准分子激光原位角膜磨镶术和准分子激光上皮下磨镶术矫正高度近视的视觉质量对比研究

A comparative study between laser in situ keratomileusis and laser epithelial keratomileusis on correcting high muopia by evaluating the visual quality

目的从视觉质量的角度评价准分子激光原位角膜磨镶术(LASIK)和准分子激光上皮下磨镶术(LASEK)矫正高度近视的疗效。方法对34人(68眼)进行LASIK或LASEK手术的高度近视患者(其中LASEK19人38眼,LASIK组15人30眼)术前,术后1月和术后3月时评价视觉质量,包括术后裸眼视力(UCVA),最佳矫正视组(BCVA组),对比敏感度,眩光和波前像差。结果LASEK组UCVA提高较LASIK组慢。LASEK和LASIK的术后BCVA无差异。LASEK组术后的对比敏感度无下降;眩光在术后1月时下降,术后3月时恢复至术前水平。LASIK组术后1月时对比敏感度和眩光均明显下降,术后3月时对比敏感度恢复但眩光仍未恢复至术前水平。LASEK组和LASIK组术后1月和3月的高阶像差RMS均较术前大,但前者比后者小。LASEK组有一定的haze发生,但程度轻。结论LASEK矫正高度近视能获得更好的视觉质量,关键在于如何更好的保留上皮瓣的活力。

Objective To compare the visual quality of high myopia after laser in situ keratomileusis （LASIK） and laser epithelial keratomileusis （LASEK）. Methods 34 patients （68 eyes） underwent LASIK or LASEK surgery for high myopia, including 19 patients （38 eyes） for LASEK and 15 patients （30 eyes） for LASIK. Visual quality evaluations including uncorrected visual acurity （UCVA）, best corrected visual acurity （BCVA）, haze, contrast sensitivity （CS）, glare sensitivity （GS） and root mean square （RMS） of high- range wavefront abberation, were performed on each eye preoperatively, one-month post-operatively and three-month postoperatively. Results The recovery of postoperative UCVA after LASEK was slower than LASIK. The BCVA after LASEK and LASIK is the same. The postoperative CS of each space frequency unchanged after LASEK, but decreased after LASIK. The CS after LASIK mostly recovered in three months. The postoperative GS of each space frequency decreased after both surgeries. GS mostly recovered in three-months after LASEK, but still decreased after LASIK. The postoperative RMS increased after both surgeries, especially after LASIK. Mild haze was observed after LASEK occasionally. Conclusions LASEK has better visual quality results than LASIK on correcting high myopia. The viability of epithelial flap of LASEK is the key.