去上皮瓣的Epi-LASIK和LASEK矫治近视的临床疗效

Clinical observation of Epi-LASIK and LASEK on myopia correction with epithelial flap removed

目的探讨去除或保留上皮瓣对机械法LASIK(epipolis LASIK,Epi-LASIK)和LASEK治疗近视的临床疗效影响。方法将42例(84眼)接受Epi-LASIK的患者随机分为留瓣组(22例44眼)和去瓣组(20例40眼);将46例(92眼)接受LASEK的患者亦随机分为留瓣组(23例46眼)和去瓣组(23例46眼)。定期随访观察4组患者术后疼痛、角膜上皮愈合时间、视力、屈光状态及haze情况。结果术后第1天2种术式中去瓣组与留瓣组之间疼痛程度差异无统计学意义(P>0.05),术后第3天、第5天2种术式中去瓣组疼痛程度明显轻于留瓣组(P<0.05);留瓣组之间和去瓣组之间疼痛程度差异无统计学意义(P>0.05)。去瓣组角膜上皮愈合时间:Epi-LASIK术后为(2.64±0.61)d,LASEK术后为(2.75±0.82)d,留瓣组:Epi-LASIK术后为(4.53±1.03)d,LASEK术后为(4.59±1.16)d,各术式去瓣组与留瓣组比较差异均有统计学意义(P均<0.05);2种术式留瓣组之间和去瓣组之间比较差异无统计学意义(P均>0.05)。2种术式术后视力、屈光状态及haze情况去瓣组与留瓣组之间比较差异均无统计学意义(P均>0.05);1个月时,haze眼数Epi-LASIK和LASEK留瓣组分别为1眼和2眼,去瓣组分别为2眼和3眼,去瓣组间和留瓣组间比较差异无统计学意义(P>0.05)。结论Epi-LASIK和LASEK矫治近视术中去除上皮瓣不影响临床疗效,而且能减轻患者术后疼痛,缩短上皮愈合时间。

Objective To evaluate the clinical effect of epipolis laser in situ keratomoleusis （Epi-LASIK） and LASEK on myopia correction with epithelial flap removed. Methods Epi-LASIK was performed on 42 patients（84 eyes）. They were classifted randomly into two groups. One group （22 patients, 44 eyes） kept the epithelial flap; The other group （ 20 patients ,40 eyes） removed the epithelial flap. LASEK was performed on 46 patients（ 92 eyes）. They were also classified randomly into two groups. One group （ 23 patients,46 eyes） kept the epithelial flap; The other group （ 23 patients, 46 eyes） removed the epithelial flap. Regular follow-up was done to observe the postoperative pain, corneal epithelium healing time, visual acuity, refraction and the degree of haze of the four groups. Results There was no significant difference in postoperative pain between flap-removed group and flap-reserved group at the 1 st day after Epi-LASIK or LASEK（ both P 〉 0. 05 ）, but at the 3rd day and the 5th day after operation flap-removed group had milder pain compared with flap-reserved group （ both P 〈 0.05 ）, and there was no significant difference in flap-removed or flap-reserved group between two kinds of operation（both P〉0.05）. Corneal epithelium healing time was （2.64 ±0.61 ） days, （4.53 ± 1.03 ） days and （ 2.75 ± 0.82 ） days, （ 4.59 ± 1. 16 ） days in flap-removed and flap-reserved groups after Epi-LASIK or LASEK, respectively. There was significant difference between flap-removed and flap-reserved groups after Epi-LASIK or LASEK（ both P 〈 0. 05 ）, but no significant difference in flap-removed or flap-reserved group between Epi-LASIK and LASEK（both P 〉 0. 05 ）. There was no significant difference in visual acuity, refraction and the degree of haze between flap-removed group and flap-reserved group after Epi-LASIK or LASEK（ all P 〉 0.05 ）. One month after operation, number of haze was 1 eye and 2 eyes in flap-reserved group with Epi-LASIK or LASEK, respectively, and 2 eyes and 3 eyes in flap-removed group with Epi-LASIK or LASEK, respectively. No significant difference was found in follow-up data between two kinds of operation in flap-reserved or flap-removed group （ both P 〉 0.05 ）. Conclusion Epithelial flap removed can alleviate postoperative pain and shorten corneal epithelium healing time in Epi-LASIK and LASEK.