LASEK治疗LASIK术后屈光异常的临床研究

Laser-assisted subepithelial keratomileusis （LASEK） for correction of irregular refractive error after laser in situ keratomileusis （LASIK）

目的探讨准分子激光原位角膜磨镶术（LASIK）后屈光异常（屈光回退、欠矫、过矫）行准分子激光角膜上皮瓣下磨镶术（LASEK）治疗的可行性及临床疗效。方法对45例（77只眼）行LASIK治疗后所致的屈光异常患者,均在原角膜瓣上行LASEK治疗。其中屈光回退26例（47只眼）,欠矫13例（19只眼）,过矫6例（11只眼）。术中制作角膜上皮瓣时,环形角膜上皮锯仅做垂直向下的轻压动作,20%酒精脱角膜上皮的时间为18-25秒。术后观察眼部刺激症状,角膜上皮瓣及角膜基质反应,视力,屈光度改变,角膜Haze,屈光回退,术后并发症等情况。随访时间均≥6个月。结果术后眼部刺激症状较轻,角膜上皮瓣对位复贴良好,角膜上皮瓣轻度水肿一般3天消失,未见明显角膜基质反应,视力于术后9-14天即可达最佳矫正视力,术后6个月平均屈光度为（＋0.25±0.32）D,术后角膜Haze发生率较少,未发生屈光回退、激素性高眼压及继发性圆锥角膜。结论LASEK治疗LASIK术后屈光异常安全可行,疗效确切,远期疗效有待进一步观察。

Objective To investigation the effectiveness, safety and feasibility of Laser-assisted subepithelial keratomileusis （LASEK） for correction of irregular refractive error （regression, undercorrection and overcorrection） after laser in situ keratomileusis （LASIK）. Methods 77 eyes of 45 patients with irregular refractive error after LASIK underwent LASEK surgery. Among the patients, 47 eyes of 26 patients were with regression, 19 eyes of 13 patients were with undercorrection, 11 eyes of 6 patients were with overcorrection. The eyes were examined after surgery for more than 6 months, with evaluation of ocular symptoms, visual acuity, refraction and slit-lamp examination of corneal epithelial flap and haze. Results The patients had less ocular discomfort than those with PRK. All the corneal epithelial flaps were well positioned, with slight edema for about 3 days. No significant corneal stromal reactions were found. The uncorrected visual acuity reached preoperative best corrected level at post-operative 9 to 14 days. The mean spherical degrees of post-operative 6 months were （＋0.25 ± 0.32）D.The incidence of haze were significantly less than those of PRK. No regression, steroid-induced ocular hypertension or secondary keratoconus were found. Conclusions LASEK is a safe and feasible choice for correction of irregular refractive error after LASIK.