高度近视患者的视野改变及屈光性角膜手术的效果观察

摘要

Objective To investigate changes in visual field of patients with high myopia and to evaluate SMILE and LASIK surgeries in treating high myopia.Methods 120 cases (214 eyes) of patients with high myopia underwent corneal refractive surgery in our hospital between January 2010 and October 2013 were selected.Visual field changes were observed and analyzed.Patients randomly received SMILE (n=111 eyes) or LASIK surgery (n=103 eyes).Visual acuity was assessed and compared between the 2 groups.Results 53 eyes in the 214 eyes had normal visual field (24.8%).161 eyes (75.2%) showed varied degrees of defect.Visual field defects were in upper field (59 eyes or 36.6%), lower field (28 eyes or 17.4%), or presented as beam defects connected to the physiological blind spot (15 eyes or 9.3%), blind spot expanding (11 eyes or 6.8%), centrally shrinking (9 eyes or 5.6%), central scotoma (5 eyes, 3.1%), or irregular defects (44 eyes or 27.3%).3 months after surgery, the uncorrected visual acuity of the 2 groups were 0.78±0.31 and 0.62±0.24 respectively.Corrected visual acuity were 0.12±0.39 and 0.79±0.33, and cornea refractive power were 39.74±5.63 and 32.13±5.04.Refractive diopter were-0.23±0.06 and-0.74±0.23.All these visual function measurements were better in SMILE group (P<0.05).The cure rate was 87.4% in SMILE group and 66.7% in LASIK group (P<0.05).Conclusions Patients with high myopia often suffer temporal upper visual field defects.Variation of the defects is also common.SMILE is better than LASIK on the improvement of visual acuity.%目的 观察高度近视患者的视野改变特点,并对飞秒激光小切口角膜基质透镜取出术(SMILE)和准分子激光原位角膜磨镶术(LASIK)的术后效果进行探讨与评价.方法 选取2010年1月至2013年10月于本院接受屈光性角膜手术的高度近视患者120例(共214只眼)为研究对象.视野检查总结视野改变特点.将120例患者随机分为观察组(103只眼)与对照组(111只眼)各60例.观察组采用SMILE术,对照组采用LASIK术.对比两组术后的视力改善情况.结果 被检查214只眼中53只眼(24.8%)视野正常.161只眼(75.2%)视野显示不同程度的缺损.视野缺损特征包括:上方缺损59只眼(36.6%),下方缺损28只眼(17.4%),与盲点相连的束状缺损15只眼(9.3%),盲点外露11只眼(6.8%),向心性缩小9只眼(5.6%),旁中心暗点5只眼(3.1%),不规则缺损44只眼(27.3%).术后3个月时两组的裸眼视力分别为(0.78±0.31)、(0.62±0.24),矫正视力分别为(0.12±0.39)、(0.79±0.33),角膜屈光力分别为(39.74±5.63)、(32.13±5.04),屈光度分别为(-0.23±0.06)、(-0.74±0.23);组间比较观察组的裸眼视力、矫正视力、角膜屈光力及屈光度均高于对照组,差异具有统计学意义(P<0.05).观察组治愈率为87.4%,对照组为66.7%,组间比较差异具有显著性(P<0.05).结论 高度近视患者的视野变化以颞上方缺损最为多见,同时具有多样性、不规则性等个体差异.SMILE对于患者视力的改善效果要优于LASIK.