【摘要】 目的:评估准分子激光原位角膜磨镶术(LASIK)对眼调节功能及AC/A的影响及其临床意义。 方法:对118例(236眼)近视患者(1.25～11.75D)施行LASIK手术，于术前、术后1,3,6,12mo分别行小瞳及散瞳(美多丽P)后电脑验光、检影检查及同视机法测定AC/A，并对其结果进行统计学分析。 结果:LASIK术后散瞳检查与小瞳下等效球镜度的差异具有非常显著意义(P<0.01)，度数均降低。术后各月散瞳前后电脑验光等效球镜度的差值均明显大于术前差值(P<0.01)。术前与术后1,3,6,12mo分别比较，AC/A改变有非常显著意义(P<0.01)，均比术前降低。 结论:近视眼LASIK术后眼的调节增加。LASIK术后AC/A值较术前降低。对于术前调节功能较差的患者，LASIK手术时应综合考虑患者的实际工作距离、调节储备量和视远的需求合理设计手术量，适当地给予保留一定的近视度数，减轻术后视疲劳症状。
【关键词】 准分子激光原位角膜磨镶术;调节;调节性集合/调节;视疲劳
Change of accommodation and AC/A after LASIK and its clinical appliance
GuoPing Cao, HaiTao Xu, Ying Wang
Department of Ophthalmology, Taizhou Peoples Hospital, Taizhou 225300, Jiangsu Province, China
AbstractAIM: To evaluate the effect of LASIK on eyes accommodation and AC/A and to detect the clinical significance.
METHODS: Totally 118 myopia cases (236 eyes), whose diopter was from1.25D to 17.75D, astigmatism degree<2.00D, spherical equivalent was 6.20D±2.52, were determined the ratio of AC/C by synoptophore and refracted by auto refractor and phoropter. MydrinP was used to disperse pupil, then, refracted again by auto refractor and phoropter before LASIK, 1, 3, 6 months and 1 year after LASIK. The results were statistically analyzed.
RESULTS: 1) The discrepancy of Sph degree was significant difference between large pupil and normal pupil 1, 3, 6, and 12 months after operation (P<0.01), all SE diminished after mydriasis. 2) The change of diopter between large pupil and normal pupil 1, 3, 6, and 12 months after operation was larger than that before operation, the discrepancy of equipotent Sph degree was significant (P<0.01). 3) The ratio of A/C 1, 3, 6, and 12 months after operation was lower than preoperative respectively, the result had notable discrepancy (P<0.01).
CONCLUSION: 1) The adjustment of the myopia eyes increases after LASIK. 2) The ratio of A/C after LASIK is lower than preoperative. 3) We cant only look the visual acuity (≥1.0) and the result of refraction in normal pupil as the standard to judge the dioptric inadequation and excess. We should refer to patients actual working distance, the amount of reserve accommodation and the requirement for looking forward to designing the amount of operation, retaining some myopic diopter, and lightening the symptom of visual fatigue.
KEYWORDS: LASIK; accommodation; AC/A; asthenopia
Cao GP, Xu HT, Wang Y. Change of accommodation and AC/A after LASIK and its clinical appliance. Int J Ophthalmol(Guoji
Yanke Zazhi)2008;8(11):22782280
0引言
准分子激光原位角膜磨镶术(excimer laser in situ keratomileusis，LASIK)是近年发展起来的一种新型的角膜屈光手术。其术后在屈光状态改变的同时调节与集合也发生了变化。为进一步对调节与集合的变化进行研究解决患者术后视疲劳问题，现将我院2006 03/2007 03所做的LASIK手术患者118例236眼统计报告如下。
1对象和方法
1.1对象 随机抽取在我院眼科由同一术者施行LASIK手术患者118例(236眼)，其中男47例94眼，女71例142眼。年龄18 ～ 43(平均25)岁。术前屈光度为：1.25～11.75D，等效球镜值为 6.20±2.52D，散光均<2.00D。双眼最佳矫正视力≥0.8。所有受试者均无全身及眼部手术禁忌证。
1.2方法
1.2.1术前检查 (1)视力：包括裸眼视力及矫正视力;(2)眼底检查：散瞳后以全视网膜镜或三面镜检查;(3)角膜地形图。
1.2.2同视机法测定AC/A比率 患者戴全矫正眼镜，于同视机(TSJ3型)前，用黄斑中心凹同时视3°画片测出自觉斜视角的三棱镜度(即△1)，随后于两侧目镜前的镜架上各插入3.00D镜片，用以刺激调节，再次测出其三棱镜度(即△2)。重复测量3次取其平均值。将所得数据代入下述公式计算：AC/A比率=(△2△1)/D，D即插入镜片值。最后，将全部所得AC/A比率的各项数据输入SPSS软件包处理。
1.2.3屈光检查 (1)电脑验光仪(日本Topcon公司，KP8100)：手术前后1,3,6,12mo各检查1次。每次先行小瞳下电脑验光，然后用美多丽P(日本参天)散瞳，每5分钟1次，共4次，20min后再次电脑验光，每眼测3次，取其平均值，且每次均为同一人测量。(2)检影验光：散瞳后进行。
1.2.4手术方法 准分子激光仪(美国科医人公司，鹰视世纪波1009)和自动微型角膜刀(法国Moria公司，M2)，按常规方法行传统的LASIK手术。
统计学处理：在SPSS 12.0统计软件包下完成分析，数据用±s，比较用配对t检验和方差分析进行统计学处理，以P<0.05作为差异有显著性。
2结果
术后1,3,6,12mo大瞳与小瞳等效球镜的改变比较，结果显示差异有非常显著意义(P<0.01，表1)。术前大瞳与小瞳电脑验光等效球镜度改变与术后各月改变的比较结果显示差异有非常显著意义(P<0.01)，改变均较术前增加(表2)。术前与术后各月AC/A的比较，结果显示差异有改变非常显著意义(P<0.01)，均较术前减低(表3)。
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