摘要目的 探讨准分子激光角膜屈光手术矫正眼球穿孔伤形成的屈光不正的安全性、有效性和预测性.方法 回顾性系列病例研究,收集采用化学法激光上皮下角膜磨镶术(LASEK)和准分子激光原位角膜磨镶术(LASIK)治疗的眼球穿孔伤后屈光不正者25例(25只眼).其中单纯角膜或角巩膜穿孔伤引起的角膜瘢痕14例,同时合并白内障进行工晶状体植入11例.年龄21 ～ 37岁.裸眼视力为0.05 ～0.3,最佳矫正视力为0.6～1.0.球镜度为+3.5 D～-4.0D,柱镜度为+5.0D～-5.0 D.常规围手术期检查,随访6个月,检测手术前、手术后1个月、3个月和6个月的裸眼视力、最佳矫正视力和屈光度.结果 术后1个月22只眼(88.0％)裸眼视力达到0.5以上,术后3个月24只眼(96.0％)裸眼视力达到0.5以上,术后6个月所有眼的裸眼视力达到0.5以上.术后1个月20只眼(80.0％)最佳矫正视力达到或超过术前,3只眼(12.0％)下降1行,2只眼(8.0％)下降2行.术后3个月22只眼(88.0％)最佳矫正视力达到或超过术前,2只眼(8.0％)下降1行,1只眼(4.0％)下降2行.术后6个月,24只眼(96.0％)最佳矫正视力达到或超过术前,仅有1只眼(4.0％)下降1行.手术后1个月、3个月和6个月球镜度在±0.5D内者分别为84.0％、84.0％和80.0％,球镜度在±1.0D以内者分别为100％、100％和96.0％;柱镜度在±0.5D以内者分别为80.0％、80.0％和76.0％;柱镜度数在±1.0D以内者分别为92.0％、96.0％和92.0％.结论 准分子激光角膜屈光手术矫正眼球穿孔伤后形成的屈光不正有较好的安全性、有效性和预测性,但要合理选择适应证.手术方式还需要进一步探讨.

abstractsObjective To evaluate the clinical efficacy,safety and predictability of laser refractive surgery for refractive errors after penetrating eye injuries.Methods It was a retrospective case series study.Twenty five eyes of 25 cases at the age of 21 to 37 yrs.were studied.They were treated by LASEK & LASIK.The eyes manifested uncorrected visual acuity(UCVA) of 0.05 ～0.3,best corrected visual acuity (BCVA) of 0.6 ～ 1.0,spherical diopter (SD) of + 3.5 D ～-4.0 D,cylinder diopter(CD) of + 5.0 D ～-5.0 D.The ametropia was result of penetrating eye injuries,in which 14 eyes only had corneal scar caused by corneal or corneoscleral perforation,the other 11 eyes combined with cataract extraction and intraocular lens (IOL) implantation at the same time for traumatic cataract.All eyes were followed up for 6 months.The UCVA,BCVA and diopter were examined before surgery and 1 m,3m and 6m postoperatively.Results There were 22 eyes(88.0％),24 eyes(96.0％),25 eyes(100％) got UCVA more than 0.5 at 1m,3m and 6m after surgery,respectively.One month after surgery,the BCVA of 20 eyes (80.0％) reached or surpassed the preoperative one,3 eyes(12.0％) declined one line and 2 eyes (8.0％) declined two lines.Three months after surgery,the BCVA of 22 eyes (88.0％) reached or the surpassed the preoperative one,2 eyes (8.0％) declined one line and 1 eye (4.0％) declined two lines.Six months after surgery,the BCVA of 24 eyes (96.0％) reached or surpassed the preoperative one,only 1 eye (4.0％) declined one line.At 1m,3m and 6m after surgery,the SD within ±0.5D was 84.0％,84.0％,80.0％ respectively,and within ± 1.0D were 100％,100％,96.0％ respectively.The CD within ± 0.5D was 80.0％,80.0％,76.0％,respectively,and within ± 1.0D was 92.0％,96.0％,92.0％ respectively.Conclusion Laser refractive surgery is efficient,safe and predictable for refractive errors caused by penetrating eye injuries.The indications must be selected reasonably and the surgical procedures also needed further investigation.