准分子激光上皮瓣下角膜磨镶术矫治近视的临床观察

Clinical reserch of myopic correction after epipolis-laser in situ keratomileusis

目的观察机械法-准分子激光上皮瓣下角膜磨镶术(epi-LASIK)矫治近视的手术特点和临床疗效。方法本院epi-LASIK手术177例(351眼),运用AMO直线式角膜上皮刀制作角膜上皮瓣,通过调节负压、刀片前进速度、振荡频率和蒂宽等参数,于术后30min、、1d、6d、14d、1月、3月、6月及12月,观察上皮瓣形成情况、术后刺激症状、角膜愈合情况、视力及haze情况。结果所有患眼均如期完成手术。随访6～12月。术中见角膜前弹力层床面垂直径为8.5～9.5mm,平均(9.00±0.13)mm;角膜上皮瓣蒂位于鼻侧;术后1d刺激评分,19眼3分,58眼2分,197眼1分,77眼0分。取接触镜视力为0.6～1.2;术后6～12月复查见视力稳定。术后3月haze反应为0～2级,6月为0～1级,12月为0～1级。结论epi-LASIK手术治疗近视具有术后刺激症状轻,上皮愈合好,视力恢复快,haze轻等特点。其远期临床疗效及haze的形成仍需更多病例和更长时间的随访和研究。

Objective To assess the clinical effect and surgical character of myopic correction after epipolis-laser in situ keratomileusis（Epi-LASIK）. Methods 351 eyes of 177 patients accepted Epi-LASIK surgery were studied. During the surgery, the epithelium flap is made using AMO Amadeus Ⅱ-Microkeratome, some parameters can be modulated such as negetive pressure, knive progressing speed, vibration preguency and predicel width outcomes of epithelium flap shape , stimulating symptom, corneal concrescence , vision acuity and hase were studied after surgery about 1 day, 6 days, 14 days, 1 month,3 months,6 months and 12 months. Resuits All patients accepted the surgery on time. The mean vertical diameter of corneal Bowen layer was （9.0 ± 0. 13 ） mm （ ranged 8. 5-9.5mm）, The predicel of epithelium flap located at nasal side. 19 eyes got 3 cents,58 eyes got 2 cents, 197 eyes got 1 cent and 77 eyes got 0 according stimulating grading cent 1 day after surgery. The vision acuity ranged 0.6 to 1.2 after picked off the contact lens and standed steadely 6 months and 12 months after surgery. The haze reaction ranged 0 to 2 grade at 3 months after surgery , ranged 0 to 1 grade at 6 months after surgery and ranged 0 to 1 grade at 12 months after surgery. Conclusions The epi-lasik precedure to correction myopia is light stimulating symptom, good epithelium healing, rapid recovery of vision acuity and mild haze reaction. But the long clinical curactive effect and hase forming need more cases and longer time follow-up and reserch.