准分子激光上皮瓣下角膜磨镶术治疗近视的临床疗效观察

Curative effects of laser-assisted subepithelial keratectomy for myopia

目的探讨准分子激光上皮瓣下角膜磨镶术（laser-assisted subepithelial keratectomy，LASEK）治疗近视的临床疗效。方法，对我院134例（227眼）近视患者行LASEK治疗，术后统一配戴软性角膜接触镜、药物滴眼，观察术后症状及角膜上皮愈合情况，记录术后2周、1个月、3个月、6个月、12个月裸眼及最佳矫正视力、屈光度，并观察术后第3周、第4周的眼压及角膜上皮下雾状混浊（haze）发生情况。结果术后第1天，195眼（85．90％）可自然睁眼；32眼（14．10％）结膜充血，有异物感伴流泪，均于2～3d后消退；29眼（12．78％）自诉有视物易疲劳、酸胀感、眩光、夜视力下降等不适。术后3个月裸眼视力在0．5以上者226眼，0．8及以上者164眼。术后第3周haze总发生率为18．94％（43眼），第4周为25．11％（57眼），均为1级或以下，经增加局部激素用量及延长用药时间，3个月后haze均消退。术后第3周激素性高眼压发生率为0．88％（2眼），第4周为1．76％（4眼），随着激素滴眼次数减少及局部滴降眼压药物后，眼压均降至14mmHg（1kPa=7．5mmHg）以下。结论LASEK是治疗近视的有效方法，其融合了PRK、LASIK的优点，但仍待进一步研究。

Objective To investigate the curative effect of laser-assisted subepithelial keratectomy （LASEK） for myopia. Methods A total of 134 myopic patients （227 eyes） in our hospital were taken LASEK,worn soft contact lens and treated with eyedrops. Postoperative symptoms and condition of corneal epithelial healing were observed. Uncorrected visual acuity, best corrected visual acuity and diopter were observed at postoperative 2 weeks,1 month,3 months,5 months and 12 months. Intraoculax pressure and haze were observed at the postoperative 3rd week and 4th week. sults At the postoperative 1st day, 195 eyes （85.90%） could open normally, 32 eyes （ 14.10% ） were with conjunctival hemorrhage,foreign body sensation and bleeding,but all symptoms decreased 2 days to 3 days later. About 29 eyes （ 12.78% ） of patients were complained of asthenopia, soreness, glare, decreased night vision and other discomfort able sensations. At postoperative 3 months, there were 226 eyes with uncorrected visual acuity more than 0.5 ,and 164 eyes with 0. 8 or more. Incidence rates of haze were 18.94% （43 eyes） at the postoperative 3rd week,and 25.11% （57 eyes） at the postoperative 4th week. Both were at 1 stage or lower, and haze was resolved at 3 months after adding doses of local hormone. The incidence rates of harmonic hyperten-sion were 0.88% （2 eyes） at the postoperative 3rd week,1.75% （4 eyes） at the postoperative 4th week. With the decreasing time of dropping hormone and local lowering intraocular pressure drugs ,intraocular pressure was lowered to 14 mmHg or less （ 1 kPa = 7.5 mmHg）. Conclusion LASEK is an effective treatment for myopia. It has the advantages of PRK and LASIK and discards their inadequacies, but more studies are needed.