作者：庞彦利,吴小影,刘双珍,胡生发 作者单位：（410008）中国湖南省长沙市，中南大学湘雅医院眼科
【摘要】目的：比较近视患者准分子激光原位角膜磨镶术(laser in stiu keratomileusis, LASIK)前后正相对调节(positive relative accommodation, PPA)、负相对调节(negative relative accommodation, NRA)的变化，探讨其对术后视觉质量影响的相关性。方法：使用综合验光仪测定45名近视患者LASIK术前戴镜、术后1mo裸眼、术后3mo裸眼的NRA、PRA值，按近视程度分为中低度近视组、高度近视组；按发病年龄分为早发性近视组、迟发性近视组；按患者年龄分为18～20岁组、21～30岁组、31～41岁组，分别进行统计学比较和分析。结果：全部患者术前戴镜、术后1mo、术后3mo的NRA、PRA值比较差异无显著意义(P>0.05)。不同程度近视组间、不同发病年龄组间的术前戴镜、术后1mo裸眼、术后3mo裸眼的NRA、PRA值差异无统计学意义（P>0.05）。不同年龄组间术前、术后1mo、术后3mo的NRA值差异有统计学意义（P<0.05）。结论：近视患者LASIK手术前后NRA、PRA值的改变没有统计学意义。NRA值随患者年龄增大而相应增高。
【关键词】 正负相对调节；近视；角膜磨镶术；激光原位
Early changes of positive and negative accommodation after myopic LASIK
YanLi Pang, XiaoYing Wu, ShuangZhen Liu, ShengFa Hu
Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
Correspondence to: XiaoYing Wu. Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China. [email protected]
AbstractAIM: By comparing the changes of positive and negative relative accommodation (PRA and NRA) in myopia treated by laser in stiu keratomileusis (LASIK), to discuss the effects of PRA and NRA on vis METHODS: The PRA and NRA of 45 myopic patients treated by LASIK were measured with Synthetic Optometry Uni before surgery, 1 month after surgery and 3 months after surgery. The patients were divided according to the myopia at low and high degree or their agesonset early or late, 1820, 2130 and 3141 years group by their age.RESULTS: The PRA and NRA among the three groups (before surgery, 1 month after surgery and 3 months after surgery) had no significant difference (P>0.05). There was also no significant difference between the two groups divided by the degree of myopia (P>0.05), and among the three groups divided by their agesonset (P>0.05). There was significant difference among the groups divided by the ages of patients (P<0.05).CONCLUSION: There were no significant differences of PRA and NRA among those groups wearing glasses before surgery, naked 1 month after surgery and 3 months after surgery. NRA is higher in the elder group than the younger one.
KEYWORDS: positive relative accommodation; negative relative accommodation; myopia; laser in stiu keratomileusis
0引言
准分子激光原位角膜磨镶术(laser in stiu keratomileusis, LASIK)治疗近视的原理是通过应用激光改变角膜前表面的曲率，将原来矫正镜片的度数转移到角膜上，以达到中和屈光不正的目的。由于手术不破坏角膜上皮及前弹力层，有术后视力恢复快、术后haze、屈光回退等并发症少的优点，在国内外得以广泛开展，使得大部分患者获得清晰的远视力，然而与此同时也出现了术后近距离阅读不适、视疲劳加重等视觉质量问题。为探讨此问题许多学者开始从术后近距离工作的调节需求变化[1,2]进行了分析。LASIK手术是否会对近视眼患者的正相对调节（positive relative accommodation, PRA）与负相对调节(negative relative accommodation, NRA)产生影响从而出现视觉质量下降呢？为此我们用综合验光仪器对近视患者LASIK手术前后的PRA、NRA值进行了检测分析，现将结果报告如下。
1对象和方法
1.1对象
选取200610/200703在我院眼科激光治疗中心就诊的近视患者45例90眼，其中男13例26眼，女32例64眼，年龄18~41岁，平均（25.13±6.42）岁。全部患者无其他疾患，无外伤史与手术史，术前最佳校正视力≥1.0，近视力=1。按近视程度分为两组：中低度近视组29例(58眼)，等效球镜屈光度数为≤6.00D；高度近视组16例(32眼),等效球镜屈光度数为≥6.25D。按发病年龄分为两组[3]：早发性近视组25例（50眼），发病年龄≤14岁；迟发性近视组20例（40眼），发病年龄≥15岁。按患者年龄分为3组：18~20岁组11例（22眼）；21~30岁组24例（48眼）；31~42岁组10例（20眼）。术后全部裸眼视力>1.0。随访资料完整的病例术后1mo为42例、术后3mo为26例。
1.2方法
常规检查患者术眼眼外、眼前节、眼底情况，ObscanⅡ角膜地形图检查、角膜曲率仪检查角膜屈光力，超声测厚仪检查角膜厚度。散瞳检影验光，采用调节平衡后的屈光度。采用日本Topcon公司生产的IS400型综合验光仪分别于术前、术后1mo及术后3mo进行NRA及PRA的测定。检查时先将调节平衡后的远视力矫正处方置于综合验光仪上，调整视近瞳距，让患者双眼注视眼前40cm处的近距视标。双眼同时以+0.25D为增率增加正镜片直至患者首次报告视标持续模糊(患者注意到视标变模糊但仍能阅读出来)，记录增加的正度数总量即NRA值[4]。将综合验光仪中的度数重新调整到原先度数，确认视标清晰后双眼同时以0.25D为增率增加负镜片直至患者首次报告视标持续模糊，记录增加的负度数总量及PRA值。使用美国VISXStarⅣ型准分子激光仪与法国MoriaⅡ自动旋转角膜刀行LASIK。
统计学处理：本研究使用SPSS 12.0统计软件包，采用方差分析、t检验、q检验、多元线性回归分析对计量资料进行统计学处理。
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