经上皮准分子激光角膜切削术与准分子激光上皮下角膜磨镶术治疗近视眼的临床效果比较

Clinical outcomes after laser epithelial keratomileusis (LASEK)and transepithelial photorefractive keratectomy (TPRK)in myopia

目的评价经上皮准分子激光角膜切削术(TPRK)与准分子激光上皮下角膜磨镶术(LASEK)两种表层角膜屈光手术后患者疼痛程度的差异及手术效果。方法回顾性病例对照研究。收集从2015年10月至2016年9月在北京协和医院眼科和河北唐山市眼科医院行LASEK和TPRK的近视眼患者各45例,LASEK组男性29例,女性16例,年龄(21.22±4.02)岁;TPRK组男性30例,女性15例,年龄(22.51±6.18)岁。所有患者均纳入右眼进行分析。采用视觉模拟评分法对术后3d疼痛程度进行评分。术后10、30、90、180d复查视力和屈光度数,观察角膜上皮下雾状混浊(haze)程度;应用Tomey角膜地形图进行角膜规则指数检查。疼痛评分、视力采用Mann-WhitneyU检验角膜规则指数的比较采用独立样本t检验,以P<0.05为差异有统计学意义。结果LASEK组和TPRK组术后3d疼痛评分分别为1(0,3)和0(0,1)分,TPRK术后患者疼痛评分低于LASEK术后患者疼痛评分(Z=5.643,P=0.001)。LASEK组和TPRK组患者术后3d视力分别为4.80±0.10和4.97±0.07(Z=6.930,P=0.000),术后10d分别为4.98±0.08和5.05±0.06(Z=8.147,P=0.000),术后30d分别为5.02±0.05和5.06±0.06(Z=2.381,P=0.017),差异均有统计学意义。而两组术后90和180d的视力差异无统计学意义(Z=1.632,0.798;P=0.425)。LASEK组和TPRK组术后残留屈光度数较少,且随恢复时间降低,术后30d两组残留屈光度数分别为(0.17±0.19)和(0.17±0.20)D(Z=0.097,P=0.923);术后90d分别为(0.03±0.11)和(0.07±0.14)D(Z=0.166,P=0.096);术后180d分别为(0.07±0.13)和(0.07±0.14)D(Z=0.002,P=0.978),差异均无统计学意义。术后30dLASEK组合TPRK组角膜规则指数分别为0.48±0.09、0.46±0.06(t=0.88,P=0.37);术后90d分别为0.49±0.07,0.47±0.06(Z=1.53,P=0.132),两组差异均无统计学意义。两组术后均有1例(4.4%)患者出现0.5级haze,并均于术后6个月完全消退。结论TPRK较LASEK患者眼部疼痛显著减轻,早期术后视力恢复快。

Objective To compare the clinical outcomes between laser epithelial keratomileusis (LASEK) and transepithelial photorefractive keratectomy (TPRK) for treatment of myopia. Methods Case-control study. We reviewed a total of 90 right eyes that underwent either LASEK or TPRK, with 45 eyes in each group (aged between 18 and 40 years;9 males and 16 females in the LASEK group, and 30 males and 15 females in the TPRK group) from 2015 to 2016 in Peking Union Medical College Hospital and Tangshan Eye Hospital. All the patients were followed up for 6 months postoperatively. Pain, uncorrected visual acuity (UCVA), and haze were measured at postoperative 3 days, 7 days, 1 month, 3 months and 6 months, and compared using an independent Student t-test between the two groups. Degree of haze, eye pain score, and visual acuity were compared by the Mann-Whitney U test. Results At 3 days, the pain score was 1 (0,3) in the LASEK group versus 0 (0,1) in the TPRK group (Z=5.643, P=0.001). The UCVA was 4.80±0.10 in the LASEK group versus 4.97±0.07 in the TPRK group (Z=6.930, P=0.000) at 3 days, 4.98±0.08 in the LASEK group versus 5.05±0.06 in the TPRK group (Z=8.147, P=0.000) at 7 days, and 5.02±0.05 in the LASEK group versus 5.06±0.06 in the TPRK group (Z=2.381, P=0.017) at 1 month. The UCVA was also measured at 3 months, 5.07±0.07 versus 5.10±0.07 (Z=1.632, P=0.103), and at 6 months, 5.10±0.07 versus 5.11±0.07 (Z=0.798, P=0.425), respectively, with no statistical significance. The residual diopter was (0.17±0.19) D in the LASEK group versus (0.17±0.20) D in the TPRK group (Z=0.097, P=0.923) at 1 month, (0.03±0.11) D versus (0.07±0.14) D (Z=0.166, P=0.096) at 3 months, (0.07±0.13) D versus (0.07±0.14) D (Z=0.002, P=0.978) at 6 months, respectively. The surface regularity index (SRI) was 0.48±0.09 in the LASEK group and 0.46±0.06 in the TPRK group (t=0.88, P=0.37) at 1 month, and 0.49±0.07 in the LASEK group versus 0.47±0.06 in the TPRK group (t=1.53, P=0.132) at 3 months. Transient haze was documented in 1 eye in each group at 1 month (4.4%), with a maximum index of 0.5. No haze was observed in either group at 6 months. Conclusion TPRK has the advantages of faster early vision recovery and significantly less pain over LASEK.