游离上皮瓣Epi-LASIK治疗近视的临床研究

Clinical study of free-flap Epi-LASIK in treatment of myopia

目的:前瞻性研究游离上皮瓣Epi-LASIK手术的临床效果及其愈合机制。方法:近视患者27例54眼,随机将1眼做游离上皮瓣的Epi-LASIK作为实验组(A组)。另1眼为标准的Epi-LASIK作为对照组(B组)。观察角膜刺激症状、疼痛分级、角膜上皮愈合时间、裸眼视力、屈光度、眼压、haze分级等,随访6mo以上。结果:疼痛分级A组1～3(平均2.2)级,B组1～3(平均2.3)级。眼异物感持续时间:A组1～3(平均2.2)d;B组1～3(平均2.9)d。上皮愈合时间A组3～6(平均4.4)d;B组5～7(平均5.8)d。术后6mo裸眼视力(UCVA)较术前最佳矫正视力(BCVA)下降1行者两组各有1眼(4.0%),其余52眼(96.0%)均达到或高于术前BCVA。无BCVA下降者。术后屈光度(等效球镜度数)A组-0.50～+0.75(平均0.28±0.27)D;B组-0.25～+0.68(平均0.23±0.26)D。haze分级A组≤0.5级者19眼(70.4%),1级者8眼(29.6%);B组≤0.5级18眼(66.7%),1级9眼(33.3%)。两组均无haze≥2级者。结论:游离上皮瓣的Epi-LASIK与普通Epi-LASIK都具有良好的安全性、预测性和屈光稳定性,但游离上皮瓣的Epi-LASIK明显缩短了术后刺激症状的持续时间,加快了视力恢复,舒适性更好。

AIM： To analyze the therapeutic effects and clinical characteristics of free- flap epipolis laser in situ keratomileusis （Epi-LASIK）. METHODS： In this prospective case-series study, 27 eyes of 27 myopic and myopic astigmatism patients underwent Epi-LASIK with free-flap as group A and the other 27 eyes underwent standard Epi-LASIK as group B. Symptoms, slit-lamp examination, uncorrected visual acuity （UCVA）, spherical equivalent refractive error, intraocular pressure, haze were observed in these patients in 6-month follow-up period. RESULTS： Pain grade： Group A 1 to 3, with an average of 2. 2; Group B 1 to 3, with an average of 2. 3. Eye sensation duration： 1 to 3 days in group A, an average of 2.2 days; Group B 1 to 3 days, an average of 2.9 days. Epithelial healing time： group A was 3 to 6 days, an average of 4.4 days; 5 to 7 days in Group B, with an average of 5.8 days. Compared with the preoperative best- corrected visual acuity （BCVA）, after six months, 1 （4.0%） eye in each group was with UCVA lower than one line, and the remaining 52 （96.0%） were at or higher than the preoperative BCVA. No BCVA declined. Diopter （spherical degree） group A -0.5D±0.75D equivalent, an average of 0.28±0.27D; group B -0.25D ±0.68D, with an average 0. 23±0. 26D. Haze grading less than or equal to 0. 5 in 19 （70.4%） eyes in group A, grade 1 in eight （29.6%） ; group B was with less than or equal to grade 0.5 in 18（66.7%）, grade 1 in nine （33. 3%） . There were no haze grade higher than or equal to 2. CONCLUSION： Both the free-flap Epi-LASIK and the ordinary Epi-LASlK have safety, predictive and refractive stability, but the free-flap Epi-LASIK surgery significantly shortened the time of stimulating symptoms and improve the recovery of visual acuity.