角膜切削术,上皮下,激光

摘要： Objective To compare the clinical outcomes between laser epithelial keratomileusis (LASEK) and transepithelial photorefractive keratectomy (TPRK) for treatment of myopia.Methods Case-control study.We reviewed a total of 90 right eyes that underwent either LASEK or TPRK,with 45 eyes in each group (aged between 18 and 40 years;9 males and 16 females in the LASEK group,and 30 males and 15 females in the TPRK group) from 2015 to 2016 in Peking Union Medical College Hospital and Tangshan Eye Hospital.All the patients were followed up for 6 months postoperatively.Pain,uncorrected visual acuity (UCVA),and haze were measured at postoperative 3 days,7 days,1 month,3 months and 6 months,and compared using an independent Student t-test between the two groups.Degree of haze,eye pain score,and visual acuity were compared by the Mann-Whitney U test.Results At 3 days,the pain score was 1 (0,3) in the LASEK group versus 0 (0,1) in the TPRK group (Z=5.643,P=0.001).The UCVA was 4.80± 0.10 in the LASEK group versus 4.97±0.07 in the TPRK group (Z=6.930,P=0.000) at 3 days,4.98±0.08 in the LASEK group versus 5.05±0.06 in the TPRK group (Z=8.147,P=0.000) at 7 days,and 5.02±0.05 in the LASEK group versus 5.06±0.06 in the TPRK group (Z=2.381,P=0.017) at 1 month.The UCVA was also measured at 3 months,5.07±0.07 versus 5.10±0.07 (Z=1.632,P=0.103),and at 6 months,5.10±0.07 versus 5.11 ±0.07 (Z=0.798,P=0.425),respectively,with no statistical significance.The residual diopter was (0.17± 0.19) D in the LASEK group versus (0.17±0.20) D in the TPRK group (Z=0.097,P=0.923) at 1 month,(0.03± 0.11) D versus (0.07±0.14) D (Z=0.166,P=0.096) at 3 months,(0.07±0.13) D versus (0.07±0.14) D (Z=0.002,P=0.978) at 6 months,respectively.The surface regularity index (SRI) was 0.48±0.09 in the LASEK group and 0.46±0.06 in the TPRK group (t=0.88,P=0.37) at 1 month,and 0.49±0.07 in the LASEK group versus 0.47±0.06 in the TPRK group (t=1.53,P=0.132) at 3 months.Transient haze was documented in 1 eye in each group at 1 month (4.4％),with a maximum index of 0.5.No haze was observed in either group at 6 months.Conclusion TPRK has the advantages of faster early vision recovery and significantly less pain over LASEK.%目的 评价经上皮准分子激光角膜切削术(TPRK)与准分子激光上皮下角膜磨镶术(LASEK)两种表层角膜屈光手术后患者疼痛程度的差异及手术效果.方法 回顾性病例对照研究.收集从2015年10月至2016年9月在北京协和医院眼科和河北唐山市眼科医院行LASEK和TPRK的近视眼患者各45例,LASEK组男性29例,女性16例,年龄(21.22±4.02)岁;TPRK组男性30例,女性15例,年龄(22.51±6.18)岁.所有患者均纳入右眼进行分析.采用视觉模拟评分法对术后3d疼痛程度进行评分.术后10、30、90、180d复查视力和屈光度数,观察角膜上皮下雾状混浊(haze)程度;应用Tomey角膜地形图进行角膜规则指数检查.疼痛评分、视力采用Mann-Whitney U检验角膜规则指数的比较采用独立样本t检验,以P＜O.05为差异有统计学意义.结果 LASEK组和TPRK组术后3d疼痛评分分别为1(0,3)和0(0,1)分,TPRK术后患者疼痛评分低于LASEK术后患者疼痛评分(Z=5.643,P=0.001).LASEK组和TPRK组患者术后3d视力分别为4.80±0.10和4.97±0.07(Z=6.930,P=0.000),术后10 d分别为4.98±0.08和5.05±0.06 (Z=8.147,P=0.000),术后30 d分别为5.02±0.05和5.06±0.06 (Z=2.381,P=0.017),差异均有统计学意义.而两组术后90和180d的视力差异无统计学意义(Z=1.632,0.798;P=0.425).LASEK组和TPRK组术后残留屈光度数较少,且随恢复时间降低,术后30 d两组残留屈光度数分别为(0.17±0.19)和(0.17±0.20) D(Z=0.097,P=0.923);术后90d分别为(0.03±0.11)和(0.07±0.14) D(Z=0.166,P=0.096);术后180 d分别为(0.07±0.13)和(0.07±0.14) D(Z=0.002,P=0.978),差异均无统计学意义.术后30 d LASEK组合TPRK组角膜规则指数分别为0.48±0.09、0.46±0.06(t=0.88,p=0.37);术后90 d分别为0.49±0.07,0.47±0.06 (Z=1.53,P=0.132),两组差异均无统计学意义.两组术后均有1例(4.4％)患者出现0.5级haze,并均于术后6个月完全消退.结论 TPRK较LASEK患者眼部疼痛显著减轻,早期术后视力恢复快.

摘要： 目的 探讨紫杉醇对准分子激光上皮下角膜磨镶术(laser subepithelial keratomileusis,LASEK)后角膜上皮下雾状混浊(Haze)形成的影响.方法 取无眼部疾病的健康新西兰大白兔108只(216眼)随机分为3组,每组36只兔(72只眼),均行LASEK,第一组术中给予紫杉醇0.3 mg/ml治疗(P组),第二组术中给予0.02％丝裂霉素(MMC)治疗(M组),第三组术中给予平衡盐液(B组),分别于术后1周、1个月、3个月各组随机选取12只(36只眼)大白兔空气栓塞处死取角膜标本.术后3 d借助裂隙灯观察兔眼部体征、角膜上皮愈合进程,术后1周、1个月、3个月观察各组动物角膜Haze分级情况;术后1周、1个月、3个月行免疫组织化学染色观察3组角膜基质层细胞转化生长因子β1(TGF-β1)表达情况.结果 LASEK术后裂隙灯显微镜检查示:兔眼均未见感染和新生血管形成,各组兔角膜上皮均在术后3～5d愈合;术后1周、1个月、3个月P组角膜Haze程度与M组相似(P>0.05),P组与M组角膜Haze程度较B组轻微(P均0.05),P组和M组术后1周、1个月、3个月角膜基质层细胞TGF-β1表达均低于B组(P<0.01);且术后角膜基质层TGF-β1表达水平随时间的延长而呈下降趋势(P<0.01).结论 紫杉醇能够较好地抑制LASEK术后兔眼角膜细胞增殖和胶原纤维形成,显著降低术后兔眼早期角膜基质层中TGF-β1的表达,从而对角膜Haze的形成有明显的抑制作用.

摘要： 目的 研究角膜上皮瓣去留对准分子激光上皮下角膜磨镶术(laser-assisted subepithelial keratomileusis,LASEK)治疗高度近视眼术后视觉质量的影响.方法 选取行LASEK手术矫正的高度近视患者30例(60眼),所有患者均随机选择一眼行去瓣LASEK手术,另一眼行留瓣LASEK手术.观察术后视力、屈光度、术后疼痛评分、角膜上皮愈合情况和主观视觉质量问卷等指标.结果 术后3个月时,去瓣组手术后最佳矫正视力提高1行的眼数明显多于留瓣组,差异有统计学意义(P<0.05).术后1,3,6个月时,2组等值球镜度随时间变化呈现正性球镜度减低趋势,时点间差异有统计学意义(P<0.05).2组术后疼痛刺激症状评分均呈降低趋势,去瓣组术后疼痛刺激症状评分低于留瓣组,组间和时点间差异有统计学意义(P<0.05).术后3 d和5 d,去瓣组眼角膜上皮完全愈合例数多于留瓣组,差异有统计学意义(P<0.05),术后7 d,2组眼角膜上皮愈合情况差异无统计学意义.术后1,3,6个月时,2组视力波动、光晕和虚影症状随时间变化均呈现减轻趋势,时点间差异有统计学意义(P<0.05);2组术后虚影症状和总体满意度评分差异有统计学意义(P<0.05),去瓣组虚影症状评分低于留瓣组,而总体满意度评分高于留瓣组.结论 去瓣LASEK治疗高度近视眼术后早期疼痛症状更轻,角膜上皮愈合更快,同时主观视觉质量更好,总体满意度更高.

摘要： 目的 观察经角膜上皮的屈光性角膜切削术(TransPRK)和准分子激光角膜上皮瓣下磨镶术(LASEK)术后恢复的差异.方法 前瞻性研究.分析行TransPRK(134例,268眼)和LASEK(90例,180眼)2种手术方式后近视患者配戴绷带镜的总时长(后文简称摘镜时间),术后ld裸眼视力(UCVA) (LogMAR),摘镜后UCVA,摘镜时等效球镜度(SE),以及术后1、3个月时患者的UCVA和SE.采用t检验、卡方检验等进行数据分析.结果 LASEK组平均摘镜时间为(5.46±1.12)d,术后3d摘镜率为57.8％,术后5d摘镜率为95.6％.TransPRK组平均摘镜时间为(3.82±0.98)d,术后3d摘镜率为89.6％,术后5 d摘镜率为100％.2种手术方式摘镜时间差异具有统计学意义(t=4.12,P＜0.001).LASEK组术后1 d UCVA为0.42±0.05,TransPRK组术后1 d UCVA为0.32±0.06,差异具有统计学意义(t=-17.81,P＜0.001).摘镜当天,LASEK组UCVA为0.23±0.17,TransPRK组为0.34±0.21,差异具有统计学意义(t=5.98,P＜0.001).摘镜当天,LASEK组的SE为(0.39±0.71)D,TransPRK组的SE为(0.33±0.66)D,差异具有统计学意义(t=-1.22,P＜ 0.001).术后l、3个月时,2组的UCVA以及SE差异均无统计学意义.结论 TransPRK比LASEK术后上皮愈合更快,摘镜时间更短,远期视力一致.%Objective To observe differences in the postoperative recovery after vans-epithelial photorefractive keratectomy (TransPRK) or laser epithelial keratomileusis (LASEK).Methods A total of 224 patients with myopia were enrolled in this prospective study after undergoing TransPRK or LASEK.The post-surgical day when the contact lenses were removed were recorded.Uncorrected visual acuity (UCVA) was recorded on the first day after surgery.UCVA and spherical equivalent (SE)were recorded on the days after contact lens removal,and again on the first and third months after surgery.Data were analyzed using t test or chi-square test.Results For LASEK group,the average time for contact lens removal was 5.46±1.12 d,and the percent of patients for whom the lenses were removed on days 3 and 5 after surgery were 57.8％ and 95.6％ respectively.For TransPRK group,the average time for contact lens removal was 3.82±0.98 d,and the percent of patients for whom the lenses were removed on days 3 and 5 after surgery were 89.6％ and 100％ respectively.UCVA when wearing contact lenses on day 1 after LASEK and TransPRK was 0.42±0.05 and 0.32±0.06,respectively (t=-17.81,P＜0.001).UCVA after contact lens removal was 0.23±0.17 and 0.34±0.21 (t=5.98,P＜0.001).SE after contact lens removal was 0.39±0.71 diopter (D) and 0.33± 0.66 D,respectively (t=-1.22,P＜0.001).There were no significant differences for UCVA or SE between the two types of surgeries at the first and third months.Conclusion Compared to LASEK,TransPRK has faster recovery times,shorter times for contact lens removal,and the same UCVAs for the long term.

摘要： Objective To investigate the safety and efficacy of topography-guided laser-assisted subepithelial keratomileusis (LASEK) in eyes with refractive error that had previously undergone radial keratotomy (RK).Methods This was a retrospective,consecutive case series study.Sixteen eyes of 13 patients with poor visual quality after RK that had previously undergone topography-guided LASEK with mytomycin C (MMC) were rcviewed.Patients were divided into a hyperopic group (11 eyes) and myopic group (5 eyes).Spherical equivalent and astigmatism were analyzed using a paired t test,and uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),and topography indices were analyzed using the Wilcoxon test.Incidence of complications were recorded.Results In the hyperopic group,the respective median UCVAs were 0.22 and 0.09(logMAR) preoperatively and one year postoperatively (Z=-1.732,P＜0.05).UCVA was 0.3 in 9 eyes and 0 or less in 5 eyes.Only 1 eye lost 1 line of BCVA.Preoperative mean SE was +2.63± 1.69 D and mean astigmatism was-1.45±0.90 D.Both SEs were significantly decreased 1 year postoperatively (t=5.365,P＜0.01;t=-2.359,P＜0.05).At 1 year,5 eyes were within ±0.50 D,and 9 eyes were within ±1.00 D of best corrected SE.A significant decrease in the index of surface variance (ISV),index of height asymmetry (IHA) and aberration coefficient (ABR) occurred (Z=-1.928,-2.135,-1.827,P＜0.05).In the myopic group,the retrospective median UCVAs were 0.92 and 0.09(logMAR) preoperatively and 1 year postoperatively (Z=-1.863,P＜0.05).UCVA was 0.3 or less in 5 eyes and 0 or less in 2 eyes.No eyes lost a line of BCVA.Preoperative mean SE was-3.63 ±2.26 D and mean astigmatism was-1.55±0.70 D and both had decreased significantly 1 year postoperatively (t=-3.549,-3.143,P＜0.05).At 1 year,2 eyes were within ±0.50 D and 5 eyes were within ±1.00 D of best corrected SE.A significant decrease in ISV and IHA had occurred (Z=-1.827,-1.827,P＜0.05).In both groups,postoperative topography showed improvement in the optic zone to some degree.Two eyes showed grade 1 and grade 3 level circle haze,but neither lost any lines of BCVA.Conclusion Topography-guided LASEK with MMC is a safe and effective treatment to correct refractive error with a small or eccentric optic zone after RK.%目的 探讨角膜地形图引导的准分子激光上皮下角膜磨镶术(LASEK)治疗放射状角膜切开术(RK)后屈光不正的有效性及安全性.方法 回顾性系列病例研究.RK术后视功能下降行角膜地形图引导的LASEK联合丝裂霉素C(MMC)治疗的患者13例(16眼),分为远视组(11眼)和近视组(5眼).对术前及术后1年等效球镜度(SE)及散光值进行配对t检验,对裸眼视力(UCVA)、最佳矫正视力(BCVA)和角膜地形图指数进行Wilcoxon秩和检验,并对手术并发症进行总结分析.结果 远视组手术前后UCVA中位数分别为0.22和0.09 (logMAR)(Z=-1.732,P＜0.05),术后9眼UCVA≤0.3,5眼UCVA≤0(logMAR);仅1眼BCVA下降1行,其余均等于或高于术前1～2行;术前平均SE为(+2.63±1.69)D,平均散光值为(-1.45±0.90)D,术后两者均下降,差异有统计学意义(t=5.365,P＜0.01;t=-2.359,P＜0.05).远视组术后5眼SE≤±0.50 D,9眼SE≤±1.00 D;术后角膜表面变异指数(ISV)、角膜高度非对称性指数(IHA)及角膜像差系数(ABR)均较术前显著下降,差异有统计学意义(Z=-1.928、-2.135、-1.827,P＜0.05).近视组手术前后UCVA中位数分别为0.92和0.09 (logMAR)(Z=-1.863,P＜0.05),术后5眼UCVA≤0.3 (logMAR),2眼UCVA≤0(logMAR);所有眼BCVA均等于或高于术前1行;术前平均SE为(-3.63±2.26)D,平均散光值为(-1.55±0.70)D,术后两者均显著下降,差异有统计学意义(t=-3.549、-3.143,P＜0.05).近视组术后2眼SE≤±0.50 D,5眼SE≤±1.00 D;术后ISV和IHA较术前显著下降,差异有统计学意义(Z=-1.827、-1.827,P＜0.05).2组术后角膜地形图显示角膜光学区偏小及偏心得到一定程度的改善.术后1年2眼有环形haze,BCVA并未下降.结论 角膜地形图引导LASEK联合MMC治疗RK术后屈光不正合并光学区偏小和(或)偏心安全、有效.

摘要： Objective To evaluate the safety,effectiveness and compliance of Bronuck (bromfenac sodium ophthalmic solution 0.1 ％) following LASEK in comparison with glucocorticoids.Methods In this prospective trial,60 patients (120 eyes) undergoing LASEK were randomized into the bromfenac sodium group (60 eyes) and control group (60 eyes).Patients in both groups initially received dexamethasone 0.1％ four times a day after LASEK for 7 days,and then the patients in the bromfenac sodium group were given Bronuck twice a day for the next 11 weeks,while the patients from the control group were given fluorometholone 0.1％ with gradually decreased doses during the same period.Results of the routine examinations done before and 3,10,30,90 and 180 days after LASEK were recorded,including uncorrected visual acuity,best corrected visual acuity,intraocular pressure (IOP),corneal topography,ocular symptoms and signs,which were used for comparison between the two groups.All data of right eyes were analyzed for their independence,normality and homogeneity of variance.Independent samples t-test or non-parametric Mann-Whitney test was performed accordingly.Results There was no statistically significant difference in IOP and corneal topography (K1,K2,SAI,SRI and CY) between the two groups postoperatively.The IOP was (16.33 ± 6.21) mmHg(1 mmHg =0.133 kPa),(15.67 ± 2.82) mmHg,(15.35 ± 2.22) mmHg and (13.10 ± 3.41) mmHg in the bromfenac sodium group,and (16.87 ± 3.68)mmHg,(14.05 ± 2.23) mmHg,(14.39 ± 2.22) mmHg and (13.18 ± 2.49) mmHg in the control group at 10,30,90 and 180 days,respectively.The bromfenac sodium group showed significantly better uncorrected visual acuity (5.16 ± 0.08) than the control group (5.02 ± 0.09) on day 30 (t =2.32,P ＜0.05).In the bromfenac sodium group,four eyes had visual fatigue,and four eyes had dry eye symptoms on day 180.Epithelial flaps were all well positioned with satisfying healing process.Each group had one case (two eyes) of haze on day 30,and the bromfenac sodium group had another case (2 eyes) of new-onset haze on day 60.But all the cases of haze were graded 0.5 according to the Fantes Standard,too mild to compromise their visual acuities,and were resolved after frequent topical medication for 1 month.Four patients from the control group were prescribed antiglaucoma medications due to elevated IOP.The refractive status remained stable for patients from both groups.Conclusions Administration of Bronuck can reduce the amount of or partially substitute for corticosteroids.Mild haze early after LASEK may disappear after intensive treatment.%目的 探讨准分子激光角膜上皮瓣下磨镶术(LASEK)后0.1％溴芬酸钠水合物滴眼液部分替代糖皮质激素的安全性、有效性及耐受性.方法 前瞻性研究.将接受LASEK的60例(120只眼)近视眼患者随机分为两组,各60只眼.所有患者LASEK术后先使用0.1％地塞米松1周,之后试验组患者术后2 ～12周给予0.1％溴芬酸钠水合物滴眼液2次/d,对照组则给予0.1％氟米龙并逐渐减量.在术前及术后3d、10 d、1个月、3个月、6个月进行常规检查,包括裸眼视力、最佳矫正视力、眼压、角膜地形图和主观症状与体征等,并对所有患者右眼记录指标进行统计分析先行描述统计探索,验证数据的独立性、正态性和方差齐性.三者都满足的行独立样本t检验,其一不满足的行Mann-Whitney非参数检验.双眼观察,统计右眼.结果 试验组和对照组术后角膜地形图检查结果无明显差异.试验组和对照组术后10 d、1个月、3个月和6个月眼压分别为(16.33±6.21)、(15.67±2.82)、(15.35±2.22)、(13.10±3.41)和(16.87±3.68)、(14.05±2.23)、(14.39±2.22)、(13.18 ±2.49) mmHg(1 mmHg =0.133 kPa,差异均无统计学意义(=0.81,1.95,1.84,0.85,P＞0.05).试验组术后1个月的视力优于对照组,分别为5.16±0.08和5.02±0.09(t=2.32,P＜0.05),余观察点差异无统计学意义.试验组在术后6个月有4只眼出现视疲劳,4只眼出现眼干.试验组术后1个月有2只眼出现0.5级角膜上皮下雾状混浊(haze),术后2个月又有2只眼新出现0.5级haze,对照组术后1个月有2只眼出现0.5级haze,但均未影响视力,且加强局部用药频率1个月后上述haze均消失.对照组总共有4例因眼压升高而使用降眼压药物.结论 0.1％溴芬酸钠水合物滴眼液用于LASEK术后可以减少糖皮质激素用量或者部分替代糖皮质激素,安全、有效、具有良好的耐受性;在术后视力、眼压、抗炎、抑制屈光回退等方面可获得满意的效果;LASEK术后早期均有0.5级haze个例发生,加强局部用药频率1个月后消失.

摘要： Objective To observe the efficacy of bromfenac sodium eye drops on relieving the irritative symptoms after LASEK surgery.Methods Sixty-four people who had received LASEK surgery were randomly divided into two groups,observing the right eye for each group,group A was given 0.1％ bromfenac sodium eye drops twice a day in three days before surgery and one day after surgery; group B was given 0.5％ ketorolac tromethamine (acular) eye drops four times a day in three days before surgery and on day after surgery.In the 1st,rd,5th and 7th day after surgery,irritative symptoms grade,duration of irritation,time for corneal epithelial healing,and uncorrected visual acuity were observed and compared between the two groups.Results 0.1％ no discomfort in group A with bromfenac sodium eye drops was observed while 0.5％ ketorolac tromethamine eye drops caused tingling,burning discomfort that lasted for 2-3 seconds in 16 of the 28 subjects (87.5％).No significant difference was observed between the irritation grades of group A and B (Z =-1.625,P =0.104) ; the duration of irritative symptom was significantly shorter in group A than that in group B (Z =-2.895,P =0.004).No significant difference was observed between the time of healing and visual acuity recovery of the two groups.Conclusion 0.1％ bromfenac sodium eye drops can effectively relieve the post-LASEK irritative symptoms,and it is better tolerated than 0.5％ ketorolac tromethamine eye drops.%目的 探讨0.1％溴芬酸钠水合物滴眼液对减轻准分子激光角膜上皮瓣下磨镶术(LASEK)后眼部刺激症状的疗效.方法 前瞻性随机对照研究.将接受LASEK治疗的屈光不正患者64例随机分为两组,每组选取右眼入组观察,溴芬酸钠组在术前3d及术后1d给予0.1％溴芬酸钠水合物滴眼液2次/d,对照组在术前3d及术后1d给予0.5％酮咯酸氨丁三醇滴眼液4次/d,在术后1、3、5、7d观察眼部刺激症状分级、持续时间、角膜上皮愈合时间以及裸眼视力,对符合正态分布的计量资料组间比较采用￡检验,非正态分布的计量资料比较采用秩和检验,计数资料的比较采用x2检验,重复测量资料采用重复测量设计的方差分析.结果 溴芬酸钠组患者滴用0.1％溴芬酸钠水合物滴眼液眼部无任何不适,对照组患者滴用0.5％酮咯酸氨丁三醇滴眼液,87.5％眼部有刺痛、烧灼感等不适,持续时间2～3s.溴芬酸钠组患者术后眼部刺激症状0、1、2级的比例分别为31.2％(10/32)、68.8％(22/32)、0.0％ (0/32),与对照组相比差异无统计学意义(Z=-1.625,P=0.104);溴芬酸钠组术后刺激症状持续时间中位数为2.00d,较对照组缩短(Z=-2.895,P=0.004);溴芬酸钠组与对照组术后角膜上皮愈合时间中位数均为5.00d,差异无统计学意义(Z=-1.723,P=0.085),两组术后1d、3d、5d、1个月、3个月裸眼视力差异均无统计学意义(F=2.086,2.180,2.869,0.143,0.401;P＞0.05).结论 0.1％溴芬酸钠滴眼液能有效缓解LASEK术后眼部刺激症状,患者的耐受性与使用便利性比0.5％酮咯酸氨丁三醇滴眼液更好.

摘要： 目的：探讨准分子激光原位角膜磨镶术（LASIK）与准分子激光上皮下角膜磨镶术（LASEK）对人眼高阶像差的影响。方法对2011年5月至2012年5月在中国人民解放军306医院眼科分别行 LASIK （46例，92眼， LASIK组）和LASEK（46例，92眼，LASEK组）的中低度近视眼患者进行为期1年随访观察。主要分析指标有总高阶像差值、慧差值、球差值。结果术后1、3个月时LASEK组总高阶相差值、彗差值、球差值明显高于LASIK组，差异均有统计学意义（P0.05）。结论 LASEK对高阶像差的影响高于LASIK，随着时间的推移二者趋向一致。

摘要： 目的 观察比较角膜表层LASEK与基质层的LASIK、飞秒LASIK屈光手术后患者主观视觉感受与视觉质量检查的相关性.方法 回顾性分析.160例（320眼）行准分子激光治疗且随诊1年以上的患者,接受表层LASEK手术40例,基质层LASIK、飞秒LASIK手术各60例.LASEK组术前SE平均为（-4.35＆#177; 1.07）D;LASIK组平均为（-5.05＆#177;1.13）D;飞秒LASIK组平均为（-5.11＆#177;1.25）D.术前及术后1年检查UCVA、BCVA、球镜及柱镜度、SE以及术后总体评价、术后与术前最佳矫正时的视觉质量及视觉症状对比采用ANOVA、两个独立样本的Mann-Whitney U检验和x2检验.结果 术后1年以上,白天及夜间开车容易程度、生活方便、白天远视力、夜间视力、总体视力的评分由高到低依次是飞秒LASIK组、LASEK组和LASIK组.同术前戴镜相比,白天远视力、生活方便是患者认为优于术前的最显著项目;眩光和夜视质量下降是患者术后最主要主诉;视近物疲劳、夜间开车眩光、夜间视力评分最差,夜视症状随时间延长明显好转,但是视觉疲劳随着时间加重.女性视近物疲劳主诉最多,男性夜视力差主诉最多.结论 准分子术后患者视觉质量评分飞秒LASIK高于LASEK和LASIK.视近物疲劳、夜视力差为手术后的长期问题.

摘要： 目的 观察比较角膜表层LASEK与基质层的LASIK、飞秒LASIK屈光手术后患者主观视觉感受与视觉质量检查的相关性.方法 回顾性分析.160例(320眼)行准分子激光治疗且随诊1年以上的患者,接受表层LASEK手术40例,基质层LASIK、飞秒LASIK手术各60例.LASEK组术前SE平均为(-4.35± 1.07)D;LASIK组平均为(-5.05±1.13)D;飞秒LASIK组平均为(-5.11±1.25)D.术前及术后1年检查UCVA、BCVA、球镜及柱镜度、SE以及术后总体评价、术后与术前最佳矫正时的视觉质量及视觉症状对比采用ANOVA、两个独立样本的Mann-Whitney U检验和x2检验.结果 术后1年以上,白天及夜间开车容易程度、生活方便、白天远视力、夜间视力、总体视力的评分由高到低依次是飞秒LASIK组、LASEK组和LASIK组.同术前戴镜相比,白天远视力、生活方便是患者认为优于术前的最显著项目;眩光和夜视质量下降是患者术后最主要主诉;视近物疲劳、夜间开车眩光、夜间视力评分最差,夜视症状随时间延长明显好转,但是视觉疲劳随着时间加重.女性视近物疲劳主诉最多,男性夜视力差主诉最多.结论 准分子术后患者视觉质量评分飞秒LASIK高于LASEK和LASIK.视近物疲劳、夜视力差为手术后的长期问题.%Objective To observe and compare the relationship between subjective visual perception and objective examination results of visual quality after LASEK,LASIK and femtosecond laser LASIK (FS-LASIK).Methods This retrospective study included 320 eyes of 160 patients in a 1-year follow-up after refractive surgery.Eighty eyes of 40 patients underwent LASEK,120 eyes of 60 patients underwent LASIK,and 120 eyes of 60 patients underwent FS-LASIK.The average preoperative spherical equivalent (SE) of the LASEK group was-4.35±1.07 D,of the LASIK group was-5.05±1.13 D,of the FS-LASIK group was-5.11±1.25 D.Uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),spherical and cylindrical values,and SE were recorded before and 1 year after surgery; meanwhile,a general evaluation and a comparison of pre-and postoperative visual quality and symptoms were performed.Using SPSS 17 software,descriptive statistics,ANOVA,two independent samples Mann-Whitney U test and a x2 test were used for statistical analysis.P＜0.05 indicated a significant statistical difference.Results Postoperative rating scores for driving and life,diurnal distant sight vision,nocturnal vision and general vision were higher in the FS-LASIK group than in the LASEK and the LASIK groups.Patients thought the diurnal distant sight vision and scales of life improved most after surgery but they complained about glare and nocturnal vision,especially tiredness when staring at close objects,glare in nocturnal driving and low nocturnal vision scores.There was an obvious improvement in nocturnal symptoms over time but tiredness became worse.The female patients complained most about tiredness when staring at close objects,while the male patients complained most about bad nocturnal vision.Conclusion Postoperative visual quality scores for the Femto-LASIK group are higher than for the LASEK and LASIK groups.Tiredness when staring at close objects and bad nocturnal vision are postoperative problems in the long term.

摘要： 一种用于激光眼外科手术的设备，包括：激光模块(12)，装备所述激光模块用于发射可变脉冲重复率的脉冲聚焦激光辐射；以及基于处理器的控制单元(18)，装备所述控制单元用于接收与通过用户输入来选择若干预先限定的脉冲重复率中的一个脉冲重复率相关的至少一项用户输入、并且根据所选定的至少一个脉冲重复率来控制所述激光模块。在某些特定实施例中，所述用户界面实现两个用户项的输入，所述用户项各自与脉冲重复率从若干预先限定的脉冲重复率中的选择相关。所述控制单元根据所述两项用户输入之一在激光治疗的第一阶段控制所述激光模块，并且在所述激光治疗的第二阶段，所述控制单元根据所述两项用户输入中的另一项来控制所述激光模块。例如，这样的特定实施例允许以与作为眼睛的经上皮角膜切削术的一部分的基质组织消融不同的脉冲重复率进行上皮组织消融。

摘要： 提供一种负型切削镶刀，以及使用所述切削镶刀的刀头更换式旋转切削工具，刀头更换式旋转切削工具系统以及切削加工方法，负型切削镶刀具有四个粗加工用长边切削刃部和四个精加工用短边切削刃部交替连结而成的切削刃，若装配在粗加工用工具主体上就可进行粗加工，若装配在精加工用工具主体上就可进行精加工。将这种切削镶刀在用于粗加工或精加工后，再装配到精加工用工具主体或粗加工用工具主体上，就可进行精加工或粗加工，从而能够不遗漏地使用切削刃全周。

摘要： 本发明提供一种切削镶刀、具有该切削镶刀的切削工具、以及使用该切削工具切削被切削件的切削方法。本发明的切削镶刀具有上表面、下表面、位于所述上表面与所述下表面之间的侧面、位于所述上表面与所述侧面的交线部的上切削刃、位于所述下表面与所述侧面的交线部的下切削刃。所述侧面具有：沿厚度方向延伸至所述上表面且将所述上切削刃截断成多个分割上切削刃的至少一个上凹部、沿厚度方向延伸至所述下表面且将所述下切削刃截断成多个分割下切削刃的至少一个下凹部。所述至少一个上凹部与所述至少一个下凹部经由沿宽度方向连续的厚壁部相互隔离。

摘要： 本发明提供一种切削工具，所述切削工具具备：第一切削镶刀，其具有连接第一上表面与第一下表面的第一侧面、位于第一上表面与第一侧面的交叉部的第一切削刃及位于第一侧面且以截断第一切削刃的方式到达第一上表面的第一槽部；第二切削镶刀，其具有第二上表面、第二侧面、位于第二上表面与第二侧面的交叉部的第二切削刃及位于第二上表面中第二切削刃侧的端部的切削刃强化部；刀夹，其安装第一切削镶刀和第二切削镶刀，第一切削镶刀及第二切削镶刀以第一切削刃及第二切削刃位于刀夹的外周侧、第一下表面与第二上表面接近、并且切削刃强化部的旋转轨道与第一槽部的旋转轨道一部分重叠的方式安装于刀夹。

摘要： 本发明提供一种切屑排出性优异的切削镶刀。根据本发明的切削镶刀，凹槽(21)的底面具有第一底面(211)和第二底面(212)，第一底面(211)与切削刃部(5)连续，第二底面(212)位于与第一底面(211)相比远离切削刃部(5)的一侧且比第一底面(211)的远离切削刃部(5)的一侧的端部的假想延长线(L1)低的位置。进而，在俯视下，一对倾斜面(23)位于与第一底面(211)的远离切削刃部(5)的一侧的端部相比远离切削刃部(5)的一侧。因此，生成的切屑一边沉入被形成为比第一底面(211)的假想延长线(L1)低位的空间一边卷曲，由此切屑的卷曲的直径变小。其结果是，切屑的排出方向稳定，从而切屑的排出性变得良好。

摘要： 本发明提供一种切削镶刀，具有：上表面、下表面、连接所述上表面和所述下表面的侧面、位于所述上表面和所述侧面的交叉部的切削刃、以及位于所述侧面并自所述上表面朝向所述下表面延伸且将所述切削刃截断的槽部，所述槽部具有第一边缘部及第二边缘部，所述第一边缘部及第二边缘部位于该槽部的宽度方向的边缘部且自所述上表面朝向所述下表面延伸，从侧面看，所述第一边缘部具有第一分离部，该第一分离部位于所述上表面侧且随着靠近所述下表面而远离基准线，该基准线穿过所述槽部的宽度方向上的中点并大致垂直于所述下表面，并且，从侧面看，所述第二边缘部具有第二分离部，该第二分离部位于所述上表面侧且随着靠近所述下表面而远离所述基准线。

摘要： 一种用于激光眼外科手术的设备，包括：激光模块(12)，装备所述激光模块用于发射可变脉冲重复率的脉冲聚焦激光辐射；以及基于处理器的控制单元(18)，装备所述控制单元用于接收与通过用户输入来选择若干预先限定的脉冲重复率中的一个脉冲重复率相关的至少一项用户输入、并且根据所选定的至少一个脉冲重复率来控制所述激光模块。在某些特定实施例中，所述用户界面实现两个用户项的输入，所述用户项各自与脉冲重复率从若干预先限定的脉冲重复率中的选择相关。所述控制单元根据所述两项用户输入之一在激光治疗的第一阶段控制所述激光模块，并且在所述激光治疗的第二阶段，所述控制单元根据所述两项用户输入中的另一项来控制所述激光模块。例如，这样的特定实施例允许以与作为眼睛的经上皮角膜切削术的一部分的基质组织消融不同的脉冲重复率进行上皮组织消融。

摘要： 本发明提供一种角膜切削系统，包括：运算单元，根据与角膜状态有关的数据制定用于矫正角膜的形态及曲率误差的综合角膜切削方案；激光控制部，基于从上述运算单元传递的综合角膜切削方案，与角膜的切削位置和切削形态相对应地控制激光模块；以及激光模块，根据上述激光控制部的控制来生成激光，并向光学部传递。上述运算单元利用与角膜的曲率误差、角膜厚度分布度及角膜后部面形态图有关的信息，利用上述角膜后部面形态图，来通过使用角膜厚度分布度来将除了偏心的角膜后圆锥的部位之外的区域的剩余部分作为对象，制定部分角膜切削方案并运行，利用点对称在最大限度减少厚度偏差消除偏心的角膜后圆锥，此时发生的曲率变动通过近视矫正用角膜切削被抵消，并在变薄的角膜的中心部形成眼压集中，来生成角膜后圆锥，从而将形态矫正成角膜后圆锥向角膜中心部集中的对称角膜形态，并联动现有低阶像差矫正运行角膜切削，来去除曲率误差，从而制定并执行对形态不良和曲率误差进行综合矫正的角膜切削方案。

摘要： 本发明属于激光加工领域，涉及一种激光切削头及其加工工艺，其结构组成是一激光束经过一激光整形元件和光束会聚元件形成一高能线状激光光斑，其线状光斑的特征是光斑的长度方向大于激光整形元件和光束会聚元件的最大尺寸。当线状光斑相对于加工的工件做旋转运动时，就可以切削出一个孔，孔的尺寸可容纳本发明的激光切削头以进行更进一步的切削；当工件作垂直于线状光斑长度方向上的运动时，可以切削出一个槽，这个槽可以容纳本发明所述的激光切削头以进行更进一步的加工。这样无论是孔的加工还是槽的加工，深度方向不受限制，同时由于线状激光束的线宽可以做得与激光光束与会聚光学元件形成的焦点尺寸相当，故精度也非常好。

摘要： 提供一种负型切削镶刀，以及使用所述切削镶刀的刀头更换式旋转切削工具，刀头更换式旋转切削工具系统以及切削加工方法，负型切削镶刀具有四个粗加工用长边切削刃部和四个精加工用短边切削刃部交替连结而成的切削刃，若装配在粗加工用工具主体上就可进行粗加工，若装配在精加工用工具主体上就可进行精加工。将这种切削镶刀在用于粗加工或精加工后，再装配到精加工用工具主体或粗加工用工具主体上，就可进行精加工或粗加工，从而能够不遗漏地使用切削刃全周。