LASIK术后5年结果分析

Five-year evaluation of laser in situ keratomileusis for myopia

目的评价准分子激光原位角膜磨镶术（LASIK）治疗近视眼的远期疗效。方法回顾性系列病例研究。选取LASIK术后随访≥5年资料完整者68例（125眼），根据术前等效球镜度分为低中度近视组76眼，等效球镜度-0．75-6．00（-3．79±1．41）D；高度近视组49眼，等效球镜度-6．12-13．25（-8．13±1．35）D。术后1个月、6个月、1年、5年检查裸眼视力（UCVA）、最佳矫正视力（BCVA）、裂隙灯、角膜地形图和眼底情况，最后一次复查填写满意程度问卷调查表。对数据进行x2检验、配对样本t检验。结果低中度近视组和高度近视组术后5年裸眼视力≥0．5的比例分别为100％和96％；术后5年等效球镜度在±1．00D范围的比例分别为93％和84％：术后最后一次复查最佳矫正视力没有变化或增加的占82％眼（103／125）；术后5年等效球镜度分别为（-0．02±0．65）D和（-0．33±0．80）D，与术后1年比较差异均无统计学意义；l眼术中发生部分游离瓣，1眼术后发生上皮植入，8眼进行了增效手术；两组术后1，5年问均没有出现与手术相关的并发症。患者的满意程度较高。结论LASIK手术治疗近视术后5年有较好的有效性、安全性和满意度，手术并发症少，术后5年屈光度稳定，远期没有手术相关的并发症发生。

Objective To evaluate long-term refractive outcomes of laser in situ keratomileusis （LASIK） for all levels of myopia. Methods This was a retrospective case series study. One hundred twenty-five eyes of 68 patients who underwent LASIK for myopia and completed over 5 years of follow-up were included in the study. Based on the preoperative spherical equivalent refraction, the eyes were divided into 2 groups. Group A eyes ranged between -0.75 and -6.00 diopters （D） （mild-to-moderate myopia）. Group B eyes ranged between -6.12 and -13.25 D （severe myopia）. Before and at 1 month, 6 months, 1 year and 5 years after the operation, uncorrected visual acuity （UCVA）, best corrected visual acuity （BCVA）, slit-lamp biomicroscopy of the anterior segment, indirect ophthalmoscopy and topography were measured. At the time of the last follow-up, all patients completed a questionnaire assessing their satisfaction with the procedure. Data were analyzed using ~2 test and paired t test. Results Uncorrected visual acuity I〉0.5 in groups A and B was obtained in 100% and 96% of eyes, and spherical equivalent refraction within _＋1.00 D was obtained in 93% and 84% of eyes at 5 years. Spherical equivalent refraction in groups A and B was -0.021＋0.65 D and -0.33＋0.80 D, respectively, at five years. The differences compared with 1-year outcomes after the operation were not statistically significant. BCVA was unchanged or improved in 82% of all eyes （103/125）. Overall, only 1 epithelial ingrowth and 1 free partial flap were identified as complications from LASIK. Refraction did not regress in either group between 1 and 5 years. Late-onset complications attributable to LASIK were not observed at the 5-year follow-up, and patient satisfaction with the procedure was high. Conclusion A long-term follow-up study of patients after undergoing LASIK for myopia shows it is a safe and effective procedure in correcting all levels of myopia.Complications were rare and patient satisfaction with the surgery was high. Refractive stability was maintained over the 5-year period. Late-onset complications attributable to LASIK were not noted.