本文選題：角膜磨鑲術(shù) + 激光原位�。� 參考：《鄭州大學(xué)》2011年碩士論文

【摘要】：背景和目的 準(zhǔn)分子激光原位角膜磨鑲術(shù)(laser in situ keratomileusis,LASIK)治療近視眼具有較好的安全性、有效性和可預(yù)測(cè)性,是目前最為常見的一種手術(shù)方式。然而,部分高度近視眼LASIK術(shù)后會(huì)發(fā)生屈光回退。近視眼LASIK術(shù)后屈光回退的機(jī)制非常復(fù)雜,目前還不是完全清楚,預(yù)防高度近視眼LASIK術(shù)后屈光回退還沒有肯定有效的方法。先前研究表明LASIK手術(shù)切削了角膜組織,眼內(nèi)壓作用于較薄的角膜組織使角膜前移是LASIK術(shù)后屈光回退的一個(gè)重要因素。本研究對(duì)高度近視眼LASIK術(shù)后可能發(fā)生屈光回退眼應(yīng)用降眼壓藥物,觀察角膜前移的變化,評(píng)估其預(yù)防屈光回退的效果。 方法 選取2010年1月～2010年10月在鄭州大學(xué)第一附屬醫(yī)院準(zhǔn)分子激光中心接受LASIK手術(shù)治療的高度近視眼,術(shù)后第1天主覺驗(yàn)光等值球鏡屈光度在0～-0.75D之間的共50人(78眼),隨機(jī)分為研究組24人(36眼)和對(duì)照組26人(42)。對(duì)照組術(shù)后常規(guī)應(yīng)用抗生素滴眼液點(diǎn)眼10天和皮質(zhì)類固醇滴眼液點(diǎn)眼1個(gè)月。研究組術(shù)后常規(guī)用藥外,術(shù)后第1天增加使用馬來酸噻嗎洛爾滴眼液每天2次點(diǎn)眼1個(gè)月。術(shù)后10天、1個(gè)月、3個(gè)月檢查眼壓、等值球鏡屈光度、和角膜地形圖等,由角膜地形圖獲取角膜后表面曲率半徑、diff值(角膜后表面中心高度)及Diff差值(角膜后表面前移量)。Diff差值是由術(shù)后角膜地形圖與術(shù)前角膜地形圖差異圖中央點(diǎn)(0。,0 mm)的讀數(shù)獲得(選取直徑為7 mm到10 mm的外環(huán)帶作為差異圖的對(duì)位適配帶)。對(duì)兩組術(shù)后1天屈光度,術(shù)后10天、1個(gè)月、3個(gè)月眼壓、角膜后表面Diff差值、角膜后表面曲率半徑及屈光度等分別進(jìn)行獨(dú)立樣本t檢驗(yàn)。P0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果 1.研究組術(shù)后10天、1個(gè)月眼壓是分別是(9.61±2.90) mmHg、(9.97±2.45) mmHg,低于對(duì)照組術(shù)后10天、1個(gè)月的眼壓(分別是11.69mmHg±2.6mmHg; 11.99 mmHg±3.07mmHg),兩組比較差異有統(tǒng)計(jì)學(xué)意義(t=-2.37,P=0.023；t=2.22,P=0.033),研究組和對(duì)照組術(shù)后3個(gè)月的眼壓分別是(10.61±2.90)mmHg、(10.92±2.65) mmHg,兩組比較差異無統(tǒng)計(jì)學(xué)意義(t=0.35,P=0.73)。 2.研究組術(shù)后10天、1個(gè)月和3個(gè)月角膜后表面Diff差值分別是(9.56±6.66)μm、(10.72±6.70)μm、(14.11±4.66)μm,低于對(duì)照組術(shù)后10天、1個(gè)月和3個(gè)月角膜后表面Diff差值(19.57±7.76)μm、(20.24±7.37)μm、(20.10±6.98)μm,兩組比較差異有統(tǒng)計(jì)學(xué)意義(t=3.08, P=0.04;t=2.25, P=0.03;t=4.19, P=0.004)。 3.研究組術(shù)后10天、1個(gè)月和3個(gè)月角膜后表面曲率半徑分別是(6.43±0.20)mm、(6.40±.25) mm和(6.35±0.13)mm,高于對(duì)照組術(shù)后10天、1個(gè)月和3個(gè)月角膜后表面曲率半徑(6.25±0.30) mm、(6.25±0.25) mm和(6.21±0.18)mm,兩組比較差異有統(tǒng)計(jì)學(xué)意義(t=2.19,P=0.04；t=2.21,P=0.03：t=2.64,P=0.012)。 4.研究組和對(duì)照組術(shù)后1天的屈光度分別是(-0.40±0.32)D、(-0.45±0.25)兩組比較差異無統(tǒng)計(jì)學(xué)意義(t=0.53,P=0.579),研究組術(shù)后10天、1個(gè)月和3個(gè)月時(shí)屈光度分別為(-0.46±0.28)D、(-0.61±0.34)D和(-0.75±0.21)D,低于對(duì)照組術(shù)后10天、1個(gè)月和3個(gè)月時(shí)屈光度(-0.67±0.23)D、(-0.93±0.23)D和(-1.05±0.29)D，，兩組比較差異有統(tǒng)計(jì)學(xué)意義(t=2.52, P=0.016; t=3.45, P=0.001;t=3.60, P=0.001)。 結(jié)論 高度近視眼LASIK術(shù)后早期應(yīng)用噻嗎洛爾滴眼液能減少角膜后表面前移,降低近視屈光度,是預(yù)防高度近視眼準(zhǔn)分子激光原位角膜磨鑲術(shù)后屈光回退的一種有效方法。
[Abstract]:Background and purpose
Excimer laser in situ keratomileusis (laser in situ keratomileusis, LASIK) has good safety, effectiveness and predictability in the treatment of myopia. It is the most common mode of operation at present. However, the refractive regression will occur after LASIK operation in some high myopia eyes. The mechanism of refraction in myopia after LASIK is very complicated. It is not completely clear that the prophylaxis of refraction in high myopia after LASIK has not been an effective method. Previous studies have shown that LASIK surgery cuts the cornea tissue and the intraocular pressure acts on the thinner corneal tissue to make the cornea move forward as an important factor in the refractive regression after LASIK. This study may have been possible after LASIK for high myopia. Ocular hypotensive drugs were used to observe the changes of corneal anterior movement and evaluate the effect of preventing refractive regression.
Method
From January 2010 to October 2010, the high myopia with LASIK surgery at the excimer laser center of the First Affiliated Hospital of Zhengzhou University was selected, and 50 people (78 eyes) with refractive index between 0 and -0.75D first days after operation were randomly divided into the study group 24 (36 eyes) and the control group (42). The control group was used for routine application after operation. The eye drops for 10 days and corticosteroid eye drops for 1 months. The study group increased the use of Timolol Maleate Eye Drops 2 times a day for 1 months after the operation, first days after the operation. The intraocular pressure was examined for 10 days, 1 months, 3 months after the operation, the refractive index of the sphere, and the topographic map of the cornea were obtained, and the corneal surface was obtained from the corneal topography. The surface curvature radius, the diff value (the posterior corneal surface center height) and the Diff difference (the posterior corneal surface shift).Diff difference was obtained by the reading of the central point (0., 0 mm) of the corneal topographic map and the preoperative corneal topographic map (0., 0 mm) (the outer band of 7 mm to 10 mm as the counterpart of the difference map). The 1 day postoperatively for the two groups was photometric, 10 days, 1 months, 3 months, 3 months of intraocular pressure, the difference of posterior corneal surface Diff, the radius of curvature of the posterior surface of the cornea and the diopter of the cornea were measured by independent sample t test, and the difference was statistically significant.
Result
1. the intraocular pressure of the study group was (9.61 + 2.90) mmHg and (9.97 + 2.45) mmHg respectively after 1 months of operation. The intraocular pressure of the study group and the control group was statistically significant (t=-2.37, P= 0.023; t=2.22, P=0.033). The intraocular pressure of the study group and the control group was respectively respectively. The intraocular pressure of the study group and the control group was respectively (9.61 + 2.90) and (9.97 + 2.45) mmHg respectively after the operation of the control group (11.69mmHg + 2.6mmHg, 11.99 mmHg + 3.07mmHg). It was (10.61 + 2.90) mmHg, (10.92 + 2.65) mmHg, and the difference between the two groups was not statistically significant (t=0.35, P=0.73).
2. after 10 days, 1 months and 3 months after operation, the Diff difference between the corneal surface and the posterior surface of the cornea was (9.56 + 6.66) mu m, (10.72 + 6.70) mu m and (14.11 + 4.66) mu m, lower than the Diff difference of the posterior corneal surface of the control group, 1 months and 3 months (6.70) mu m, and the difference was statistically significant (t=3.08, P=0.04; t=2). .25, P=0.03; t=4.19, P=0.004).
3. the radius of posterior corneal surface curvature was (6.43 + 0.20) mm, (6.40 +.25) mm and (6.35 + 0.13) mm respectively after 10 days, 1 months and 3 months after operation, which was higher than that of the control group after 10 days, 1 months and 3 months of corneal surface curvature radius (6.25 + 6.43) mm, (t=2.19, P=0.04; t=2), respectively (t=2.19, P=0.04; t=2). .21, P=0.03:t=2.64, P=0.012).
4. the diopter of the 4. group and the control group was (-0.40 + 0.32) D and (-0.45 + 0.25), respectively, and there was no significant difference between the two groups (t=0.53, P=0.579). The diopter of the study group was 10 days, 1 months and 3 months after operation (-0.46 + 0.28) D respectively, (-0.61 + 0.34) D and (-0.75 + 0.21) D, lower than that of the control group after operation, 1 months and 3 months. 0.67 + 0.23) D, (-0.93 + 0.23) D and (-1.05 + 0.29) D, the difference between the two groups was statistically significant (t=2.52, P=0.016, t=3.45, P=0.001, t=3.60, P=0.001).
conclusion
The early application of timolol eye drops after LASIK for high myopia can reduce the movement of the posterior corneal surface and reduce the diopter of myopia. It is an effective method to prevent the refraction of the high myopia after excimer laser in situ keratomileusis.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R779.63

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 牟章兵;李旭松;朱晉;向金梅;謝艾芮;;降眼壓藥物治療LASIK術(shù)后屈光回退的效果評(píng)估和機(jī)制探討[J];國際眼科雜志;2008年10期

2 鄒捷敏;孫建華;王雙喜;劉躍芬;;準(zhǔn)分子激光原位角膜磨鑲技術(shù)分步多區(qū)切削治療高度近視的療效分析[J];國際眼科雜志;2009年03期

3 楊麗娟;于世輝;張清生;;噻嗎洛爾眼液治療LASIK術(shù)后屈光回退54例療效分析[J];國際眼科雜志;2010年03期

4 蘇東風(fēng);張豐菊;魯智利;于芳蕾;;LASIK術(shù)后屈光回退的多因素分析[J];眼科新進(jìn)展;2006年02期

5 張立軍;張巖;王佼佼;蔣華;;SBK與LASIK治療高度近視眼患者的臨床對(duì)比研究[J];眼科新進(jìn)展;2010年06期

6 倪海龍,王勤美,瞿佳;準(zhǔn)分子激光原位角膜磨鑲術(shù)后角膜后表面屈光力變化[J];眼科研究;2002年06期

7 潘青,顧揚(yáng)順;近視LASIK術(shù)后屈光回退眼和非回退眼角膜形態(tài)改變的差異[J];眼科研究;2005年01期

8 潘怡,張泳,廉井財(cái),王康孫;準(zhǔn)分子激光原位角膜磨鑲術(shù)后眼壓和角膜厚度的研究[J];中華眼科雜志;1999年05期

9 廉井財(cái),張瓊,葉紋,周德佑,王康孫;準(zhǔn)分子激光原位角膜磨鑲術(shù)后屈光度數(shù)回退的原因分析[J];中華眼科雜志;2002年06期

10 赫天耕,王力軍,孫智勇,史秀茹;準(zhǔn)分子激光角膜上皮瓣下磨鑲術(shù)與準(zhǔn)分子激光屈光性角膜切削術(shù)治療近視的比較[J];中華眼科雜志;2004年09期

本文編號(hào)：2033234