近视LASIK术后调节与集合功能变化的研究

发布时间：2018-10-17 13:55

【摘要】：目的研究近视患者准分子激光原位角膜磨镶术(laser in stiu keratomileusis, LASIK)后调节与集合功能的变化及近距离工作疲劳症状的变化,并分析LASIK术后调节与集合功能的各项参数对近距离工作疲劳症状的影响。方法选择在宁夏医科大学附属医院准分子激光治疗中心接受LASIK手术且符合入选条件的73位近视患者146眼,按近视屈光度等效球镜值分为低度组20例、中度组26例和高度组27例;同期收集正视者19例38眼作为对照。测定正视组和近视组患者术前、术后一周、一个月、三个月时的调节幅度、正相对调节和负相对调节、调节灵活度、集合近点、融合范围、调节性集合与调节比率(accommodative convergence per unit of accommodation ratio, AC/A)及近距离工作疲劳症状得分,并进行统计学分析。结果1.近视组各组患者术后一周时的调节幅度较术前降低(P0.05),之后逐渐升高,术后一个月时与术前相比无明显差异(P0.05),术后三个月时近视组各组患者的调节幅度均高于术前(P0.05),接近正视组水平(P0.05)。 2.近视组各组患者的正相对调节在术后一周、术后一个月时与术前比较,差异无统计学意义(P0.05),术后三个月时较术前升高(P0.05),与正视组相比无差异(P0.05)。 3.近视组各组患者的负相对调节术后各时期与术前相比均无明显差异(P0.05),与正视组相比,亦无明显差异(P0.05)。 4.近视组各组患者的调节灵活度术后各时期与术前相比均无明显差异(P0.05),与正视组相比,亦无明显差异(P0.05)。 5.近视组各组患者术后一周时的集合近点与术前相比均远离眼前(P0.05),之后逐渐向眼前靠近。术后三个月时集合近点与正视组相比无明显差异(P0.05)。 6.近视组各组患者的融合范围术后各时期与术前相比均无明显差异(P0.05),与正视组相比,亦无明显差异(P0.05)。 7.近视组各组患者术后一周时AC/A值较术前降低(P0.05),之后逐渐升高,术后三个月时与术前相比差异无统计学意义(P0.05),接近正视组水平(P0.05)。 8.近视组患者术后一周时的近距离工作疲劳症状得分高于术前( P0.05),之后评分逐渐减低,术后一个月时与术前相比无明显差异(P0.05),至术后三个月时各组患者的评分均低于术前(P0.05),与正视组水平接近(P0.05)。 9.对低度近视组、中度近视组和高度近视组三组间的视疲劳及调节集合功能各参数进行单因素方差分析,结果显示三组间差异无统计学意义(P0.05)。 10.相关分析显示,LASIK术前患者的调节幅度及正相对调节越小、调节灵活度越差、集合近点越远、术前戴镜AC/A值越小,术后早期的视近疲劳症状越明显(P0.05);术后一个月时视疲劳症状加重与调节幅度降低、集合近点增加、AC/A值降低有关(P0.05);术后三个月视疲劳症状的改善与调节幅度增加、正相对调节增加有关(P0.05)。结论准分子激光原位角膜磨镶术可以改善近视患者的调节集合功能,缓解近距离工作疲劳症状。
[Abstract]:Objective to study the changes of regulation and collective function after (laser in stiu keratomileusis, LASIK) in myopic patients with laser in situ keratomileusis (LASIK) and the changes of fatigue symptoms in close range work. The effects of the parameters of adjustment and collective function after LASIK on the fatigue symptoms of working in close range were analyzed. Methods one hundred and forty-six eyes of 73 myopia patients who were treated with LASIK in the excimer laser treatment center of affiliated Hospital of Ningxia Medical University were divided into low group (n = 20), moderate group (n = 26) and height group (n = 27) according to myopic diopter equivalent spherical value. At the same time, 19 cases 38 eyes of emmetropia were collected as control. Before operation, one week, one month and three months after operation, the adjustment amplitude, positive relative regulation and negative relative regulation, adjustment flexibility, aggregation near point and fusion range were measured in the emmetropia group and myopia group. Adjustment set and accommodation ratio (accommodative convergence per unit of accommodation ratio, AC/A) and close working fatigue symptom score were analyzed statistically. Result 1. The adjustment amplitude of myopia group was decreased one week after operation (P0.05), and then increased gradually. At one month after operation, there was no significant difference between before and after operation (P0.05). At 3 months after operation, the adjustment range of myopia group was higher than that of preoperative group (P0.05), which was close to the level of emmetropia group (P0.05). The positive relative regulation of myopia group in one week after operation, one month after operation compared with preoperative, there was no significant difference (P0.05), three months after surgery compared with preoperative (P0.05), compared with the emmetropia group, there was no difference (P0.05). There was no significant difference in negative relative regulation between each stage of myopia group and before operation (P0.05), and there was no significant difference compared with emmetropia group (P0.05). The adjustment flexibility of myopia group was not significantly different from that before operation (P0.05), and there was no significant difference compared with emmetropia group (P0.05). Myopia group at one week after the collection of close points compared with the preoperative distance from the eyes (P0.05), and then gradually closer to the eyes. There was no significant difference between the group and the emmetropia group at 3 months after operation (P0.05). There was no significant difference in the range of fusion between the myopia group and the preoperative group (P0.05), and there was no significant difference compared with the emmetropia group (P0.05). The AC/A of myopia group decreased one week after operation (P0.05), then gradually increased. There was no significant difference between three months after operation (P0.05), close to the level of emmetropia group (P0.05). In myopia group, the scores of close working fatigue symptoms at one week after operation were higher than those before operation (P0.05), and then the scores decreased gradually. There was no significant difference at one month after operation compared with preoperative (P0.05), and the scores of each group were lower than those of pre-operation (P0.05) at the end of three months after operation, and were close to the level of emmetropia group (P0.05). The results showed that there was no significant difference among the three groups (P0.05) in the analysis of variance of the parameters of visual fatigue and regulation of collective function among the three groups of low myopia, moderate myopia and high myopia (P0.05). Correlation analysis showed that the smaller the adjustment amplitude and the positive relative regulation, the worse the adjustment flexibility, the closer the set, the smaller the AC/A value of preoperative wear mirror in LASIK patients. The early postoperative symptoms of periocular fatigue were more obvious (P0.05); at one month after operation, the symptoms of visual fatigue increased and the range of regulation decreased, the aggregation near point increased and the AC/A value decreased (P0.05); the improvement and adjustment range of the symptoms of visual fatigue increased three months after operation. The positive relative regulation was related to the increase (P0.05). Conclusion Excimer laser in situ keratomileusis can improve the collective function of myopia patients and relieve the fatigue symptoms in close range.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.63

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