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目的探讨准分子激光角膜原位联合角膜瓣背面磨镶术治疗高度近视的有效性和安全性。方法对28例(43眼)高度近视,单纯行LASIK手术后角膜基质床的剩余厚度低于250μm的患者行准分子激光角膜原位联合角膜瓣背面磨镶术治疗。结果术后复查角膜瓣平整,复位良好。裸眼视力(uncorrected visual acuity,UCVA)术前、术后1天、1周、1个月、3个月均值分别为0.1±0.07;0.68±0.21;0.81±0.23;0.87±0.23;0.91±0.24。术前屈光度(按等效球镜)平均(-9.83±1.98)DS,散光平均(-1.50±1.15)DC;术后3个月时屈光度平均为(-0.75±0.71)DS,散光度平均为(-0.52±0.56)DC,与术前相比差异具有非常显著性意义(t=28.31,P<0.05;t=5.02,P<0.05)。术后3个月时34眼达到或超过术前最佳矫正视力(Best corrected visual acuity,BC-VA),占79.07%;18眼高于术前最佳矫正视力1~2行,占41.86%;9眼低于术前最佳矫正视力1~2行,占20.93%,主要由于欠矫所致。结论准分子激光角膜原位联合角膜瓣背面磨镶术可以安全、有效地治疗术前预测角膜厚度不够的高度近视患者,而且无明显并发症的发生,但远期疗效还有待于进一步观察。
Objective To investigate the effectiveness and safety of excimer laser corneal in situ keratomileusis combined with corneal flap in the treatment of high myopia. Methods 28 cases (43 eyes) of high myopia, simple LASIK surgery corneal stroma after the remaining thickness of less than 250μm in patients with corneal in situ keratomileusis combined with corneal flap inlay. Results Postoperative corneal flap was flat and well reset. The uncorrected visual acuity (UCVA) preoperative, postoperative 1 day, 1 week, 1 month and 3 months mean values were 0.1 ± 0.07; 0.68 ± 0.21; 0.81 ± 0.23; 0.87 ± 0.23; 0.91 ± 0.24 respectively. The average preoperative refraction (equivalent spherical mirror) was (-9.83 ± 1.98) DS and the average astigmatism (-1.50 ± 1.15) DC. The average refraction was (-0.75 ± 0.71) DS at 3 months and the average astigmatism (-0.52 ± 0.56) DC, which was significantly different from that before operation (t = 28.31, P <0.05; t = 5.02, P <0.05). 34 eyes achieved or exceeded preoperative best corrected visual acuity (BC-VA) at 3 months, accounting for 79.07%; 18 eyes were better than preoperative best corrected visual acuity of 1 to 2, accounting for 41.86% ; 9 eyes were lower than preoperative best corrected visual acuity of 1 to 2 lines, accounting for 20.93%, mainly due to undercorrection due. Conclusion In situ keratomileusis and corneal flap ablation can safely and effectively treat patients with high myopia whose corneal thickness is not enough before operation, and there is no obvious complication. However, the long-term therapeutic effect remains to be further observed.