保留与去除上皮瓣LASEK治疗近视的疗效观察

Clinical evaluation of epithelial flap retention or removal during LASEK for myopia

目的比较LASEK术中去除与保留角膜上皮瓣矫治近视的临床效果。设计前瞻性病例系列。研究对象LASEK手术患者50例(100眼)。方法对接受LASEK手术的50例(100眼)患者,术中随机去除一只眼上皮瓣为试验组,而对侧眼保留上皮瓣为对照组。术后随访6个月。主要指标角膜上皮愈合时间、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)程度。结果术后去瓣组角膜上皮愈合时间平均(3.54±0.54)天,对照组为(4.74±0.75)天(t=9.161,P=0.000);术后无痛反应去瓣组36眼(72%),对照组34眼(68%)(χ2=0.190,P=0.663);术后1周视力≥0.8者去瓣组16眼(32%),对照组5眼(10%),(χ2=7.294,P=0.007)。术后6个月裸眼视力达到或超过术前最佳矫正视力去瓣组47眼(94%),对照组48眼(96%)(χ2=0.211,P=0.646)。术后0级haze去瓣组44眼(88%),对照组45眼(90%)(χ2=0.102,P=0.749)。结论 LASEK术中去除上皮瓣治疗近视安全、有效,术后角膜上皮愈合较快、视力易恢复。

Objective To evaluate the efficacy of removing or retaining corneal epithelial flap during LASEK for myopia. Design Prospective case series. Participants 100 eyes of 50 patients who underwent LASEK from July 2006 to June 2008 were included. Methods One eye per subject during LASEK was randomly treated as removing epithelial flap and the other eye as retaining epithelial flap. All patients were followed up to 6 months. Main Outcome Measures Epithelial healing time, postoperative irritations, best corrected visual acuity, and haze intensity. Results The mean epithelial healing time was shorter in epithelial flap removal group （3.54±0.54 days） than that in epithelial flap retaining group （4.74±0.75 days） （P〈0.0001）. 32% in epithelial flap removal group or 10% in control group had visual acuity t〉0.8 at one week postoperation （P=0.007）. Subjective irritations, best corrected visual acuity and the occurrence of haze did not show difference in two groups at the 6th month. Conclusion Epithelial flap removal in LASEK for myopia was proved to be effective and safe with shorter healing time and a faster visual acuity recovering process.