Academic paper on myopia surgery-clinical study on myopia correction surgery
Objective To statistically analyze the surgical situation of myopia patients in our hospital and Shanghai New Vision Eye Hospital, and expound the development status and future trend of myopia correction surgery. Methods By summarizing, counting and analyzing the methods and types of myopia correction surgery in our hospital and Shanghai Xinshijie Eye Hospital, the new ideas of myopia correction surgery in the future were discussed. Results Myopia correction surgery experienced a new process from excimer laser to femtosecond laser combined with excimer laser, from corneal laser surgery to lens refractive surgery. Conclusion The development of myopia correction surgery, from the initial posterior scleral reinforcement to the combination of various flap-making techniques and personalized laser cutting techniques, from simple corneal laser correction to a brand-new intraocular lens treatment method, has made myopia treatment technology enter a brand-new personalized era.
Myopia correction surgery; Clinical; study
In order to explain the development status and future trend of myopia correction surgery, the methods, types and cases of all myopia patients in our hospital and Shanghai Xinshijie Eye Hospital were summarized, counted and analyzed.
1 data and methods
1. 1 general data collection: 50,080 patients with refractive surgery in our hospital and Shanghai New Vision Eye Hospital since 2004.
Methods The year, mode and proportion of 1.2 operation were analyzed retrospectively. To summarize the data of myopia correction surgery in our hospital and refractive surgery center of Shanghai Xinshijie Eye Hospital over the years.
Two results
Results The results were expressed by the percentage of all kinds of operations in myopia correction surgery in that year. See table 1.
The number of personalized corneal refractive surgery such as making corneal flap with femtosecond laser and implanting posterior chamber intraocular lens to correct myopia is increasing gradually. Traditional EK surgery is gradually decreasing, while EPI surgery for making epithelial flap with epithelial knife is gradually increasing, and SBK surgery for ultra-thin flap is also increasing year by year, and refractive surgery is developing towards surface cutting and corneal flap thinning.
3 discussion
Myopia correction surgery has experienced decades of development, mainly including corneal refractive surgery and lens implantation surgery. From the initial high progressive myopia, posterior scleral reinforcement can effectively alleviate the development of myopia, but it can not be completely corrected. Corneal refractive surgery was first performed by the former Soviet Union in 1979. Although the incision is located outside the visual area, it is safe and reliable for low myopia, but it is eliminated because of complications such as corneal perforation, postoperative vision fluctuation, glare, vision drift, traumatic eyeball rupture and so on. Astigmatism keratotomy (AK) can correct astigmatism. Corneal stromal ring implantation (ICRS), keratoplasty and epikeratoplasty are used to correct myopia, but their predictability and best corrected vision are poor, so they are rarely carried out. Since 1988, excimer laser has opened a new era of treatment, namely excimer laser keratectomy (PRK). However, due to postoperative ocular pain, subepithelial opacity, undercorrection or overcorrection, glare, refractive regression, dry eye, hormonal high intraocular pressure, delayed corneal epithelial healing, eccentric incision and central island complications, it will gradually be used for excimer laser in situ treatment of cornea. This method begins with 1990. Making pedicled corneal flap on cornea with microkeratome. After opening the flip cover, excimer laser cutting is carried out on the exposed base layer. It can correct myopia, hyperopia and astigmatism, and has the advantages of less irritation, quick recovery and good foresight. It has become the most widely used type of refractive surgery in China and even in the world. Its main characteristics are that the intact epithelial tissue and anterior elastic layer tissue are preserved, the postoperative pain and irritation symptoms are alleviated, the visual acuity is restored quickly, and there is almost no haze formation. The range of correctable diopter is much larger than PRK. However, the higher the degree, the worse the predictability and the more complications, which is also limited by the thickness and curvature of cornea. The main complications include broken flap, button flap, free flap, corneal epithelial implantation, DLK, corneal dilatation, infectious keratitis and dry eye.
The main risk factors of corneal dilatation are high myopia, too thin cornea, too deep cutting depth, too thin corneal stroma bed and no keratoconus found before operation. In view of the above situation, in view of the thin cornea and high diopter, a method of making epithelial flap appeared, that is, alcohol immersion excimer laser subepithelial keratomileusis (LASEK). This method started from 1999. Its advantages are avoiding complications related to corneal flap, keeping a thick stroma bed, and the risk of corneal dilatation after operation is much lower than LASIK, especially suitable for ametropia patients whose cornea is too thin to perform LASIK or engage in eye trauma. Its main disadvantages are easy to produce smog, serious irritation symptoms and slow vision recovery [2]. In order to avoid some defects in EK surgery, in 2003, excimer laser epithelial keratoplasty (epi-LASIK) appeared, which uses microkeratome technology to make corneal epithelial flap instead of ethanol, and then carries out excimer laser cutting. Its advantage is to avoid the chemical toxic side effects of ethanol on corneal epithelium during EK operation, and the corneal epithelial flap has better activity, but its disadvantages are the same as those of EK, but to a lesser extent. In recent years, there is another corneal knife with thinner corneal flap, namely SBK, which uses mechanical lamellar knife to make thinner corneal flap and complete laser corneal refractive surgery.
Then, in order to avoid the complications caused by corneal flap in myopia correction, femtosecond laser made by Interlace Company was used in refractive surgery in 2002, which can cut the inner layer of corneal stroma to make corneal flap, greatly improving the safety and accuracy of corneal flap making. The thickness of corneal flap made by this method is uniform, and its predictability and accuracy are much higher than that of microkeratome, and the size and position of flap pedicle can be selected according to needs. If the cornea is not suitable for refractive correction or I cannot undergo corneal refractive surgery, lens refractive surgery can be performed [3], including fixed angle, fixed sclera and posterior chamber. The current posterior chamber type, also known as implantable contact lens (ICL), is a method to fix ciliary sulcus in the posterior chamber. Its advantage is that the foldable lens is implanted through a small incision of 2.8 mm, and there is a certain gap between the implanted lens and its own lens, so the loss rate of corneal endothelial cells is low. The incidence of glaucoma is low, and there is generally no pupil deformation [4].
According to the statistics of our hospital, LASIK surgery was the main method at first, and only a few myopia patients who could not accept LASIK adopted PRK method. However, since 2004, personalized LASIK guided by wave difference has been started, and there is an upward trend, with a significant increase in 2005. Since 2006, the epithelial flap soaked in alcohol has been made, which gives some corneal flap patients a choice. At the same time, in September 2006, the femtosecond laser machine came out, which opened a new era of ametropia treatment. In just four months, they accepted this kind of operation. In all refractive surgery in 2007, IK surgery with lamellar knife accounted for nearly 565,438+0.00% of all surgical eyes. Femtosecond laser scratches account for 38.90%. At the same time, the proportion of ICL surgery has reached 0.6%. Since 2008, the rate of making corneal flap with lamellar knife has dropped from 48. 10% to 25.20% now. According to the data, IK surgery is decreasing year by year, but the proportion of SBK surgery has increased year by year since 2008. EK surgery decreased from 8.05% to 0.50%, and EPI surgery increased from 2. 15% to 5. 15%, indicating that EPI surgery, which can better preserve corneal epithelial vitality, was gradually replaced. Femtosecond laser corneal flap surgery has increased from 40.70% to 59.95%, which fully shows the advantages of femtosecond laser corneal flap making and the further improvement of people's cognition, and also better reminds doctors that in corneal refractive surgery, surgery is developing in a safer and more accurate direction. ICL also increased from 0.60% to 9.65%, indicating that for some operations with high myopia or limited corneal thickness and curvature, it is safer and more personalized to carry out corrective surgery that is very in line with the physiological characteristics of the eyes.
To sum up, the development of myopia correction surgery not only has great changes in quantity, quality, patients' requirements, operators' psychological endurance, but also scientific and advanced methods gradually replace traditional methods, making myopia correction surgery safer, more accurate, more precise and more personalized. Myopia treatment surgery is not only the correction of vision, but also the method from cornea to lens. More importantly, the postoperative visual quality is better, which really adds to the icing on the cake.
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[1] Cheng Zhenying, Li Jinghai. Effect of excimer laser in situ keratomileusis on refractive regression after excimer laser photorefractive keratectomy [J]. Chinese Journal of Ophthalmology, 2002,38 (1): 246-247.
Dai Jinhui, Chen Chongda, Chu Renyuan, et al. Mechanical excimer laser subepithelial keratomileusis for high myopia [J]. Chinese Journal of Ophthalmology, 2005,41(2): 21-215.
Yao Ke, Xu Wen. Clinical study of anterior chamber intraocular lens implantation in the treatment of high myopia [J]. Chinese Journal of Ophthalmology, 2003,39 (2): 339-342.
Shen Ye, Gu Yangshun. Posterior chamber intraocular lens implantation to correct high myopia [J]. Journal of Ophthalmology, 1999,1(5):146-148.
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