LASIK治疗近视行飞秒激光与角膜刀制瓣术后视觉效果Meta分析

Femtosecond laser versus mechanical microkeratome in LASIK for myopia： A meta-analysis comparison of visual effect postoperative

目的对激光角膜原位磨镶术（LASIK）术中应用飞秒激光与角膜刀制瓣两种方式的术后屈光度、视力、波前像差进行Meta分析。方法电子检索PubMed、EM—base、CNKI、VIP、中国生物医学文献数据库及万方数据库，另检索百度文库、Google学术搜索网页及ASCRS资源库。检索时间（2004年1月1日至2013年5月14日），检索语种为中、英文，手工检索1篇韩语文献。纳入LASIK行飞秒激光与角膜刀两种制瓣方式治疗近视的对照试验，依据Cochorane系统评价方法选择实验，文献的质量评估按照Jadad量表进行评价，数据采用RevMan5．2软件进行Meta分析，对连续性变量应用加权均数差（WMD）（95％CI）分析统计量，计数资料则用优势比（OR）（95％CI）。结果共纳入19篇符合纳入标准的文献，并按Jadad量表评分。分析结果显示：两种制瓣方式分别于术后l、3个月屈光度≤±0．50D眼例数飞秒激光组稍高于角膜刀组，差异无统计学意义[MD=1．29，95％CI（0．61，2．73），P=0．50，P〉0．05]、[MD=1．28，95％CI（0．72，2．28），P=0．41，P〉0．05]；术后3、6个月裸眼视力飞秒激光组高于角膜刀组，差异有统计学意义[MD=0．04，95％CI（0．03，0．06），P〈0．01]、[MD=0．03，95％CI（0．00，0．05），P=0．03，P〈0．05]；术后3个月裸眼视力（UCVA）≥术前最佳矫正视力（BSCVA）眼例数飞秒激光组高于角膜刀组，差异有统计学意义[MD=I．70，95％CI（1．34，2．15），P〈0．01]；术后3、6个月总高阶像差飞秒激光组低于角膜刀组，差异有统计学意义[MD=-0．11，95％CI（-0．17，-0．04），P=0．0008，P〈0．05]、[MD=-0．08，95％CI（-0．13，-0．03），P=0．002]，术后3个月球差飞秒激光组低于角膜刀组，差异有统计学意义[MD=-0．05，95％CI（-0．09，-0．00），P=0．04]，术后3、6个月慧差飞秒激光组低于角膜刀组，差异有统计学意义[MD=-0．04，95％CI（-0．08，-0．01），P=0．01，P〈0．05]、[MD=-0．08，95％CI（-0．14，-0．01），P=0．02]。结论LASIK术中应用飞秒激光制瓣术后患者视觉效果稍优于角膜板层刀制瓣组。

Objective To evaluate the clinical effectiveness of femtosecond laser-assisted com-pared to microkeratome-assisted in LASIK for myopic. Methods Electronic searched of PubMed, EM-base, CNKI, VIP, SinoMed, Wanfang data, Baidu library, Google scholar and ASCRS data. Search time from January 1, 2004 to May 14, 2013 in Chinese and English. Search for study about femtosecond Laser versus mechanical microkeratome in LASIK for myopia. The randomized con-trolled trials （RCTs） were included in accordance with the Cochrane reviews methodology. The quali-ty of included literature was scored according to the Jadad Scale. The statistical analysis was per-formed using a RevMan 5.2 sol, ware. The methodological quality was evaluated by two reviewers in-dependently with weighted mean difference （WMD） for the effectiveness analysis and odds ratio （OR） for counting variable. Results Total of 19 studies were include in the meta-analysis. The re-sults showed that the total patients of manifest refraction spherical equivalent within ±0.50 diop-ters（D） at 1 month and 3 months postoperatively was not significantly different between these two groups, although the femtosecond group set slightly higher than the microkeratome group [MD=1.29, 95%CI （0.61,2.73）, P =0.50], [MD=1.28, 95%CI （0.72,2.28）, P =0.41]; the postoperative uncor-rected visual acuity （UCVA） at 3, 6 months showed that femtosecond group higher than microkera-tome group with significantly differences between groups [MD=0.04, 95%CI （0.03, 0.06）, P 〈 0.00001], [MD=0.03, 95%CI （0.00, 0.05）, P =0.03]; the percentage of eyes that postoperative UC-VA at 3 months as good as or better than the preoperative best spectacle-corrected visual acuity （BSCVA） showed that femtosecond group more than microkeratome group with significantly differenc- es between groups [MD=1.70, 95%CI （1.34, 2.15）, P 〈0.0001]; there were significantly differences in total high-order aberration （HOA） and coma aberration （CA） at 3, 6 months postoperatively be-tween groups, femtosecond group was immediately below microkeratome group, describe the se-quence showed total HOA[MD=-0.11, 95%CI （-0.17,-0.04）, P =0.0008], [MD= -0.08, 95%CI （-0.13,-0.03）, P =0.002], CA[MD=-0.04, 95%CI （-0.08,-0.01）, P =0.01], [MD=-0.08, 95%CI （-0.14,-0.01）, P =0.02]; and the spherical aberration at 3 months postoperatively also showed that femtosecond group was immediately below microkeratome group with significantly differences be-tween groups [MD= -0.05, 95%CI （-0.09,-0.00）, P =0.04]. Conclusions The LASIK that corneal flap made by femtosecond laser may get better visual effect than that by mechanical microkeratome.