超薄角膜瓣LASIK与LASEK治疗角膜相对较薄高度近视眼的角膜地形图和波前像差的对比研究

Comparative study of ultra-thin flap LASIK and LASEK for the treatment of high myopia with relative thin cornea

目的对超薄角膜瓣准分子激光原位角膜磨镶术(LASIK)和准分子激光上皮下角膜磨镶术(LASEK)治疗角膜相对较薄的高度近视眼术后的角膜地形图和波前像差进行比较,探讨其与视觉质量的关系。方法随机选择在使用常规130μm刀头行LASIK治疗后剩余角膜基质床厚度<280μm的50例高度近视患者分为两组。使用超薄角膜瓣LASIK治疗的患者设为A组:25例(50只眼);球镜度-6.00～-10.0 D,平均-7.18 D;柱镜度0～-2.00 D,平均-0.84 D。使用LASEK治疗的患者设为B组:25例(50只眼);球镜度-6.00～-10.00D,平均-7.15 D;柱镜度0～-2.00 D,平均-0.96 D。两组各指标分别于治疗后1周、1、3、6、12个月检查角膜地形图、波阵面像差改变等并进行比较。结果术后6个月时两组角膜地形图形态都以中央对称均匀型为最多。两组术后1周SimK等效值、SimK差值均较术前减小,差异有显著意义;但术后各期之间及两组之间比较,差异无显著意义。两组手术方式术后1周SAI及SRI值与术前相比,术后各期之间比较,两组之间术后各期比较,差异均无显著性。两组术后1周时各高阶像差和总高阶像差均较术前增加,差异均有统计学意义(P<0.05)。两组术后1个月时各高阶及总高阶像差与术前比较,术后1、3、6及12个月之间比较,差异无统计学意义。两组之间比较:在术后1周两组之间比较,B组的各高阶像差和总高阶像差均较超薄瓣LASIK的值大,且3、5、6、7阶差异有统计学意义。在术后1、3、6及12个月比较,LASEK组的各高阶像差和总高阶像差均较超薄瓣LASIK的值小,但差异无统计学意义。结论超薄瓣LASIK和LASEK对于角膜相对较薄的高度近视眼患者来说,都是安全和有效的手术。两者在角膜地形图及波前像差的各项指标比较中无明显差异。

Objective To explore the change of corneal topography and wavefront aberration of the ultra-thin flap LASIK and LASEK for the treatment of high mypia with relative thin corneal and the relativity with vision quality. Methods 100 eyes of 50 cases with high mypia with relative thin cornea were divided into two groups. 50 eyes of 25 cases received ultra-thin flap LASIK were included in group A. 50 eyes of 25 cases received LASEK were included in group B. The mean preoperative spherical equivalent was （ -7.18 ± 0.85 ） D and （ -7.15 ±0.92） D respectively. The change of corneal topography and wavefront aberration were observed and compared during after surgery. Results There were no threatening complications for vision during surgery. The corneal topographies were mainly smooth figure after 6 months Postoperatively. The SimK value difference and SimK equivalent value at 1 week postoperatively showed statistic significant difference compared with preoperation,but none showed statistic significant difference compared with each postoperative period. The value of SRI and SAI are none showed statistic significant difference compared with preoperative and each postoperative period. RMS of each and total high order aberration in group A and group B were all increased at t week after operation. RMS of each and total high order aberration in group B was increased at 1 week after operation than group A ,and 3,5,6,7 order showed statistic significant difference. At 1,3,6,12 months postoperatively, RMS of each and total high order aberration in group B was decreased than group A , but no showed statistic significant difference. Conclusion Ultra-thin-LASIK and LASEK with ultra-thin for high myopia with relative thin cornea are all fit. Each figure of the corneal topography and wavefront aberration none showed statistic significant difference compared with each postoperative period.