Epi—LASIK治疗不同屈光度近视患者的临床评价

Clinical evaluation of different diopter myopia after epipolis laser in situ keratomileusis

背景机械法准分子激光角膜上皮瓣下磨镶术（Epi—LASIK）是一种新的角膜激光屈光手术，具有较好的临床应用价值，但手术的有效性和安全性仍有值得关注的问题。目的探讨不同屈光度近视患者行Epi—LASIK的临床疗效和手术安全性。方法采用回顾性研究，选择2008年1—9月行Epi—LASIK矫治近视并随访1年的患者共104例208眼，按术前屈光度分为低中度近视组111眼（屈光度≤一6．00D）和高度近视组97眼（屈光度〉-6．00D），分析比较2组手术眼术后的眼部刺激症状分级、上皮愈合时间及术后1、3、6个月、1年的视力、屈光度、眼压、手术安全指数、有效指数和角膜雾状混浊（haze）形成情况。结果与低中度近视组比较，高度近视组术后眼部刺激症状1级以上的眼数分别为20眼（18．02％）和29眼（29．90％），差异有统计学意义（X^2=4．060，P〈0．05）；低中度近视组和高度近视组角膜上皮愈合时间分别为（5．49±0．83）d和（5．85±0．68）d，差异有统计学意义（u=3．377，P〈0．05）；低中度近视组和高度近视组术后1年术眼的裸眼视力≥1．0者分别为101眼（90．99％）和73眼（75．26％），最佳矫正视力与术前相比提高≥1行者分别为1l眼（9．91％）和16眼（15．46％）；下降≥1行者分别为4眼（3．60％）和6眼（6．18％），残余屈光度≤±1．00D者分别为102眼（91．89％）和83眼（85．57％），安全指数分别为1．04和1．01，有效指数分别为0．98和0．96。2组间术后1年内的视力、残留屈光度、手术安全性和有效指数的差异均无统计学意义（P〉0．05）。低中度近视组6眼发生haze，高度近视组9眼发生haze，但术后1年内2组间平均haze分级的差异均无统计学意义（P〉0．05）。低中度近视组和高度近视组术后出现皮质类固醇性高眼压者分别为10眼和9眼，噻吗洛尔滴眼液点眼后恢复正常。结论Epi—LASIK术后刺激症状轻，haze的发生率低，对不同屈光度的近视眼均具有较好的预测性和稳定性，是一种安全有效的屈光矫治手术方式。

Background Epipolis laser in situ keratomihusis（Epi-LASIK） is an potential surgery for myopia because it synthesize advantages of LASEK and LASIK. But its clinical effectiveness and safeness is remarkable. Objective This study was to evaluate the clinical curative effects and safeness of Epi-LASIK for myopia in different diopter of population. Methods Retrospective study was designed for 208 eyes of 104 patients who underwent Epi- LASIK for the correction of myopia. The patients were divided into two groups according to preoperative diopter：lower myopia group（≤-6. O0 D,111 eyes）and high myopia group（ 〉-6.00 D,97 eyes）. The time of epithelial healing, postoperative syndrome, postoperative visual acuity, refraction, intraocular pressure （ IOP）, the safe index, the efficacy index and haze were evaluated at 1,3,6,12 months postoperatively. The written informed consent was obtained from each individual before surgery. Results After operation,20 eyes （ 18.02% ） of lower myopia group and 29 eyes （29.90%） of high myopia group had obvious pain, presenting statistically significant difference between two groups （X^2 = 4. 060, P〈0.05 ）. The mean time of epithelial healing was （5.49±0.83） days in lower myopia group and （5.85 ± 0. 68）days in high myopia group with a delayed epithelial healing time in high myopia group（ u= 3. 377 ,P〈0.05 ）. One year after the treatment,the uncorrected visual acuity （UCVA） ≥ 1.0 was 90. 99% （ 101 eyes） in lower myopia group and 75.26% （ 73 eyes） in high myopia group, and 9.91% （ 11 eyes） and 15.46% （ 16 eyes） of the eyes improved byl line or more in best spectacle corrected visual acuity （BCVA） ;whereas 3.60% （4 eyes）and 6. 18% （6 eyes）lost a line or more. 91.89% （ 102 eyes） and 85.57% （ 83 eyes） in both groups gained within 1. O0 D of the attempted correction. The safety index and efficacy index were 1.04 and 0.98 in lower myopia group,and 1.01 and 0.96 in high myopia group without statistically significant difference（ P〉0. 05 ）. haze occurred in 6 eyes in lower myopia group and 9 eyes in high myopia group and the difference in haze grading was not statistically significant between two groups （ P〉0. 05 ）. The high intraocular pressure appeared in 10 eyes and 9 eyes in low myopia group and high myopia grouprespectively during the fellow up duration and back to normal after topical use of timolol. Conclusion Epi-LASIK is an effective and safe method for correction of different diopters of myopia because of its mild symptom and lower incidence of haze.