不同准分子激光手术方式治疗近视的效果分析

Analysis the treatment efficacy of choosing different surgical to correct ametropia

目的探讨准分子激光原位角膜磨镶术（LASIK）及准分子激光角膜前弹力层下磨镶术（SBK）、准分子激光个性化手术（ORK-CAM）治疗近视、散光等屈光不正的安全性并进行效果分析。方法采用德国SCHWIND公司生产的爱丽丝准分子激光手术系统对706例患者（1410只眼），其中男290例（580只眼），女416例（830只眼），年龄18-50岁，平均25岁，术前近视屈光度-1．50～8．00DS，散光-0．50～1．50DC。患者随机分为三组，分别给与LASIK、SBK、ORK-CAM进行治疗。术中测量角膜瓣厚度，术后随访两年，观察角膜知觉的恢复时间、白天及夜间视力、夜间眩光、主观眼干表现、Schirmer试验、BUT及角膜地形图进行复查。结果随访两年半，术后患者裸眼视力：LASIK矫正视力占2％，SBK至术前BCVA占2．5％，而ORK-CAM至术前BCVA占95．5％。术后角膜知觉恢复的时间：SBK平均约两个月左右，LASIK及ORK-CAM约为六个月。术后眼干的症状：SBK最轻，LASIK及ORK-CAM持续时间长。术后主诉夜间视力：LASIK下降且有眩光症状者占83％，而ORK-CAM术后占5％，SBK占12％。结论LASIK、SBK、ORK-CAM均为安全有效的屈光手术，三者相比较ORK-CAM的手术效果优于LASIK、SBK，如结合SBK及ORK-CAM手术，效果将有质的飞跃。

Objective To explore the safety and efficacy of laser in situ keratomileusis （LASIK）, sub-bowman keratomileusis （SBK） and ORK-CAM for the treatment of ametropia. Methods One thousand four hundred and ten eyes from 706 patients with myopia or astigmatism were treated with laser in situ keratomileusis （LASIK） or sub-bowman keratomileusis （SBK surgery）. Among them, male were 290 cases （580 eyes）, female were 416 cases （830 eyes）. Age was from 18-50, myopia from-1.50DS -8.00DS, astigmatism degree from-0.50DC -1.50DC. All the patients had elaborate check before the surgery, and then divided into three groups voluntary, and the patients received LASIK or SBK or ORK-CAM. During the surgery, the thick of cornea flap was measured; after the surgery, such condition was investigated： the time of recovery of corneal sensitivity, the vision in day and at night, the dazzling glare, the symptom of dry eye etc. Results Patients were followed up for more than two years. After SBK, the time of recovery of corneal sensitivity was about two months, but after LASIK or ORK-CAM about six months; uncorrected visual acuity ≥ BCVA accounted for 2% in LASIK, 2.5% in SBK, 95.5% in ORK-CAM. The symptom of dry eye was very light for SBK. And the night vision was decreased for SBK and ORK-CAM surgery. The patients had dazzling glare after surgery was about 83% for LASIK, 12% for SBK, and 5% for ORK-CAM. Conclusions LASIK, SBK, ORK-CAM for the treatment of amtropia are safe and efficacy. Compare with LASIK, SBK and ORK-CAM is more effective. The surgery efficacy will get better if combine the SBK with ORK-CAM.