无酒精LASEK治疗近视和近视散光的临床疗效

Clinical efficacy of alcohol-free LASEK on myopia and myopic astigmatism

目的对比无酒精准分子激光上皮瓣下角膜磨镶术(laser-assisted sub-epithelial keratectomy,LASEK)与常规LASEK治疗近视和散光的有效性和安全性。方法选取术前角膜接触镜配戴史小于1个月的中低度近视和散光(球镜≤-8.00 D,散光≤5.00 D)患者86例(172眼),其中39例行无酒精LASEK(无酒精组),47例行常规LASEK(酒精组)。术后1周、2周、1个月、3个月检测两组患者裸眼视力、屈光度数和角膜上皮下雾状混浊。术后1 d、3 d检查刺激症状,1周内观测角膜上皮愈合时间。结果术后1周,无酒精组视力≥0.5者70眼(89.7%),酒精组视力≥0.5者73眼(77.7%),差异有统计学意义(P=0.035)。术后2周,无酒精组和酒精组全部患者视力均≥0.5,无酒精组视力≥0.8者76眼(97.4%),酒精组视力≥0.8者78眼(83.0%),差异有统计学意义(P=0.002);术后2周无酒精组视力≥1.0者69眼(88.5%),酒精组视力≥1.0者70眼(74.5%),差异有统计学意义(P=0.020)。术后各时间点两组患者球镜和柱镜度数差异均无统计学意义(均为P>0.05)。术后无酒精组角膜上皮愈合时间为(3.51±1.14)d,酒精组为(4.29±2.06)d,差异有统计学意义(P=0.003)。术后两组间第1天刺激症状差异有统计学意义(P=0.008),而术后两组间第3天的刺激症状差异无统计学意义(P=0.301)。术后3个月两组间角膜上皮下雾状混浊形成差异无统计学意义(P=0.480)。结论无酒精LASEK在术后早期视力恢复、角膜上皮修复以及减轻刺激症状方面优于常规LASEK,因此,其对角膜接触镜配戴史小于1个月的中低度近视患者是一种安全、有效的治疗方法。

Objective To compare the efficacy and safety of alcohol-free laser- assisted sub-epithelial keratectomy（LASEK） and conventional LASEK treating myopia and myopic astigmatism. Methods With the history of contact lens wearing shorter than 1 month, 86 patients （ 172 eyes ） with low to moderate myopia （ spherical lens ≤ - 8.00 D, astigmatism≤ 5.00 D） were selected, of which 39 patients （ 78 eyes） received alcohol-free LASEK （ alcohol-free group ）, 47 patients （ 94 eyes ） received conventional LASEK（ alcohol group）. Uncorrected visual acuity （UCVA）, refractive diopter and haze were measured at 4 points-in-time：1 week,2 weeks, 1 month and 3 months after the op- eration. Corneal irritation symptom was examined 1 day and 3 days after the operation. Corneal epithelial healing time was also monitored on the dally basis within 1 week after the operation. Results At the 1st point-in-time,proportion of eyes with UCVA≥0.5 in alcohol-free group （ 89.7% , 70 eyes） were significantly higher than that in alcohol group（77. 7% ,73 eyes） （P = 0.035 ）. At the 2nd point-in-time, all eyes have a UCVA≥ 0. 5 ,proportion of eyes with UCVA≥0.8 in alcohol-free group（97.4% ,75 eyes） were significantly higher than that in alcohol group（ 83.0% ,78 eyes） （P = 0.002 ） ;Proportion of eyes with UCVA≥ 1.0 in alcohol-free group（88.5% ,69 eyes） were significantly high- er than that in alcohol group （ 74.5% , 70 eyes） （ P = 0. 020 ）. No significant difference was found between diopter of spherical power, diopter of cylindrical power of the two groups at any point-in-time（ all P 〉 0.05 ）. Corneal epithelial healing time of alcohol-free group was（3.51 ± 1. 14）days and that of alcohol group was（4.29 ± 2.06）days;There was significant difference （P = 0. 003 ）. Corneal irritation symptom of the two groups were significantly different from each other 1 day after the operation （P = 0. 008 ）, but they were not 3 days after the operation （P = 0.301 ）. At the 4th point-in-time, haze of the two groups were not significantly different from each other （P = 0. 480）. Conelu- slon Alcohol-free LASEK is superior to conventional LASEK with regard to UCVA re-covery, corneal epithelium healing, and irritation symptom alleviation at the early period or postoperation, and thus a sate an（1 effective treatment for patients with low to moderate myopia, whose history of contact lens wearing are shorter than 1 month.