【作者】 生晖；

【导师】 王传富；

【作者基本信息】 青岛大学 ， 眼科， 2002， 硕士

【摘要】 目的： 分析准分子激光屈光性角膜切削术(photorefractive keratectomy,PRK)和准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)治疗近视术后角膜表面形态、偏中心切削及角膜屈光力与临床效果的关系。方法：对术前屈光度为-3.00～-10.00D，平均为(-6.08±1.21)D的患者，76例(150只眼)行PRK，75例(150只眼)行LASIK，分为PRK组和LASIK组。术后1、3、6、12个月行角膜地形图检查。结果：1．PRK和LASIK术后角膜地形图形态分为平滑型、半圆型、钥匙孔型，肾型、中央岛型和不规则型6种类型。LASIK术后未见中央岛型。术后1、3、6、12个月平滑型所占比例在PRK组分别为48.0％、60.0％、66.7％和66.7％，在LASIK组分别为80.0％、90.0％、90.0％和90.0％。LASIK组平滑型明显多于PRK组(P＜0.01)。术后1、3、6、12个月，两组中各种类型角膜地形图所占比例的差异均有非常显著意义(P＜0.001)。术后3个月以后，两组中各种类型所占比例基本稳定。两组中角膜地形图均有逐渐变平滑的趋势。2．中央岛型和不规则型术后UCVA较术前BCVA下降≥2行的比例最高，平滑型最低。PRK组术后UCVA较术前BCVA下降≥2行的比例高于LASIK组(P＜0.05)。3．偏中心距离≤0.5mm者，在PRK组占95.3％，在LASIK组占94.7％。偏中心方位位于鼻上象限者，在 论文：PRK和MIK治疗近视术后角膜地形图与临床效果关系的分析 PRK组占61．30，在LASIK组占68．0o一 两组术后偏中心距离及 方位的差异无显著意义（P＞0．05人 偏中心距离 o 0．50 mm 者， 术后 UCVA较术前 BCVA下降 3 2行的比例高于偏中心距离 ＜ 0．smm者（P＜0．001）。4．LASIK组 SlinK值的变化量小子 PRK 组（P＜0刀1），术后不同时间SlinK值变化的差异有显著意义 0 ＜0．05＼ 结论：l．PRK组和LASIK组术后角膜地形图形态分为 平滑型、半圆型、钥匙孔型、肾型、中央岛型和不规则型6种类 型，以平滑型居多，LASIK术后未见中央岛型。术后3个月以后， 两组中各种类型所占比例基本稳定。两组角膜地形图均有逐渐变 平滑的趋势。LASIK组平滑型多于PRK组，差异有显著意义。2． 两组术后UCVA较术前BCVA下降32行者，其角膜地形图多数 为中央岛型和不规则型，术后不同时间，LASIK组UCVA较术前 BCVA下降32行的比例低于PRK组，差异有显著意义。3．两组 术后偏中心距离及方位不随时问推移而改变，与PRK和LASIK 的手术方式无关。偏中心距离 o 0 50 mm 时，可导致术后视力恢 复不良。4．两组术后不同时间，SlinK值变化的差异有显著意义， LASIK术后SlinK值的波动小于PRK术后，差异有显著意义。SlinK 值变化的是预测屈光回退的一个重要指标。更多还原

【Abstract】 Objective: To identify the associations of corneal topography and postoperative outcomes after photorefractive keratectomy(PRK) and laser in situ keratomileusis (LASIK)for correction of myopia. Method: A total of 151 patients(300 eyes) with preoperative refraction of -3.00D～-10.00D (-6.08±1.21)D were treated with PRK and LASIK and followed up for 12 months. The patients were divided into 2 groups: PRK group, 76 cases(150 eyes); LASIK group, 75 cases(150 eyes). Corneal topography was examined 1,3,6,12 months postoperatively,and associations with postoperative outcomes were analyzed. Result: 1. Corneal topographic patterns were classified as uniform, semicircular,keyhole, kidney, central island and irregularity after PRK and LASIK. There was no central island pattern after LASIK. 1, 3, 6, 12 months after PRK, 48.8%, 60.0%, 66.7% and 66.7% showed uniform respectively; 1, 3, 6, 12 months after LASIK, 80.0%, 90.0%, 90.0% and 90.0% showed uniform respectively. 3 months after surgery, corneal topographic patterns tended to be stable. Uniform pattern after LASIK was more than that of PRK (P<0. 01). There was statistical significant difference among the3percentage of corneal topographic patterns after PRK and LASIK (P<0.001). Patterns of both groups tended to become more regular. 2. Central island and irregularity patterns affected the postoperative uncorrected visual acuity (UCVA) greatly. UCVA after LASIK was better than that of PRK (P<0.05). 3. Decentration was similar after PRK and LASIK, there was no statistical significant difference between them (P>0.05). Decentration more than 0.50mm affected the postoperative UCVA greatly(P<0.001). 4. The change of SimK after LASIK was smaller than that of PRK (P<0.01). There was statistical significant difference among the change of SimK postoperatively(P<0. 05). Conclusions: 1 .Corneal topographic patterns were classified as uniform, semicircular, keyhole, kidney,central island and irregularity after PRK and LASIK. There was no central island pattern after LASIK. Corneal topographic patterns showed little change after 3 months postoperatively. Patterns of both groups tended to become more regular. Uniform pattern after LASIK was more than that of PRK, there was statistical significant difference. 2. Central island and irregularity patterns affected the postoperative UCVA greatly. UCVA after LASIK was better than that of PRK, there was statistical significant difference. 3. Decentration had no change with time. There was no statistical significant difference between PRK and LASIK. Decentration more than 0.50mm affected the postoperative UCVA greatly. 4. The change of SimK at different times postoperatively was different, there was statistical significant difference among them. The change of SimK after LASIK was smaller than that of PRK, there was statistical significant difference. SimK was important in predicting refractive regression.更多还原