准分子激光双面式原位与上皮瓣下角膜磨镶术治疗高度近视评价

Comparision of the effect of both-side lasik and lasek for high myopia

目的比较准分子激光双面式切削原位角膜磨镶术（Both-sideLasik，BSL）和准分子激光角膜上皮瓣下磨镶术（LASEK）治疗薄角膜高度近视的临床效果，两种手术方法的优缺点。方法应用BSL和LASEK治疗近视度数〉-8．00D，角膜厚度471～546μm的患者。BSL组45例51只眼，近视球镜度数为-8．25-13．25D，平均-9．71D。LASEK组39例67只眼，近视球镜度数-8．25—12．75D，平均-9．26D。分别于术后10d、1、3、6、12个月检查裸眼视力，矫正视力，屈光度和角膜雾样混浊（Haze）等，并进行比较。结果BSL组术后反应轻，裸眼视力恢复快，术后10d、1、3、6、12个月裸眼视力达到术前最佳矫正视力的比例，BSL组分别为为72．55％、80.39％、84．31％1．31％、78A3％和68．63％，LASEK组分别为47．76％、65．67％、71．64％、70．15％和61．19%，未出现矫正视力下降2行及以上者。两组屈光度均由手术早期的过矫逐渐转变为后期的欠矫，LASEK组发生Haze的比例明显高于BSL组，差异有统计学意义（P〈0．05），但多为0．5-1级Haze，术中、术后无严重并发症。结论准分子激光双面式切削原位角膜磨镶术治疗薄角膜高度近视安全、有效，与LASEK相比，其角膜雾样混浊发生率更低，且程度轻，视力恢复更快。

Objective To compare the clinic effect of both-side laser in situ keratomilieusis （BSL） and laser epithelial keratomilieusis （LASEK） thr high myopia with thin cornea and explore their efficacy and safety.Methods BSL and LASEK were treated high myopia patients with corneal tbichness between 471 and 546p m. 51 eyes of 45 patients with average spherical equivalent of-9.71D （range from -8.25 to -13.25D） were treated with BSL.and 67 cases of 39 patients with average SE of-9.26D （range from -8.25 to -12.75D） were treated with LASEK. The uncorrected visual acuity, best corrected visual acuity, spherical epuivalent, haze were examined 10 days. 1,3,6 and 12 months postoperatively.Results Postoperative reaction was mild and UCVA was quickly recovered in BSL group. At 10 days 1,3,6 and 12 months postoperatively, the percentage of UCVA above BSCVA was 72.55%, 80.39%, 84.31%, 78.43% and 68,63% in BSL group and 47.76%, 65.67%, 71.64%, 70.15% and 61.19% in LASEK group respectively, None patient had 2 lines decreased. Refraction was changed from over-correction I month to under-correction 12 months postoperation. Corneal haze was much higher in LASEK group than BSL, group （P 〈0.05）,but corneal haze was mainly 0.54-1 grades which had no affect on visual acuity. There was no severe complications occurred in-operation and postoperatively.Conclusions The investigation shows that the BSL,with the advantages of the low incidence and less severity of haze density and short recovery period, is a safer and better means to treat high myopia with thin cornea than LASEK.