激光上皮瓣下角膜磨镶术治疗近视的初步观察

Clinical study of laser epithelial keratomileusis for Myopia.

目的评价准分子激光上皮下角膜磨镶术(LASEK)治疗近视的临床效果。方法我院LASEK手术25例50眼与同时期进行的LASIK手术的25例50眼,进行对比观察,两组均用Technolas 217Z准分子激光机,由同一位医生使用相同程序进行手术。术后随访3月,对术后裸眼视力、最佳矫正视力及屈光状态进行对比。结果术后1周、1月和3月的屈光检查结果LASEK组等效球镜度依次为(+0.85±0.64)D,(+0.25±0.78)D,和(-0.28±0.38)D;LASIK组则为(+0.28±0.84)D,(-0.34±0.53)D,和(-0.32±0.40)D。两组间差异,术后1周和1月有统计学意义(P<0.05),术后3月差异无统计学意义(P>0.05);术后1周和1月、3月裸眼视力≥1.0者,LASEK组依次为50%、96%和97%而LASIK组则为95%、97%和97%,两组间差异术后1周有统计学意义(P<0.05),而术后1月、3月则无统计学意义(P>0.05)。LASEK组手术后3天内有不同程度的畏光流泪等症状,5天内上皮完全愈合。结论LASEK具有与LASIK相同的临床效果,LASEK更适用于角膜较薄的近视。并避免了相关的并发症,但术后早期的疼痛及视力恢复较慢是其美中不足之处。

Objective Purpose To assess the clinical results of Laser epithelial keratomileusis （ LASEK）. Methods The results of Lasek surgery were compared with Lasik surgery in 50 eyes of 25 patients . All procedures were performed using the Technolas 217Z excimer laser（ Chiron Technolas, Irvine, CA） All the patients were followed uI： more than 3 months. The UCVA, BCVA, and refraction were measured at lweek, and 1 ,3 months. The corneal epithelium healing time and the subepithelia cornea haze were also detected. Results Preoperatively, the mean spherical equivalent （MSE） was （ -10. 25± 3.20） D in the LASEK eyes and （ -8.40 ± 4.60） D in the LASIK eyes. The difference was not statistically significant（P 〉 0.05） Postoperatively, at 1 week, 1,3 months, the MSEs were （0.85 ±0.64）D , （0.25 ± 0.78）D , and （ - 0.28 ± 0. 38 ） D, respectively in LASEK group and （ 0. 28±0. 84）D , （ -0.34 ± 0.53）D and（ -0.32 ±0.40） D in LASIK group. The differences were not statistically significant at 3 months but statistically significant at 1 week and 1 month. In LASEK group, the BVCA more than 1. 0 at 1 week, 1 and 3 months were 50% , 96% and 97% ; In LASIK group, the BVCA more than 1.0 weft： 95% , 97% and 97%, at 1 week, 1 and 3 months. There were no statistically significant between the two group at 1 and 3 months but statistically significant at 1 week. Conclusions LASEK provided similar results with LASIK . It was safe and effect ive in treating myopia. The potential advantages of LASEK over LASIK include the elimination of stromal flap complications and greater choice in patient selection. The disadvantages include varying degree pain 2 or 3days and blurry vision for several days postoperatively.