激光角膜上皮瓣下磨镶术和激光原位角膜磨镶术治疗中高度近视的对比研究

Comparison of laser epithelial keratomileusis and laser in situ keratomileusis for moderate to high myopia

目的 比较激光角膜瓣下磨镶术 (L ASEK)和激光原位角膜磨镶术 (L ASIK)治疗中高度近视的临床效果。方法 中高度近视患者 198例 (394只眼 )。其中 L ASEK手术治疗 93例 (184只眼 ) ,L ASIK手术治疗 10 5例 (2 10只眼 )。结果 术后 1天 ,L ASIK组 2 8%裸眼视力达到 1.0 ,L ASEK组无 1例裸眼视力达到 1.0。术后 1周、1、3、6月裸眼视力大于或等于 1.0者 ,两组比较差异无显著性 (P =0 .36 ,P =0 .5 8,P =0 .4 4 ,P =0 .6 4 )。角膜地形图分析平均角膜中央屈光力与周边屈光力的差异 ,L ASEK组 (0 .6 9)明显小于 L ASIK组 (2 .6 2 )。结论 L ASEK手术矫正中高度近视均有良好的治疗效果 ,是一种安全、有效、预测性好的屈光手术。

Objective To compare the effectiveness, safety, and stability of laser epithelial keratomileusis (LASEK) with those of laser in situ keratomileusis (LASIK) for the correction of moderate to high myopia. Methods 198 cases(394 eyes)of the moderate to high myopia were randomly assigned as LASEK group : 93 cases(184 eyes) with preoperative myopia - 4.00D ~ -12.00 D , astigmatic errors -0.50D ^-2.50 D and LASIK group: 105 cases(210 eyes) with preoperative myopia - 4.00D ~ - 13.00 D, astigmatic errors -0.50D ~ -3.00 D. Patients from both groups were followed postoperatively for 6 months, measuring visual acuity, manifest refraction, corneal haze, and corneal topographic meridians of 3mm,5mm,and 7mm. Results At 1 day, the uncorrected visual acuity ( UCVA) was 20/20 or better in 59 LASIK eyes (28%) and no patient in LASEK group achieved a UCVA of 20/20. There was no statistically significant difference in the UCVA of 20/20 at 1 week (P=0.36), 1 month (P=0.58), 3 months(P=0.44),and 6 months (P=0.64) between LASIK and LASEK group. It was increased in the number of eyes with low astigmatic power and decreased in the number of eyes with high astigmatic power in both groups. The incidence of corneal haze : LASEK group showed 7 % of 0.5 degree. The analysis of corneal topographic meridians showed that fewer aberrations resulted from LASEK than from LASIK. Conclusion LASEK in this study appeared safely effectively, predictable treated eyes with moderate to high myopia. LASEK has some advantages in comparison with LASIK. It avoids all the well-known complications related to the LASIK flap and it is easier .