我国LASIK矫正近视远期效果的文献定量分析

Evaluation of the long-term effects of LASIK correction for myopia in China

目的定量分析我国LASIK矫正近视的远期效果、预测性和安全性等。方法检索1988～2008年在中、英文数据库发表的关于LASIK矫正近视的远期效果文献,进行Meta分析。结果共有8篇中、英文文献1338例近视患者(2465眼)被纳入本研究,术后随访时间2～7年不等。Meta分析结果显示,LASIK矫正低中度近视(≤-6.0D)的效果优于矫正高度近视(>-6.0D),差异有统计学意义(OR=8.36,95%CI:6.31～11.08)。比较术后裸眼视力达到0.5(20/40)和1.0(20/20)的比例发现,在低中度近视组随访2年时分别为99.7%和92.2%,随访5～7年则分别为100%和88.8%;在高度近视组分别达84.9%和54.4%(随访2年)以及87.7%和51.0%(随访5～7年)。虽然术后裸眼视力达0.5的比例随时间变化略有增加,达1.0的比例有所降低,但差异均未显示有统计学意义。手术预测性或准确性方面,无论是低中度近视还是高度近视组,随访5年及以上的术后屈光度在±1.0D的比例较术后2年有明显降低,差异具有统计学意义(χ2=58.74,P<0.01;χ2=226.1,P<0.01);术后5～7年,屈光度在±1.0D以内的比例分别是78.5%和38.3%。术后5年以上最佳矫正视力较术前下降2行的比例为1.0%～3.4%。眩光、屈光度数回退或欠矫及术后干眼是LASIK的主要术后长期并发症。结论LASIK矫正近视的长期效果是满意的,但对高度近视者的预测性较低,尚缺乏视功能方面的远期效果研究。

Objective To evaluate the long-term efficacy and safety of laser in situ keratomileusis （LASIK） correction for myopia in China.Methods A comprehensive literature search was performed using two Chinese databases and the PubMed database.A meta-analysis was performed based on the results.Results This research study included 2,465 eyes （1,338 patients） from 8 independent studies.The follow-up period was 2 to 7 years.Meta analysis showed the efficacies in low to moderate myopia surpass that in severe myopia.The pooled odds ratios （OR, for≤-6.0 D vs 〉-6.0 D of myopia） were 8.36 （95% CI： 6.31-11.08）. During 5 to 7 years postoperatively, all eyes had 20/40 or better UCVA and 88.8% had 20/20 or better in the ≤-6.0 D myopia group. Among patients with 〉-6.0 D of myopia, 87.7% had 20/40 or better UCVA and 51.0% had 20/20 or better tJCVA. Among all patients, 78.5% and 38.3% of eyes were within ±1.0 D of the attempted corrected in low to moderate myopia and severe myopia, respectively. During 5 to 7 years postoperatively, 1.0% to 3.4% of eyes lost ≥2 lines of best spectacle-corrected visual acuity, 3.1% to 28.6% of patients reporled glare and halns at night, and 12.2% of patients reported dry eye syndrome. Conclusion LASIK surgery is effective and safe. The efficacies in low to moderate myopia are hetter than that in high myopia.