LASEK和LASIK治疗散光的疗效对比研究

A comparative study on therapeutic effects of laser subepithelial keratomileusis and laser in situ keratomileusis for astigmatism treatment

目的:比较分析准分子激光角膜上皮瓣下磨镶术(LASEK)和准分子激光原位角膜磨镶术(LASIK)治疗近视性散光的疗效。方法:近视性散光行LASEK治疗的患者84例(168眼),LASIK治疗的患者92例(184眼),根据散光分为Ⅰ组(散光-0.25～-1.75D)、Ⅱ组(散光-2.0～-3.75D)和Ⅲ组(散光-4.0～-5.75D),随访6mo观察两术式的治疗效果。观察指标包括术后裸眼视力(UCVA)、散光度、裂隙灯检查、眼压及角膜地形图。结果:术后6moⅢ组中裸眼视力(UCVA)≥1.0者LASEK占78.6%,LASIK占50.0%,两术式相比较差异有显著性(χ2=4.661,P<0.05);残余散光度LASEK为-0.43±0.35D,LASIK为-0.72±0.46D,两术式相比较差异有显著性(t=2.524,P<0.02);Δsimk值LASEK为0.60±0.39D,LASIK为0.86±0.47D,两术式相比较差异有显著性(t=2.149,P<0.05)。结论:LASEK治疗高度散光具有良好的效果,与LASIK相比其安全性、预测性更好,是一种值得推荐的术式。

AIM：To compare and analyze the therapeutic effects of laser subepithelial keratomileusis（LASEK） and laser in situ keratomileusis（LASIK） for astigmatism treatment. METHODS：LASEK was performed in 168 eyes of 84 patients with myopic astigmatism and 184 eyes of 92 patients with myopic astigmatism received LASIK.These eyes were divided into Group Ⅰ（-0.25D——1.75D）,Group Ⅱ（-2.0D——3.75D） and Group Ⅲ（-4.0D——5.75D）.Uncorrected visual acuity（UCVA）,astigmatism,slit-lamp examination,intraocular pressure（IOP）,corneal topography were observed in these patients in 6-month follow-up period. RESULTS：At 6 months after surgery in Group Ⅲ,22 eyes（78.6%） which received LASEK and 12 eyes（50.0%） which received LASIK achieved a UCVA better than 20/20.There was a significant difference of UCVA between LASEK and LASIK（ χ^2=4.661,P〈0.05）.Remnant astigmatism in LASEK was-0.43±0.35D and that in LASIK was-0.72±0.46D.There was significant difference of astigmatism between two methods of surgery（ t=2.524,P〈0.02）.△simk after surgery was 0.60±0.39D in LASEK and 0.86±0.47D in LASIK.There was significant difference of△simk between two kinds of surgery（t=2.149,P〈0.05）. CONCLUSION：For high astigmatism,LASEK was safer,more effective and more predictive than LASIK.