摘要
混合性屈光参差患者行角膜屈光手术后，双眼视力可出现“同步手术、异步恢复”的特点，即近视侧恢复较快，而远视侧视力波动及恢复滞后更为常见。其机制可能与近视和远视消融模式差异、远视侧角膜生物力学扰动及上皮代偿性重塑、高阶像差及Kappa角相关视觉质量下降、术后调节痉挛，以及双眼视融合重建过程中的中枢适应有关。本文围绕上述机制进行综述，并提出术前预期管理、术后散瞳验光鉴别、眼表及上皮重塑监测和个体化视功能康复策略，以期为混合性屈光参差患者角膜屈光术后的围手术期管理提供参考。
关键词： 屈光参差；飞秒激光辅助准分子激光原位角膜磨镶术；角膜上皮重塑；调节痉挛；双眼视功能
Abstract
Patients with mixed anisometropia may experience asynchronous visual recovery between both eyes after corneal refractive surgery, characterized by relatively rapid recovery in the myopic eye and more frequent visual fluctuation or delayed recovery in the hyperopic eye. The underlying mechanisms may be associated with differences in myopic and hyperopic ablation profiles, greater corneal biomechanical disturbance and compensatory epithelial remodeling in the hyperopic eye, reduced visual quality related to higher-order aberrations and angle kappa, postoperative accommodative spasm, and central adaptation during the reconstruction of binocular visual fusion. This review summarizes the above mechanisms and proposes perioperative management strategies, including preoperative expectation management, postoperative cycloplegic refraction for differential diagnosis, monitoring of the ocular surface and epithelial remodeling, and individualized visual function rehabilitation, with the aim of providing a reference for the perioperative management of patients with mixed anisometropia undergoing corneal refractive surgery.
Key words： Anisometropia; Femtosecond laser-assisted laser in situ keratomileusis; Corneal epithelial remodeling; Accommodative spasm; Binocular visual function
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