飞秒激光LASIK术中开放式冲洗与闭合式冲洗疗效的对比分析

Analysis of closed and open flushing methods in femtosecond laser surgery

目的对比飞秒激光LASIK术中开放式冲洗与闭合式冲洗的疗效,以寻找更为安全的冲洗方法。方法按飞秒激光LASIK术中冲洗方法的不同将360例(700眼)患者分2组,闭合式冲洗为A组,共180例(356眼),等效球镜度数为-1.50～-10.50D,平均-7.13D;开放式冲洗为B组,共180例(344眼),等效球镜度数为-2.75～-11.00D,平均-7.04D。观察术后1d、7d、30d两组患眼视力及术后早期并发症情况,并作统计学分析。结果术后1d、7d、30d裸眼视力A组分别为5.18±0.10、5.23±0.16、5.15±0.25,B组分别为5.20±0.12、5.21±0.18、5.24±0.13,两组各时间点视力相比差异均无统计意义(均为P>0.05)。术后1d,角膜水肿A组6眼(1.7%),B组1眼(0.3%),两组角膜水肿发生率相比差异无统计学意义(P>0.05)。术后早期,层间异物残留A组32眼(9.0%),B组9眼(2.6%);角膜瓣皱褶A组32眼(9.0%),B组8眼(2.3%);弥漫性层间角膜炎A组26眼(7.3%),B组10眼(2.9%);上皮植入A组16眼(4.5%),B组2眼(0.6%);以上并发症发生率两组相比差异均有统计学意义(均为P<0.05)。结论飞秒激光术中采用开放式冲洗方法简便、安全、并发症少、疗效理想。

Objective To compare the effects of closed and open flushing methods in femtosecond laser surgery and explore the safer flushing method. Methods A total of 350 patients （700 eyes ） were divided into 2 groups by different flushing methods. A total of 180 patients（356 eyes） with closed flushing were selected as group A, whose spherical equivalent was from - 1.50 D to - 10.50 D and average was -7.13 D. 180 patients （344 eyes） with open flushing were selected as group B, whose spherical equivalent was from - 2.75 D to - 11.00 D and average was - 7.04 D. The vision and complications were observed at postoperative 1 day,7 days and 30 days and then variance analysis was performed. Results The naked vision in group A at postoperative 1 day,7 days,30 days were 5. 18 ± 0.10,5.23 ± 0. 16,5.15 ± 0. 25,group B were 5.20 ± 0. 12,5.21 ± 0. 18,5.24 ± 0. 13,so there was no significant difference at different time point（ all P 〉 0.05 ） ;At postoperative 1 day,there were 6 eyes（ 1.7% ） with corneal edema in group A and 1 eye （0. 3% ） in group B, and the two groups had no significant difference（P 〉 0.05 ） ;there were 32 eyes（9.0% ） with foreign objects of layers in group A, 9 eyes （ 2.6% ） in group B, and the two groups had significant difference （ P 〈 0.05 ） ; 32 eyes（9.0% ） with conaeal flap striae in group A,8 eyes（2.3% ） in group B,and the two groups had significant difference（P 〈 0.05 ） ;26 eyes（7.3% ） with diffuse lamellar interface keratitis in gronp A and l0 eyes （ 2.9% ） in group B, there was significant difference （ P 〈 0.05 ）. After the surgery for 7 days, there were 16 eyes （ 4.5% ） with the epithelial implantation in group A and 2 eyes（ 0.6% ） in group B, and they were significantly different（ P 〈 0.05 ）. Conclusion Open flushing adopted in femtosecond surgery is proved to be a simple and safe method with few complications and ideal curative effect.