惟论近视矫正眼外与眼内手术方式的选择

doi:10.6040/j.issn.1673-3770.1.2020.001

摘要/Abstract

摘要： 近30年来成人近视屈光手术飞速发展,手术量逐年增加。手术方式主要有眼外激光角膜屈光手术和眼内有晶体眼后房型人工晶体植入术(ICL)。激光角膜屈光手术安全、有效、可预测性强、远期稳定性好,适应于中低度近视和高度近视个性化的矫正,为现今主流屈光手术方式;但对于“四高一低”即屈光度数高、角膜曲率高、角膜散光高、角膜地形图不对称性高和角膜厚度薄,以及角膜直径过小、形态不规则的近视患者不宜首选。ICL具有矫正范围广、效果稳定、无需去除角膜组织、像差影响小和视觉质量佳等诸多优点,但是对于前房深度不足、角膜像差大、眼内结构变异和特殊职业等情况不推荐选择ICL。两者相辅相成,使屈光手术适应证和矫正范围越来越广,术者根据患者不同特点而推荐适合的最佳术式,使其获得最满意疗效。

关键词: 近视, 角膜, 激光, 屈光手术, 有晶体眼后房型人工晶体植入术

Abstract: Adult myopia refractive surgery has developed rapidly over the past 30 years, and the number of operations has increased yearly. The main surgical methods include laser corneal refractive surgery and posterior chamber intraocular lens implantation(ICL). Laser corneal refractive surgery is suitable for low to moderate myopia and high myopia customized correction, which is safe, effective, and predictable and provides good long-term stability. Some special cases, however, including high refractive diopters, high corneal curvature, high corneal astigmatism, high corneal topography asymmetry, and thin corneal thickness, as well as too small a corneal diameter and irregular corneal shape, are not appropriate for laser corneal refractive surgery. For these cases, ICL provides many advantages, such as wide range of correction, stable effect, no need to remove corneal tissue, small effect of aberration, and good visual quality. ICL has been widely used in clinical practice, and the number of operations has increased year by year. However, ICL is not recommended for conditions such as insufficient anterior chamber depth, large corneal aberration, intraocular structural variation, and special occupation. These two surgical methods complement each other, widening the scope of refractive surgery indications and correction, and therefore, patients can receive the best choice of operation.

Key words: Myopia, Cornea, Laser, Refractive surgery, Posterior chamber intraocular lens implantation

中图分类号:

R778

李莹,姜洋. 惟论近视矫正眼外与眼内手术方式的选择[J]. 山东大学耳鼻喉眼学报, 2020, 34(2): 1-6.

LI Ying, JIANG Yang. A discussion on the choice of surgical methods for correction of myopia[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(2): 1-6.

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