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改良的“Y”型瓣准分子激光上皮下角膜磨镶术(英文)

A clinical evaluation of “Y-flap” laser epithelial keratomileusis
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摘要 目的比较常规准分子激光上皮下角膜磨镶术(lasersubepithelialkeratomileusis,LASEK)与改良的“Y”型上皮瓣的LASEK在近视矫正中的临床结果。方法50例近视患者(100眼)均匀分为两组。组1常规使用20%乙醇20s后制成一个完整的上皮瓣,并分离至上方角膜缘,激光切削后将上皮瓣复位至切削区。组2角膜上皮也使用20%乙醇相同时间后制成三个角膜瓣,其中心点即“Y”字的中心,位于瞳孔缘的上方,三个上皮瓣的切缝向角膜周边延伸,直径约达8mm,然后分别将三个角膜瓣分离至角膜周边,完整地暴露约8mm直径的角膜床,激光切削后将上皮瓣复位,接缝呈“Y”型。两组术毕均使用绷带型角膜接触镜(Acuvue2,美国强生公司),并滴眼药水3d。评估两种LASEK的瓣完整性、制瓣所需时间、眼部刺激反应(角膜缘充血和角膜水肿反应)、舒适度的主观评分(从差到很好记为0至5分)及术后3个月时的裸眼视力(LogMAR记录法)。结果制瓣所需时间,组1平均为(5.36±1.18)min,组2为(2.89±0.46)min。组1有88%获得完整的角膜瓣,而组2有94%为完整瓣。两组术后角膜反应轻微,均在5周内完全消失。舒适度的主观评分两组差异无显著性(1周时组1为3.1±0.69,组2为3.2±0.64;3个月时组1为4.3±0.66,而组2为4.3±0.63)。裸眼视力两组差异也无显著性(1周时组1为0.21±0.13,组2为0.22±0.12;3个月时组1为0.01±0.08,而组2为0.01±0.06)。两组术后裸眼视力均在术后3个月时达到术前最佳矫正视力。结论“Y”型LASEK与常规LASEK比较,更易制瓣,成功率更高,并且不影响手术的视觉效果。 Objective To compare clinical outcomes between routine and "Y-tlap" LASEK procedures in correction of myopic.Methods Fifty myopic patients (100 eyes) were randomly assigned to 2 groups. In group 1, an intact epithelial flap was made and retracted after the corneal surface was treated by 20% ethyl alcohol. Laser ablation was performed at the stromal bed, followed by rolling. back of the flap onto the ablated area. In group 2, a "Y"-incision was made through the full thickness epithelium of the cornea followed by the procedures identical to those in group 1, resulting in 3 epithelial valves covering the ablated area. A handage contact lens (Acuvue 2 Johnson & Johnson) was applied to the top of the epithelial flap followed by topical admnistration of eye drop of ofloxacin and lodoxoamide for 3 days. These two LASEK procedures were evaluated in ilap integrity, time spent on formation of the flap, ocular irritation (limbal hyperemia and corneal edematous response), subjective evaluation of comfort (score 0 to 5: poor to excellent) and un-corrected visual acuity (UCVA) for 3 months post-surgically.Resolts The mean time requited for flap creation was 5.36± 1.18 minutes in group 1 trod 2.89± 0.46 minutes in group 2.An intact flap was achieved in 88 % of the subjects in group 1 and 94% of the subbjects in group 2. Corneal irritation was mild in the two groups postsurgically and this conmpletely diessppeared within 5 weeks. There was no significant difference in the score of subjective evaluation of comfort (1^st week: 3.1±0.69 in group 1vs 3.2±0.64 in group 2 and 3 months: 4.3±0.66 in group 1vs 4.3± 0.63 in group 2) and UCVA (1^st week: 0.21±0.13 in group 1 vs0.22±0.12 in group 2and 3 months: 0.01±0.08 in groups 1and0.01±0.06 in group 2). The UCVA approached the pre-surgical best corrected visual acuity in both the groups at 3 months of the surgery. Conclusion The Y-type flap for LASEK surgery is easier to be created with a higher successful rate and does not compromise the post-surgical outcomes when compared to the routine LASEK procedure.
作者 王勤美 瞿佳
出处 《眼视光学杂志》 2006年第1期1-4,共4页 Chinese Journal of Optometry & Ophthalmology
基金 十五国家科技攻关项目(2004BA720A16)
关键词 上皮下角膜磨镶术 准分子激光 “Y”型上皮辩 近视 角膜 laser subepithelial keratomileusis Y-taye flap myopia comea
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