以準分子雷射屈光角膜切削術治療高度近視之視覺表現

Visual Performance after Excimer Laser Photorefractive Keratectomy for High Myopia

劉又綾(Yu-Ling Liu)

指導教授 ： 林昌平

長榮大學/健康科學學院/醫學研究所/碩士(2009年)

https://doi.org/10.6833/CJCU.2009.00179

摘要

目的:
評估以準分子雷射屈光角膜切削術治療-8D以上近視之功效、並評估其預測性、穩定性、安全性及其視覺表現。
方法:
近視-8D至-13.5D及散光最高至-4D的54位患者(104眼)，以德國Allegretto Wave version 1009-1準分子雷射儀進行雷射屈光角膜切削術治療，於術後第一、三、七、十四天及第一、三、六、十二個月回診，檢查項目包括視力、自覺屈光度、角膜裂隙燈、角膜地圖儀、眼壓測量、視覺對比敏感度、眼球前導波像差。
結果:
術後十二個月時，97%的眼睛達目標屈光的度數1D以內，88%的眼睛未矯正視力達到或優於0.8，97%的眼睛最佳矯正視力等於或優於術前之矯正視力。非常輕微的角膜霧狀混濁於術後第一個月達最高峰，而後在第三個月時逐漸減少；平均視覺對比敏感度輕微下降；眼球球面像差及高階像差皆有顯著增加。有一眼因角膜上皮癒合延遲及使用類固醇藥物，併發角膜疤痕及眼壓升高。另外有一眼因患者於術後第一個月自行停止使用類固醇藥水而導致二級的角膜霧狀混濁，接受準分子雷射治療性角膜切除術治療，成功去除角膜霧狀混濁，最佳矯正視力恢復至1.0。
結論:
以準分子雷射屈光角膜切削術治療-8D以上近視及-4D以下散光，具良好之功效、預測性、穩定性、安全性。併發症的發生極低，唯視覺對比敏感度輕微下降、眼球球面像差及高階像差顯著增加仍有改善空間。所有適合接受準分子雷射層狀角膜切除術的患者皆可接受準分子雷射屈光角膜切削術。

關鍵字

準分子雷射屈光角膜切削術 ； 高度近視

並列摘要

Purpose:
To evaluate the efficacy, safety, predictability, and visual performance of excimer laser photorefractive keratectomy for myopia greater than -8 diopters.
Methods:
Fifty-four patients (104 eyes) with myopia from -8D to -13.5D and cylinder up to -4D received surface ablation technique with the Allegretto Wave version 1009-1 excimer laser to correct their refractive error. The patients were examined on day 1, 3, 7, 14 and 1, 3, 6, 12 months postoperatively. Visual acuity, manifest refraction, corneal haze, topography, intraocular pressure, contrast sensitivity, and wavefront aberration were evaluated.
Results:
Twelve months postoperatively, 97% eyes were within 1D of the intended correction. 88% eyes attained uncorrected visual acuity of 0.8 or better, and 97% eyes improved or remained their best corrected visual acuity. Barely detectable corneal haze peaked in the first month, and with gradual reduction in the third month. Average contrast sensitivity decreased slightly. Spherical and high order aberration increased significantly. One eye was complicated with corneal scar and ocular hypertension due to delayed corneal epithelial healing and corticosteroid use. Another eye received phototherapeutic keratectomy for corneal haze after the postoperative regimen of corticosteroids was discontinued by the patient herself. The beset corrected visual acuity of the eye recovered to 1.0.
Conclusions:
Excimer laser PRK is effective and predictive for treatment of high myopia greater than -8D with or without astigmatism up to -4D. The incidence of complication was low, but effort should be made to improve reduction of contrast sensitivity and induced spherical and high order aberration. All patients who are candidates for LASIK can be candidates for surface ablation.

並列關鍵字

excimer laser photorefractive keratectomy ； high myopia

參考文獻

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