Summary

通过单眼双非球面消融剖面矫正老花眼

Published: September 20, 2024
doi:

Summary

本文提供了使用单眼双非球面消融剖面矫正老花眼的分步指南。

Abstract

该研究旨在评估用于矫正老花眼手术的单眼双非球面消融曲线前后的视力和客观视觉质量。这项前瞻性自我对照研究包括 2023 年 1 月至 2024 年 1 月在山东中医药大学眼科医院接受近视老花眼单眼双球面消融轮廓矫正的 20 例和 38 只眼睛的患者。选取这些患者进行观察,评价每例患者术前和术后未矫正远视力 (UDVA)、未矫正近视力 (UNVA)、矫正远视力 (CDVA)、球差 (SA) (6 mm 以内)、水平和垂直昏迷 (6 mm 以内) 和角膜非球面指数 (Q 值) (6 mm 以内)。在手术前后的不同时间点进行统计数据分析。手术前后优势眼和非优势眼的 UDVA 存在统计学显着差异 (Z = -3.784,p < 0.001; Z = -3.817,p < 0.001)。 术后,90% 的非优势眼达到 J1 及以上的 UNVA,95% 的双侧眼达到 J1 及以上的 UNVA。在优势眼的 SA 中发现显着差异,显示正增加 (Z= -3.784,p < 0.001); 然而,与优势眼相比,非优势眼的 SA 呈负向增加,但差异无统计学意义 (p = 0.08)。手术前后优势眼垂直昏迷情况差异有统计学意义,但非优势眼的垂直昏迷情况差异无统计学意义。术前和术后双眼水平昏迷的变化差异无统计学意义。手术前后双眼 Q 值有显着变化 (Z = -3.923,p < 0.001 ;Z = -3.51,p < 0.001)。 单眼双非球面消融剖面后,非优势眼角膜呈长方形,负 SA 增加,术后 UDVA 和 UNVA 改善。

Introduction

老花眼是由于晶状体和睫状肌功能丧失而导致近视力丧失的与年龄相关的调节幅度降低1。到 2030 年,全球老花眼人口预计将超过 20 亿,未矫正和未矫正的老花眼会影响社会经济发展2。老花眼的矫正包括晶状体矫正、手术方法和药物治疗。角膜手术是矫正老花眼的角膜手术的主要形式之一,因为它的侵入性较小、并发症较少且恢复更快3

Ruiz 于 1996 年推出了 Presby 激光辅助原位角膜磨镶术 (LASIK),该手术将角膜消融成多焦点模式并增加负 SA 以实现同时近视力和远视力 4,5。根据邻近区域,Presby LASIK 可分为周边模型6(近视力的周边区域和远视力的中央区域)和中央模型7(远视力的周边区域和近视力的中心区域)8,9单眼双非球面消融术是一种混合型 Presby LASIK,它结合了多种程序的优点,包括微单眼视觉、双非球面和多焦点。优势眼的远视力完全矫正,非优势眼的中央区域保留大约 -0.89D 的近视力折射,周边角膜消融远视力,近加范围 (ADD) 在 +1.25D 到 2.50D 之间,中央和周边区域都使用非球面切割1011.

与之前的单视 LASIK 相比,单眼双球面消融剖面后非优势眼的多灶性形态减少了两眼之间的屈光参差。SA 的负增加引入了焦深,可以更好地改善近视力,同时改善中间视力,减少对立体视觉的影响,提高患者的接受度和满意度 11,12,13。单眼模式会导致优势眼完全矫正,可以实现术后最快的清晰全视力,降低 UDVA 下降的风险,更适合对 UDVA 和 UIVA 要求相同的老花眼患者,而其他算法是双眼多灶性的,术后需要更多时间适应,有 UDVA 下降的风险1415,16.本文介绍了准分子激光多焦点双非球面消融模式的详细手术步骤,作为手术指南。

Protocol

以下方案由山东中医药大学附属眼科医院伦理委员会审查和批准(Grant No.HEC-KS-2020002KY),并严格遵守赫尔辛基宣言。所有患者均签署了知情同意书。 1. 患者选择 注:20 例 (38 眼) 经准分子激光单眼多焦点双球面消融治疗的老花眼患者被收治在山东中医药大学附属眼科医院屈光外科。进行基线和随访检查。 ?…

Representative Results

本研究共分析了 20 例接受单眼双非球面消融术矫正老花眼的患者。患者术前年龄为 47 (± 3.36) 岁,术前优势眼和非优势眼的球面等效量 (SE) 分别为 -4.47 D (± 2.16) D 和 -4.34 D (±2.09 D)。所有手术均已完成,无术后并发症。 视力结果手术前后优势眼和非优势眼的 CDVA 差异无统计学意义,但手术前后优势眼、非优势眼和双眼的 UDVA…

Discussion

目前,恢复眼部调节的有效方法有限,使老花眼成为屈光手术的重要研究领域。双非球面消融术是一种广泛认可的老花眼矫正临床方式,已显示出良好的安全性和有效性,术后结果令人满意 15,16,17。然而,缺乏专注于单眼模式的研究。在这项研究中,我们提出了单眼双球消融剖面手术的综合指南,并?…

Disclosures

The authors have nothing to disclose.

Acknowledgements

山东省医疗卫生科技发展计划项目(202207020806)

Materials

0.9% Sodium Chloride Physiological Solution Shandong Qidu Pharmaceutical Co., Ltd. H37020764
AMARIS 1050RS Excimer Laser System SCHWIND eye-tech-solutions,DE https://www.eye-tech-solutions.com/amaris1050-excimer-laser
Compound Electrolyte Intraocular Irrigating Solution Shenyang Xingqi Ophthalmic Co. http://sinqi.com/html/SYXQ/202006/948671948671019061.html
Dexamethasone Eye Drops Alcon-Couvreur H20150119
Dextran 70 Chengdu Qingshan Likang Pharmaceutical Co. 6941684920076
Glycerol Eye Drops Chengdu Qingshan Likang Pharmaceutical Co. 6941684920076
Hypromellose 2910 Chengdu Qingshan Likang Pharmaceutical Co. 6941684920076
Levofloxacin Hydrochloride Eye Drops Shandong Bausch & Lomb Freda Pharmaceutical Co., Ltd 6924090700180
Proparacaine hydrochloride Eye Drops Alcon-Couvreur H20103352
SCHWIND Cutom Ablation Manager for Amaris Consorzio Servizi Ortopedici,Turin,IT N/A
Sirius 3D anterior segment and corneal aberration analyzer Consorzio Servizi Ortopedici,Turin,IT YM0020207 
Skin disinfectant Jinan Xinyongtai Shiye Co., Ltd http://www.sdxyt.cn/zh/products_detail.asp?id=23
Sterile Irrigator for Single Use Shandong Weigao Group Medical Polymer CO.,Ltd https://weigaogroup.com/photo/show-114.aspx
Sterile medical sponge for Single Use Beijing Kang'an Kelin Technology Co., Ltd SS-96A
Tobramycin Eye Drops Alcon-Couvreur H20150119
Transparent Film Dressing Frame Style Minnesota Mining and Manufacturing 1624WCN
VisuMax femtosecond laser system Carl Zeiss Meditec, Inc., Dublin, CA 20183241728

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Cite This Article
Wang, X., Li, L., Wang, Q., Bi, H., Fan, H., Wang, X., Ji, P. Correction of Presbyopia by Monocular Bi-Aspheric Ablation Profile. J. Vis. Exp. (211), e67173, doi:10.3791/67173 (2024).

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