Epi-LASIK和LASIK矫治高度近视的疗效比较

Comparison of the therapeutic results of Epipolis laser in situ keratomileusis and laser in situ keratomileusis on correcting high myopia

目的探讨微型角膜刀准分子激光角膜上皮瓣下磨镶术(Epi-LASIK)和准分子激光原位角膜磨镶术(LASIK)矫治高度近视的疗效。设计前瞻性、病例对照研究。研究对象62例(123眼)高度近视患者。方法对62例(123眼)高度近视患者进行Epi-LASIK(28例56眼)或LASIK(34例67眼)手术。由患者自行决定采用何种术式,对于角膜相对较薄者和从事职业存在角膜瓣风险者,医生推荐Epi-LASIK手术。观察术中术后并发症。记录两组患者术后1周、1、3、6个月裸眼视力(UCVA)、最佳矫正视力(BCVA)、屈光状态及总的高阶波前像差均方根(RMS)。主要指标UCVA、BCVA、屈光状态及总的高阶波前像差RMS值。结果术中、术后无严重并发症。术后1周Epi-LASIK组UCVA≥0.8眼数比例(46.4%)明显少于LASIK组(77.6%),差异有统计学意义(P=0.0003);术后1、3、6个月Epi-LASIK组UCVA≥0.8眼数比例(85.7%、94.6%、91.1%)与LASIK组(92.5%、95.5%、94.0%)差异无统计学意义(P=0.590、0.822、0.530)。两组术后的BCVA无一例下降。Epi-LASIK组术后1周、1、3、6个月等效球镜值在±0.50D以内的比例(42.9%、51.8%、60.7%、64.3%)与LASIK组(53.7%、59.7%、71.6%、73.1%)比较差异无统计学意义(P= 0.230、0.378、0.200、0.290)。两组术后的高阶像差RMS均较术前增大:Epi-LASIK组术后l、3、6个月的高阶像差RMS值(1.51±0.77)μm、(1.32±0.76)μm、(1.18±0.71)μm与术前(0.87±0.27)μm相比,差异均有统计学意义(P=0.016、0.019、0.026);LASIK组术后1、3、6个月的高阶像差RMS值(2.41±0.81)μm、(2.17±0.63)μm、(1.89±0.87)μm与术前(0.91±0.22)μm相比,差异亦均有统计学意义(P=0.011、0.008、0.006)。Epi-LASIK组对高阶像差的影响小于LASIK组:两组之间术后1、3、6个月高阶像差RMS比较差异均有统计学意义(P=0.039、0.035、0.033)。Epi-LASIK组Ⅰ级角膜上皮下雾状混浊(haze)2眼。结论Epi-LASIK矫正高度近视虽然视力恢复较LASIK慢,但能获得更好的视觉质量。(眼科,2007,16:336-339)

Objective To evaluate the efficacy of Epipolis laser in situ keratomileusis （Epi-LASIK） and laser in situ keratomileusis（LASIK） on high myopia patients. Design Prospective, case-controlled study. Participants 62 patients （123 eyes） with high myopia. Methods 62 patients （123 eyes） underwent Epi-LASIK or LASIK surgery for high myopia： 28 patients （56 eyes） underwent Epi-LASIK and 34 patients （67 eyes） underwent LASIK. The differences in postoperative uncorrected visual acuity （UCVA）, best corrected visual acuity （BCVA）, refraction, and root mean square （RMS） of high-range wavefront aberration were compared one-week, one-month, three-months and six-months postoperatively. Main Outcome Measures UCVA, BCVA, refraction, and RMS of high-range wavefront aberration. Results There was no serious complication during and after the operation. The recovery of postoperative UCVA after Epi-LASIK was slower than that of LASIK. One week postoperatively, the proportion of UCVA≥0.8 of Epi-LASIK （46.4%）was less than that of LASIK （77.6%） （P=0.0003）. No significant differences were found in those of Epi-LASIK （85.7%, 94.6%, 91.1%） and those of LASIK （92.5%, 95.5%, 94.0%） one-month, three-months and six-months postoperatively （P=0.590, 0.822, 0.530）. BCVA was same after Epi-LASIK and LASIK. The proportion of mean spherical equivalents within ±0.50D for Epi-LASIK （42.9%, 51.8%, 60.7%, 64.3%） had no difference with those for LASIK （53.7%, 59.7%, 71.6%, 73,1%） one-week, one-month, three-months and six-months postoperatively （P=0.230, 0.378, 0.200, 0.290）. The postoperative RMS increased after both surgeries, especially after LASIK. At postoperative one-month, three-months and six-months RMS of Epi-LASIK （1.51±0.77）μm, （1.32±0.76）μm, （1.18：l：0.71）μm were much higher than the （0.87±0.27）μm preoperative ones （P=0.016, 0.019, 0.026）. At postoperative one-month, three-months and six-months RMS of LASIK （2.41±81）μm, （2.17±0.63）μm, （1.89±0.87）μm were also much higher than the preoperative （0.91±0.22）μm （P=0.011, 0.008, 0.006）.There were significant differences between the RMS of Epi-LASIK and LASIK one-month, three-months and six-months postoperatively （P=0.039, 0.035, 0.033）. The I grade haze was found in two eyes after Epi-LASIK. Conclusion Epi-LASIK has better visual quality result than LASIK on correcting high myopia.