PRK与LASEK治疗近视比较的Meta分析

Photorefractive keratectomy versus laser subepithelial keratectomy （LASEK） for the correction of myopia： a meta-analysis

目的系统评价和比较准分子激光屈光性角膜切削术（PRK）与准分子激光角膜上皮瓣下磨镶术（LASEK）治疗近视的疗效。方法Meta分析。按Cochrane系统评价方法，计算机检索Pubmed、EMbase、中国知网和重庆维普数据库，文献语种限制为中、英文。收集对PRK与LASEK治疗近视进行比较的随机对照试验，并按Cochrane系统评价方法选择试验、评价质量和提取有效数据．用RevMan5．0软件进行Meta分析。结果共纳入9篇随机对照试验，884只近视眼。Meta分析结果显示，PRK和LASEK治疗近视的有效性（OR=1．08，95％CI：0．62～1．89），可预测性（OR=0．81，95％CI：0．53～1．24）以及安全性差异无统计学意义。术后角膜上皮生长完整的时间（WMD=-0．04，95％CI：-0．82～0．73）及术后眼部疼痛发生率（WMD=0．41，95％CI：0．00～0．82）差异均无统计学意义。与PRK相比，LASEK术后角膜上皮下混浊程度较轻（WMD=0．23，95％CI：0．13～0．331。结论PRK和IASEK治疗近视疗效相同，但LASEK术后上皮下混浊程度较轻。

Objective To assess the clinical effectiveness of photorefractive keratectomy （PRK） versus laser suhepithelial keratectomy （LASEK） for the correction of myopia. Methods A recta-analysis of the literature was conducted that included a review of randomly controlled trials in Pubmed, EMbase, National Knowledge Infrastructure and CQVIP. Data were selected by two independent reviewers using an extraction method. The results included efficacy outcomes （UCVA≥0.8, UCVA≥1.0 postoperatively）, accuracy outcomes （proportion of eyes within ±0.50 diopters of the target refraction postoperatively）, safety outcomes （loss of ≥2 lines of BSCVA postoperatively）, mean pain scores on day 1 postoperatively, timeline for complete healing of epithelial defects and mean corneal haze scores postoperatively. The Cochrane Collaboration＇s RevMan 5.0 software was used for statistical analysis. Results Nine RCTs involving 884 eyes with myopia were included. Meta-analysis showed that the efficacy （OR=1.08, 95%CI：0.62-1.89）, accuracy （OR=0.81, 95%CI：0.53-1.24） and safety outcomes between PRK and LASEK were comparable. Compared to PRK, LASEK was better in reducing postoperative corneal haze intensity （WMD=0.23, 95%CI：0.13-0.33）. Conclusion PRK and LASEK have the same effectiveness, accuracy and safety for myopia, but LASEK results in less corneal haze intensity than PRK postoperatively.