超薄角膜瓣LASIK与LASEK的观察对比

Comparison of Ultra- thin Corneal Flap LASIK and LASEK

目的通过观察对比超薄角膜瓣的准分子激光角膜原位磨镶术(laser in situ keratomlleusis,LASIK)与准分子激光角膜上皮瓣下角膜磨镶术(laser epithelial keratomlleusis,LASEK),并对术后结果进行分析,来探讨两种手术方式的效果。方法对笔者医院34例近视患者共计68眼,其中制作超薄角膜瓣后行LASIK手术的19例(38眼),设为超薄瓣组,行LASEK手术的15例(30眼),设为EK组。另外,在各组里面按照近视度数不同,分为中低度近视超薄瓣组(≤-6.00D),简称超薄瓣1组,及高度近视超薄瓣组(>-6.00D),简称超薄瓣2组;中低度EK组(≤-6.00D),简称EK1组,及高度近视EK组(>-6.00D),简称EK2组。术后进行检查,比较各组中患者手术前后的视力、术后症状及球差、慧差、高阶像差(RMSH)及低阶像差(RMSL)。结果视力恢复情况,术后第1天,超薄瓣组(86.84%)明显好于EK组(76.67%),两组差异有统计学意义(P<0.05);术后第1周及第1个月,超薄瓣组(94.74%)和EK组(93.33%)差异无统计学意义(P>0.05)。术后症状情况,术后第1天及术后第1周,超薄瓣组(13.16%)明显好于EK(26.27%)组,两组差异有统计学意义(P<0.05);术后第1月,两组差异无统计学意义(P>0.05)。手术前及手术后1个月比较,术后两组中球差、慧差、高阶像差(RMSH)及低阶像差(RMSL)均较术前有明显增加(P<0.01);在中低度近视范围内,术后球差、慧差、总体像差(RMS)的增加值,超薄瓣1组和EK1组差异无统计学意义(P>0.05);在高度近视范围内,术后球差、慧差、低阶像差(RMSL)及高阶像差(RMSH)的增加值比较(P>0.05),差异无统计学意义。结论从长期效果来看,无论是中低度近视的患者(≤-6.00D),还是高度近视的患者(≤-6.00D),超薄瓣的LASIK手术和LASEK手术,术后视力及视觉效果并没有明显的区别,但超薄瓣LASIK手术术后恢复更快,故超薄瓣的LASIK手术更具优势。

Objective To compare the ultra - thin corneal flap LASIK with LASEK. Methods Thirty four cases of 68 eyes, 38 of which underwent ultra - thin corneal flap group,another 30 cases with LASEK group, according to the different degrees of myopia, each group is divided into ultra- thin corneal flap 1 group（ ~〈 -6.00D） and high myopia ultra -thin corneal flap 2 group（ 〉 -6.00D） , and LASEK 1 group（ 〈~ -6.00D） and LASIK 2 group, comparing before and after surgery, include vision and visual quality, spherical aber- ration, coma, total aberration RMS, low order aberrations RMS, higher order aberrations RMS. Results The vision recovered better in ultra- thin corneal flap group（86.84% ）than in LASEK （76.67%）group（P 〈 0.05） 1st day after surgery, but which had no significant difference 1st week and month after surgery. The post - operative symptoms fighter in ultra - thin corneal flap group （ 13. 16% ） than in LASEK （26. 67% ）group（P 〈 0.05） , I st day after surgery,but which had no significant difference 1 st week and month after surgery. The spherical aberration, coma, total aberration RMS, low order aberrations and higher order aberrations RMS increased more significantly （P 〈 0.01） in both groups postoperative,which had no significant difference between two groups. Conclusion Though the two group had same effect postoperative, ultra -thin corneal flap LASIK recovered faster than LASEK.