飞秒激光透镜切除术矫正近视眼的临床研究

The clinical study of femtosecond lenticule extraction for myopia

目的探讨飞秒激光透镜切除术矫正近视的有效性、安全性和预测性。方法前瞻性连续病例研究。在伦理委员会同意下，入选10例（10只眼）近视眼患者，年龄在18～53岁，平均（34±11）岁。裸眼远视力0．06～0．2，最佳矫正视力0．6—1．0。等效球镜度数-4．88～-9．25DS，平均（-6．94±1．50）DS，柱镜度数0．50～3．00DC，平均（1．28±0．73）DC。角膜厚度（527．10±29．05）μm。常规围手术期检查。术后常规随访6～10个月。检测视力、眼压、屈光度、像差、角膜地形图及前节光学相干断层扫描（OCT）。结果飞秒激光透镜切除术中顺利，无扫描异常发生，术后无感染，边缘Ⅰ期愈合。末次随访裸眼远视力提高至0．6～1．2，最佳矫正视力0．7～1．2，其中较术前提高2行或以上2只眼，提高1行2只眼，不变6只眼，无最佳矫正视力下降者。术后眼屈光度数与目标屈光度数的差值平均为（-0．25±0．33）DS。角膜地形图显示无偏心，球差8只眼较术前轻度增加，2只眼下降。OCT显示手术后基质面对合良好。结论飞秒激光透镜切除术矫正中高度近视安全有效、预测性和稳定性好，飞秒激光透镜切除术后基质面对合紧密；术后像差变化规律有待进一步研究。

Objective To evaluate the clinical efficacy, safety and predictability of femtosecond lenticule extraction （FLEx） for myopia. Methods This is a prospective Clinical trial involved 10 cases （10 eyes）. The patients aged from 18 years old to 53 years old, an average of （34 ± 11） years old. Femtosecond lenticule extraction （FLEx） was used to treat myopia from - 4. 88 DS to - 9. 25 DS, an average of （ - 6. 94±1.50） DS with cylinder from 0. 50 DC to 3.0μm DC an average of （ 1.28 ± 0. 73 ） DC. Their corneal thickness were （527. 10± 29. 05 ）μm in an average. The patients were followed up for 6 to 10 months with visual acuity, manifest refraction, intraocular pressure, wavefront aberration, corneal topography and optical coherence tomography （OCT）. SPSS software was used to analysis. Results FLEx procedure was done well in every patients without any scanning problem. No infection happened to in the trial. The patients＇ UCVA improved to 0. 6-1.2 while BCVA improved 0. 7-1.2 postoperatively. BCVA improved more than 2 lines in 2 eyes whereas 1 line in 2 eyes. No eye lost BCVA. The difference between pre- and postoperative refraction was within ± 0.75 DS, an average of SE （ - 0. 25± 0. 33 ） DS. No epicenter showed in topography. Spherical aberration increased slightly in 8 eyes but decreased in 2 eyes. OCT showed that stroma bed fit to each other very well. Conclusion Femtosecond lenticule extraction appears to be efficiency, safety and predictable for myopia. Femtosecond lenticule extraction could have a good stroma fit. Its wavefront aberration changes need to further investigation. （Chin J Ophtbalmol, 2011, 47：584-588 ）