中华眼科杂志 1999年第5期第35卷 论 著
作者：潘 怡 张 泳 廉井财 王康孙
单位：200025 上海第二医科大学附属瑞金医院眼科中心
关键词：近视眼；准分子激光原位角膜磨镶术；眼压；角膜厚度
【摘要】 目的 探讨准分子激光原位角膜磨镶术（excimer laser in situ keratomileusis, LASIK）后眼压、角膜厚度的变化及其关系。方法 对接受LASIK的156例221只近视眼患者手术前后的屈光度、角膜厚度及眼压（非接触式和Goldmann压平眼压）情况进行观察。结果 LASIK术后实际角膜厚度大于预计角膜厚度，屈光度数越高差别越明显，术后屈光度回退也越多。术后3个月角膜厚度大于术后1个月。术后眼压值明显低于术前，差异有显著性（P＜0.01）。眼压改变量与角膜厚度的改变量相关(r=0.2，P＜0.002）。术后Goldmann压平眼压计测定的眼压改变量较非接触式眼压计测定的眼压改变量小。结论 LASIK实际切削角膜厚度低于预计厚度。术后常规方法测量眼压值低于实际值，眼压的测定方法尚需进一步校正。LASIK 后选择Goldmann压平眼压计测量眼压较合适。
Analysis of intraocular pressure and corneal thickness after laser in situ keratomileusis
PAN Yi, ZHANG Yong, LIAN Jingcai, et al.
Ruijin Eye Institute, Ruijin Hospital, Shanghai Second Medical University, Shanghai 200025
【Abstract】 Objective To analyze the changes and relationship of the intraocular pressure (IOP) and the corneal thickness (CT) after laser in situ keratomileusis (LASIK). Methods This prospective study comprised two groups: noncontact tonometer group 221 eyes (156 patients) 1 month after LASIK and 72 eyes (50 patients) 3 months after LASIK; Goldmann applanation tonometer group 60 eyes (36 patients) 1 month after LASIK. The spherical equivalent, the corneal thickness and the IOP readings were measured pre- and post-LASIK.Results The CT was thicker than the predicted value and it was much more prominent in the higher myopic group with more regression degree of refraction. The CT at postoperative 3 month was thicker than that at 1 month. There was a statistical decrease in mean tonometer readings, both with non-contact tonometer and Goldmann applanation tonometer; and there was statistically significant correlation between the changes of central corneal thickness and the changes of non-contact tonometer readings (r=0.2, P＜0.002). The IOP decrease with Goldmann applanation tonometer was less than that with noncontact tonometer.Conclusions The actual ablation depth of cornea is lower than the predicted. The IOP readings of the patients after LASIK are lower than the real IOP values. Further efforts should be made to improve the accuracy. Goldmann applanation tonometer is a better choice measuring IOP after excimer photoablative corneal refractive surgery.
【Key words】 Myopia Laser in situ keratomileusis Intraocular pressure Corneal thickness
目前临床检测眼压的方法有压平式、非接触式及压陷式眼压计。Goldmann压平眼压计被认为是最精确的一种方法。但角膜厚度可影响其测量值。准分子激光屈光性角膜手术治疗近视，如准分子激光屈光性角膜切削术（photorefractive keratectomy，PRK）和准分子激光原位角膜磨镶术（excimer laser in situ keratomileusis, LASIK）均可致术后角膜变平、变薄，角膜厚度明显降低，因此影响眼压的测定。LASIK是在角膜瓣下用准分子激光对角膜基质进行切削治疗近视，保持了角膜上皮及前弹力层的正常结构，效果优于PRK。临床检查已发现，LASIK术后眼压测定值普遍下降。为此，我们对本院采用LASIK后的156例221只近视眼患者手术前、后的屈光度、角膜厚度及眼压（非接触式和Goldmann压平眼压计）进行观察，现报告如下。
资料和方法
1．对象:按眼压测量方法将156例(221只眼)接受LASIK治疗的患者分为非接触眼压计及Goldmann压平眼压计两组。每组又根据术前近视度数+散光度数/2折算的等量球镜度数分为3组：Ⅰ组，3.25～-8.00 D; Ⅱ组，-8.25～-14.00 D; Ⅲ组，-14.25～-22.00 D。
非接触眼压组：选择接受LASIK的近视患者221只眼。术后随访1个月者156例（221只眼），男89只眼，女132只眼；术后3个月者50例（72只眼），男30只眼，女42只眼。年龄18～54岁，平均（30.2±8.3）岁。近视度数为-2.50～-21.00 D，散光度数为≤-5.50 D。术前Ⅰ组51只眼, 平均近视度数（-6.59±1.13） D; Ⅱ组131只眼，平均度数（-11.15±1.71）D; Ⅲ组39只眼, 平均度数（-16.02±1.68） D。术后1及3个月各组随访的眼数分别为Ⅰ组51只眼，15只眼；Ⅱ组131只眼，48只眼；Ⅲ组39只眼，9只眼。
Goldmann眼压组：选择接受LASIK治疗的近视眼36例（60只眼），其中男26只眼，女34只眼。Ⅰ组，17只眼，平均近视度数为(-6.13±1.41) D；Ⅱ组，35只眼，平均度数为（-10.63±1.65） D；Ⅲ组8只眼，平均度数为（-16.64±1.82） D。
2. 方法：
（1）术前检查：视力，屈光度，裂隙灯显微镜，直接检眼镜，非接触式眼压计，角膜厚度的测量，角膜地形图检查。
（2）仪器：采用美国Chiron/Vision公司的自动角膜成形器及Chiron/Technolas Keracor-117准分子激光器。能量密度为120 mJ/cm2，激光频率50 Hz，光斑直径2 mm。用扫描式随机切削角膜基质。
（3）手术方法：见文献［1］。术后第1天，术眼滴0.1%氟米龙+0.3%氟嗪酸眼液，每日4次，共10天。术后1及3个月复查眼压、视力、屈光度及角膜厚度。
（4）统计学方法：用SAS 6.04统计软件包中Pearson相关分析及 student t检验（配对、非配对）。P＜0.05为差异有显著性。
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