角膜瓣的旋切式与平切式对LASIK效果的影响

Comparison of the rotating and oscillating microkeratomes in LASIK

目的 :探讨旋切式与平切式角膜瓣对 L ASIK效果的影响。方法 :随机选用平推式角膜刀制成平切式角膜瓣后行 L ASIK手术16 0例 30 5眼 ,用旋切式角膜刀制成蒂在上方的旋切式角膜瓣后行 L ASIK手术 2 0 2例 386眼 ,随访 6个月。对两组不同类型角膜瓣的术后裸眼视力、术中及术后早期并发症进行分析比较。结果 :术后第一天 ,高度近视组的裸眼视力旋切组显著优于平切组(p<0 .0 5 ) ,术后第十天和一个月超高度近视组的裸眼视力旋切组明显高于平切组 (p<0 .0 5及 p<0 .0 1) ,术后三个月、六个月各组间无显著性差异 ;与微型角膜刀相关的并发症发生率旋切组多于平切组 ,但切缘出血旋切组大大减少 (p<0 .0 0 0 1) ,旋切组术后仍有 1例角膜瓣漂移。结论 :蒂在上方的旋切式角膜瓣术后视力恢复快 ,术中切缘出血少 ,术中角膜瓣对复位容易 。

Objective: To compare the clinical results of LASIK with different corneal flaps by rotating and oscillating microkeratomes. Methods: According to randomized fashion, LASIK were performed on 305 eyes of 160 cases with oscillating corneal flap (OCF) using oscillating microkeratome and on 386 eyes of 202 cases with rotating corneal flap (RCF) using rotating microkeratome. All of them were followed up for six months. Their postoperative naked visual acuity, the intraoperative and early postoperative complications between two types of the corneal flap were analyzed and compared. Results: At the first day after surgery, the mean of naked visual acuity in the cases with RCF was significantly better than that in the cases with OCF in the high myopia group (p < 0. 05). At the tenth day and the first month, the mean of naked visual acuity in the cases with RCF was also significantly better than that in the cases with OCF in the extreme myopia group (P < 0. 05, P < 0. 01; respectively). There were no market differences between the two types in the other time. In RCF group, the incidence of the complications related to microkeratome was higher, but the rate of bleeding in the cut edge was much lower (p < 0. 001). There was still one eye in which the corneal flap drifted in RCF group. Conclusion: Faster visual recovery, almost no bleeding in the cut edge, easier flap paraposition and reposition were found in the RCF group with superior hinge. Various intraoperative complications, however, were still met and postoperative sliding flap could not be effectively prevented in the patients with RCF procedure.