去上皮瓣的Epi-LASIK临床观察

Clinical evaluation after epipolis laser in situ keratomileusis with flap removal

目的:探讨去除上皮瓣和常规的机械法准分子激光角膜上皮瓣下磨镶术(Epi-LASIK)治疗近视的临床疗效。方法:对30例(60眼)近视患者施行EPi-LASIK,采用法国MORIA角膜上皮分离器完成手术眼上皮分离,30例患者均左眼(30眼)保留角膜上皮瓣蒂于鼻侧,右眼(30眼)直接去除角膜上皮,采用Zeiss-Mel-80型准分子激光治疗仪进行激光切削后,去除组直接置入亲水性角膜接触镜,保留组待上皮复位后置入接触镜。术后第1,3,6d;1mo随访。分析比较两组术后疼痛程度、角膜上皮愈合时间、视力、角膜上皮下雾状混浊程度(Haze)。结果:术后疼痛:去瓣组明显轻于常规组,比较有统计学意义。角膜上皮愈合时间:去瓣组平均3.30±0.55d,留瓣组4.90±0.49d,两者比较差异有统计学意义。裸眼视力:术后第6,30d两组比较差异无统计学意义。术后1moHaze程度:去瓣组0级30眼,常规组0级30眼,两组无差异。结论:两组术后患者,去瓣组Epi-LASIK疼痛程度轻、上皮愈合和视力恢复较快、视觉质量更好,总体临床疗效优于常规Epi-LASIK。

AIM. To evaluate the clinical efficacy of epipolis laser in situ keratomileusis （Epi-LASIK） combined with flap removal for myopia. METHODS： Thirty cases （60 eyes） with myopia were treated with Epi-LASIK and the corneal epithelium was removed by MORIA keratome. The corneal flap of 30 cases was kept at nasal side in the left eye （30 eyes） and removed directly in the right eye （30 eyes）. After laser treatment with Zeiss Mel-80 excimer laser, the contact lens were planted in right eye group directly and after epithelium back to stroma layer in left eye group. The pain extent, corneal epithelium healing time, visual acuity （VA） and corneal haze were recorded at 1, 3, 6 days and 1 month after surgery. RESULTS： Pain in the right eye group was obviously slighter than left eye group and there was significant difference. Corneal epithelium healing time was 3.30 ± 0.55 days in the right eye group and 4.90 ± 0.49 days in the other group. There was significant deference between the two groups. There was no significant difference in uncorrected VA between the two groups at 6 and 30 days after operation, neither in the corneal haze between the two groups at 1 month after operation. CONCLUSION： The Epi-LASIK has less pain, faster healing and quicker visual recovery in flap-removal group than in the flap-keeping group.