WG-LASIK与WG-LASEK治疗中低度近视的临床疗效比较

Comparison of wavefront-guided laser epithelial keratomileusis and wavefront-guided laser in situ keratomileusis for low to moderate myopia

目的:比较波前像差引导的准分子激光原位磨镶术(wave-front-guided LASIK,WG-LASIK)与波前像差引导的准分子激光上皮瓣下磨镶术(wavefront-guided LASEK,WG-LASEK)治疗中低度近视的疗效。方法:80例患者(160眼)随机分为WG-LASIK组和WG-LASEK组,每组40例(80眼)。术后随访观察上皮愈合时间与疼痛情况,术后2wk;1,2,3,6mo;1a时术后裸眼视力、屈光度数、角膜上皮下雾状混浊(Haze)和高阶像差。术后3,6mo时做视觉质量问卷调查。结果:两组术后眼痛程度,上皮愈合时间,屈光度数及角膜Haze无显著性差异。两组裸眼视力、暗视瞳孔下高阶像差的均方根值有显著性差异,且时间曲线不相同。结论:WG-LASIK与WG-LASEK矫正中低度近视均能取得较好的临床效果,用来矫正中低度近视是安全,有效的。术后裸眼视力、视觉成像质量及视力稳定程度方面,WG-LASEK更优于WG-LASIK。

AIM： To evaluate the efficacy, safety and stability of wavefront-guided laser epithelial keratomileusis （WG- LASEK） for the correction of low to moderate myopia compared with wavefront-guided laser in situ keratomileusis （WG-LASIK）. METHODS.. In a randomized prospective study, 80 eyes of 40 patients undergoing WG-LASEK and 80 eyes of 40 patients undergoing WG-LASlK after each procedure were thoroughly examined. Every patient was followed up for postoperative pain, epithelial healing time, and uncorrected visual acuity （UCVA）, manifest refraction （spherical equivalent, SE）, corneal haze, and higherorder aberrations （HOAs） were observed at 2 weeks, 1, 2, 3, 6 months, 1 ：year after surgery. Vision quality questionnaires were collected at 3 months and 6 months after operation. RESULTS： During the follow-up period, there were no significant differences in epithelial healing time, postoperative pain, SE or corneal haze between the two groups. There was significant difference in postoperative UCVA between the two groups, and significant difference was found at 2 weeks and 1 month after surgery. The root mean square （RMS） of HOAs was significantly smaller in the WG- LASlK group than in the WG-LASEK group at postoperative 1 month. The difference in HOAs between the two groups disappeared at postoperative 3 months and 6 months. CONCLUSION： Satisfactory clinical results were gained in both WG-LASEK and WG-LASlK groups. They are effective and safe for the correction of low to moderate myopia. Better postoperative visual acuity and stability are seen in WG-LASEK group. The HOAs in the scotopic condition were different between two groups and had different time curves. This finding suggests that postoperative changes in aberration contribute to the final outcome of wavefront-guided ablation.