8 eyes) to restore near-vision performance. Preoperative MRSE group 1 was myopic: -2.79 ± 1.88 D; hyperopic +2.19 ± 1.88 D; and +2.10 ± 0.87 D in group 2. Preoperative UDVA in group 1 was 0.67 ± 0.30 LogMAR; 0.46 ± 0.18 LogMAR; and Jaeger ≥4 in 90% in group 2. Postoperative MRSE: -0.29 ± 0.86 D (myopic LASIK) (p < 0.001), +0.34 ± 0.62 D (hyperopic LASIK) (p < 0.001) and -1.25 ± 0.59 D (non-dominant eye) in presbyopic LASIK. Postoperative UDVA in myopic LASIK was 0.15 ± 0.30 (p = 0.001) and 0.11 ± 0.11 (p < 0.001) for hyperopic LASIK. In group 2, binocular UDVA was 0.16 ± 0.17 (p = 0.12) and UNVA was ≥J2 in 100% of the patients.
Even though elder patients may present greater LASIK restrictions due to lens and other ocular age-related changes, patients ≥65 years that were candidates for conventional and presbyopic LASIK showed satisfactory and safe refractive and visual outcomes.
报告65岁及以上患者接受准分子原位角膜磨镶术（LASIK）手术的安全性、有效性和屈光效果。
本研究为病例系列研究，纳入了2010年6月至2015年6月期间在墨西哥蒙特雷的赞布拉诺·埃利翁医院接受角膜屈光手术的65岁及以上患者。纳入标准为地形图正常、中央角膜厚度>500μm、术前明显屈光不正球镜等效值（MRSE）达-8.5D至+6.0D、柱镜达-6.0D、最佳矫正视力（CDVA）为20/25或更好且无其他眼部病变。
共纳入44只眼（24例患者）。平均年龄为67.2±2.1岁（范围65 - 80岁），平均随访时间为12.2±1.3个月。20例患者（第1组，36只眼）接受传统LASIK手术以改善最佳矫正视力（10只眼为近视性LASIK，26只眼为远视性LASIK），4例患者（第2组，8只眼）接受老视性LASIK（单眼视）以恢复近视力。第1组术前MRSE近视：-2.79±1.88D；远视+2.19±1.88D；第2组为+2.10±0.87D。第1组术前最佳矫正视力为0.67±0.30 LogMAR；0.46±0.18 LogMAR；第2组90%的患者Jaeger≥4。术后MRSE：近视性LASIK为-0.29±0.86D（p<0.001），远视性LASIK为+0.34±0.62D（p<0.001），老视性LASIK非优势眼为-1.25±0.59D。近视性LASIK术后最佳矫正视力为0.15±0.30（p = 0.001），远视性LASIK为0.11±0.11（p<0.001）。在第2组中，双眼最佳矫正视力为0.16±0.17（p = 0.12），100%的患者近视力≥J2。
尽管老年患者由于晶状体及其他与年龄相关的眼部变化可能在LASIK手术中有更多限制，但65岁及以上适合传统和老视性LASIK手术的患者在屈光和视觉效果方面显示出满意且安全的结果。
