去瓣机械法准分子激光角膜上皮瓣下磨镶术矫治近视疗效观察

Clinical Results of epithelial removal Epi-LASIK on myopia

目的探讨去瓣机械法准分子激光角膜上皮瓣下磨镶术（Epi—LASIK）矫治近视的手术特点和近期临床疗效。方法收集2007年6月至9月在眼科行Epi—LASIK手术近视患者共34例（68只眼），分为两组。第1组46只跟，行去瓣Epi—LASIK术（去瓣组），第2组22只跟，常规Epi—LASIK术（对照组）。观察角膜上皮愈合时间、术后刺激症状、术后最佳矫正视力及角膜上皮下雾状混浊（Haze）形成情况，随访时间3个月。结果术后去瓣组角膜上皮愈合时间平均为（3．39±0．649）d，对照组为（5．41±0．796）d，两组比较差异有统计学意义（P〈0．05）。术后无疼痛反应去瓣组33只眼（71．74％），对照组4只眼（18．18％），两组比较差异有统计学意义（P〈0．05）。术后5d内去瓣组比对照组最佳矫正视力明显提高，两组比较差异有统计学意义（P〈0．05）；至术后3个月最佳矫正视力两组间比较差异无统计学意义（P〉0．05）。术后去瓣组有41只眼（89．1％）出现0级Haze，对照组有20只眼（90．9％）出现0级Haze，两组间比较差异无统计学意义（P〉0．05）。结论去瓣Epi—LASIK手术治疗近视安全、有效。并有术后角膜上皮愈合快、刺激反应轻且术后最佳矫正视力和Haze与常规Epi—LASIK手术无差别的优点。其远期临床疗效及对Haze的形成作用仍需更多病例和更长时间的随访和研究，

Objective To evaluate the effectiveness of epithelial removal in Epipolis laser in situ eratomileusis for treatment of myopia. Methods 34 patients（68 eyes）with myopia were divided into 2 groups. Group 1 consisted of 23 patients （46 eyes）with the epithelial flap was pulled away from the base,and group 2 consisted of 11 patients（ 22 eyes ）who underwent the regular Epi-LASIIK operation, observations of the time of epithelial healing,postoperative syndrome,postoperative best corrected visual acuity,and haze were recorded. All patients were fellow up for 3 months. Results The mean time of epithelial healing was （3.39± 0.649）days in epithelial removal Epi-LASIK eyes,while （5.41± 0.796）days in normal Epi-LASIK eyes,the difference of epithelial healing time between the two groups was statistically significant .After operation 33 eyes （ 71.74% ）of group 1 and 4 eyes （ 18.18% ）of normal Epi-LASIK group had no pain. the difference of the two groups was statistically significant （P 〈0.05 ）.5 days after operation,the BCVA in group 1 improved significantly compare with the group 2. the difference of the two groups was statistically significant（P 〈0.05 ）. 3 months after operation there was no significant difference in BCVA between the two groups .corneal haze was found in 41 eyes （89.1%）of epithelial removal Epi-LASIK group and 20 eyes （90.9%）of normal Epi-LASIK group, but the grade haze was below 0.5 and had no effect on visual acuity, the differenc6 of the two groups was not statistically significant（P 〉0.05 ）. Conclusion Epithelial removal Epi-LASIK is effective and safe method for treatment of myopia,the epithelial healing time is short moreover have no severe syndrome after operation .Furthermore it is no difference between the BCVA and haze in group 1 or group 2, As for the clinical effectiveness of this method on a long-term basis and the role it plays in the formation of haze after the operation, there should be more case studies conducted on a long-term basis.