【摘要】  　　目的：探讨LASIK手术中患者所发生的瞳孔中心移位的特点。方法：LASIK手术患者203例394眼术前应用VISX波前像差仪在暗室中进行虹膜照相检查，显示术前瞳孔直径。LASIK术中利用VISX S4-IR激光机进行虹膜定位检查，显示术中的瞳孔直径，以及瞳孔缩小后的中心移位情况。结果：在暗室中右眼平均瞳孔直径为6.9±2.1mm，左眼瞳孔直径为6.8±2.3mm；术中394眼瞳孔均缩小，右眼瞳孔平均为3.25±0.48（2.3~4.7）mm，左眼瞳孔平均为3.16±0.57（1.9~4.7)mm，术中左眼瞳孔直径较右眼明显偏小。术中394眼均发生了瞳孔中心移位，其中，85.2%右眼瞳孔中心向上方移位，平均移位距离为x=0.18mm，y=0.16mm；71.0%瞳孔中心向鼻上方移位。76.7%左眼瞳孔中心向上方移位，平均移位距离为x=-0.31mm，y =0.11mm；75.6%瞳孔中心向鼻上方移位。结论：LASIK手术时患者瞳孔较暗光时明显缩小，此时有一定程度的瞳孔中心移位。

【关键词】  准分子激光手术　瞳孔直径　瞳孔中心移位

　　The observation of shift in pupil center locations during LASIK

    Yao-Yu Li, Yan Qiu, Huai-Yu Qiu, Yu-Lan Di, Guo-Guang Zhai, Zhe Qu

    Department of Ophthalmology, General Hospital of Beijing Command Area of PLA, Beijing 100700, China

    Abstract AIM: To study the pupil diameter and pupil center location shift characteristics between the WaveScan wavefront examine and surgery during LASIK. · METHODS: The pupil camera of Visx WaveScan wavefront device was used to obtain images of 394 eyes (203 patients) before refractive laser surgery. Additionally, an infrared camera was mounted on the Visx Star S4-IR excimer laser system to obtain another image immediately before the laser was fired. After surgery, the two images were compared to determine the pupil diameter and center locations between the measurement and surgery. RESULTS: The mean diameter of pupil was 6.9±2.1mm in right eye and 6.8±2.3mm in left eye as the pupil dilated in the dark room. The mean diameter of pupil was 3.25±0.48mm in right eye and 3.16±0.57mm in left eye immediately before the laser was fired. The diameter of left eyes was smaller than that of right ones. Pupil center shift between the measurement and surgery occurred in all the eyes. Pupil center location was shifted to its superior and superior-nasal in 85.21% and 71% of right eyes, respectively, with the mean shift distance: x =0.18mm, y=0.16mm. Pupil center location was shifted to its superior and superior-nasal in 76.7% and 75.6% of left eyes, respectively, with the mean shift distance: x=-0.31mm, y=0.11mm. CONCLUSION: As the pupil diameter from large to small, pupil center shift between the measurement and surgery occurred all the eyes.

    · KEYWORDS: excimer laser operation; pupil diameter; shift of pupil center

　　0引言

    随着波前像差技术的引进，准分子激光原位角膜磨镶术（LASIK）的精度得到了很大提高，患者术后眩光以及视觉质量差等问题得到了根本性解决，因此，波前像差引导的LASIK手术在国内外已经成为了一个普及性的屈光手术。但由于波前像差检查一定要在暗室中进行，此时患者的瞳孔处于较大状态，而我们在手术时由于存在着灯光照明以及患者紧张等因素而会使瞳孔会明显缩小。这种术前和术中瞳孔直径的明显变化，将会在一定程度上造成治疗时的瞳孔中心移位。瞳孔中心移位的结果很有可能造成激光的偏中心切削，从而影响患者术后的视觉质量[1,2]。为解决这种手术误差，我们采用美国VISX公司的WaveScan 3.62版的波前像差检查系统和VISX S4-IR激光机对203例患者的术前和术中瞳孔直径以及瞳孔中心的移位情况进行了观察和研究如下。

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