激光角膜近视手术回顾

　　李莹 姜洋北京协和医院眼科李莹

　　作者单位：100730 中国医学科学院 北京协和医学院 北京协和医院眼科

　　通信作者：李莹，Email：liyingpumch@sohu.com 

　　【摘要】激光角膜近视手术是目前成人屈光不正矫正的主要手段，已经广泛应用于临床。回顾20多年的历程，手术种类越来越多，由原来的准分子激光屈光性角膜切削术（PRK），逐渐发展为准分子激光原位角膜磨镶术（LASIK）、准分子激光前弹力层下角膜磨镶术（SBK），直到近几年由“刀”向“飞秒”的大转化：飞秒激光辅助下制瓣的LASIK术、飞秒激光小切口角膜基质透镜取出术（SMILE）等。手术越来越安全，人们越来越重视角膜生物力学的稳定性。特别是，全准分子激光经角膜上皮准分子激光治疗性角膜切削术（TransPRK）的出现逐渐代替酒精制上皮瓣的LASEK术式、机械刀制上皮瓣的epi-LASIK术式，临床应用也显示出其良好的效果。围手术期的检查、评估、用药等越来越精细、重点化和个性化。以往屈光手术后的问题关注点主要在于眼部角膜结构、角膜并发症和视力稳定性方面，现在则更关注单眼角膜像差、地形图与双眼视觉的关系 ，以及个性化视觉要求、远期角膜结构的稳定性，甚至患者心理和精神层面的需求。

　　【关键词】激光；角膜；近视手术；飞秒

　　The review of laser corneal refractive surgery

　　Li Ying, Jiang Yang

　　Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730,China

　　Corresponding author: Li Ying, Email:liyingpumch@sohu.com

　　[Abstract] Laser corneal refractive surgery is the means of refractive errors correction, with wild clinical application. In the history of more than 20 years, we have more kinds of surgery, from PRK, LASIK and SBK gradually, in recent years by the "knife" to "femtosecond" transformation, femtosecond laser assistant LASIK, surgery is more safe. More attention to the corneal biomechanical stability is paid.     Especially the excimer laser TransPRK gradually replacing LASEK, it shows a good clinical effect with more precise, focused and personalization. Post-operation focus is mainly on the problem of corneal structure, complications and visual acuity, recently more on the monocular corneal aberration, topographic maps and the relationship between binocular vision, and personalized visual requirements and long-term stability of corneal structure, even on the psychological and spiritual needs.‍