Vinciguerra P, Kohnen T, Azzolini M, Radice P, Epstein D, Koch D D
Divisione Oculistica, Ospedale S. Gerardo, Monza, Italy.
J Cataract Refract Surg. 1998 Jan;24(1):21-30. doi: 10.1016/s0886-3350(98)80070-9.
To compare the effects of two treatment patterns in the correction of hyperopia by noncontact holmium:YAG laser thermal keratoplasty (LTK).
Divisione Oculistica, Ospedale S. Gerardo, Monza, Italy.
Using two treatment patterns, we performed noncontact LTK in one session in 16 eyes of 8 patients with isometropic hyperopic refractive errors; mean preoperative subjective cycloplegic refraction was +4.90 diopters (D) +/- 1.17 (SD). The treatment consisted of 24 spots in three concentric rings of eight spots each; ring diameters were 6.0, 7.0, and 8.0 mm, respectively. Each spot received seven pulses of laser energy at 30 mJ/pulse. We treated one eye of each patient with a radial pattern (the spots of the three rings aligned on the eight semimeridians) and the fellow eye with a staggered pattern (the spots of the contiguous rings at 22.5 degrees from each other). Follow-up at 1, 15, 30, 90, 180, and 360 days included subjective cycloplegic refraction, uncorrected (UCVA) and spectacle-corrected visual acuity (SCVA), computerized videokeratography (CVK), and Scheimpflug camera examination.
One year postoperatively, the mean subjective cycloplegic refraction was +2.75 +/- 1.6 D in the eyes treated with the radial pattern and +3.40 +/- 1.6 D in those treated with the staggered pattern; the mean change in subjective cycloplegic refraction was 2.15 and 1.50 D, respectively. Mean UCVA improved by five lines in the radial group and by four lines in the staggered group. Mean SCVA returned to preoperative levels by day 15 in the radial group and at 1 year in the staggered group; at 1 year, SCVA improved by one line in the radial group and remained unchanged in the staggered group. No eye lost one or more lines of SCVA. Refractive astigmatism was essentially unchanged in both groups. Scheimpflug photography and CVK indicated larger and more uniform corrected zones in the radial group.
Radial and staggered patterns effectively corrected low hyperopia, although both were subject to a certain amount of regression. The radial pattern produced faster postoperative recovery of SCVA and demonstrated greater refractive stability.
比较非接触钬激光热角膜成形术（LTK）两种治疗模式矫正远视的效果。
意大利蒙扎圣杰拉尔多医院眼科。
我们采用两种治疗模式，对8例等轴性远视屈光不正患者的16只眼进行了单次非接触LTK治疗；术前平均主观睫状肌麻痹验光为+4.90屈光度（D）±1.17（标准差）。治疗包括在三个同心环中各有8个点，共24个点；环直径分别为6.0、7.0和8.0毫米。每个点接受7个脉冲的激光能量，脉冲能量为30毫焦/脉冲。我们对每位患者的一只眼采用放射状模式治疗（三个环的点在八个半子午线上对齐），另一只眼采用交错模式治疗（相邻环的点彼此成22.5度角）。在1、15、30、90、180和360天进行随访，包括主观睫状肌麻痹验光、未矫正视力（UCVA）和戴镜矫正视力（SCVA）、计算机化视频角膜地形图（CVK）和Scheimpflug相机检查。
术后一年，采用放射状模式治疗的眼平均主观睫状肌麻痹验光为+2.75±1.6 D，采用交错模式治疗的眼为+3.40±1.6 D；主观睫状肌麻痹验光的平均变化分别为2.15和1.50 D。放射状组的平均UCVA提高了5行，交错组提高了4行。放射状组的平均SCVA在第15天恢复到术前水平，交错组在1年时恢复到术前水平；在1年时，放射状组的SCVA提高了1行，交错组保持不变。没有一只眼的SCVA下降一行或多行。两组的屈光性散光基本未变。Scheimpflug摄影和CVK显示放射状组的矫正区更大且更均匀。
放射状和交错模式均能有效矫正低度远视，尽管两者都存在一定程度的回退。放射状模式术后SCVA恢复更快，屈光稳定性更高。
