飞秒激光制作不同大小角膜瓣LASIK手术治疗近视的临床疗效分析

FS-LASIK with small corneal flap versus big corneal flap for myopia

目的评价飞秒激光制作不同大小角膜瓣准分子激光原位角膜磨镶术（laser-assisted in situ keratomileusis,LASIK）治疗近视的临床疗效。方法回顾性分析飞秒激光制瓣LASIK手术患者的临床资料,根据角膜瓣大小分为两组对患者展开随访,角膜瓣直径〉8.8~9.2 mm为大角膜瓣组,〉8.3~8.8 mm为小角膜瓣组,比较两组术后6个月视力、高阶像差、对比敏感度和眩光对比敏感度。共有222例（441眼）患者完成了随访,其中大角膜瓣组107例（212眼）,小角膜瓣组115例（229眼）。结果术后6个月裸眼视力大角膜瓣组为1.03±0.11,小角膜瓣组为1.04±0.13,2组差异无统计学意义（P〉0.05）;等效球镜大角膜瓣组为（0.44±0.54）D,小角膜瓣组（0.34±0.47）D,2组差异无统计学意义（P〉0.05）。术后6个月大角膜瓣组彗差（0.26±0.10）小于小角膜瓣组（0.32±0.11）,2组差异有统计学意义（P〈0.05）。眩光对比敏感度在18.0 c·d-1空间频率下大角膜瓣组优于小角膜瓣组,2组差异有统计学意义（P〈0.05）。结论飞秒激光辅助制瓣LASIK治疗近视,大角膜瓣更有优势。

Objective To investigate the effects of different flap sizes on clinical outcomes after the FS-LASIKK. Methods The clinical data of patients who underwent LASIK with flap creation using the femtosecond laser was retrospectively reviewed. Patients receive treatment with 8. 8- 9. 2 mm diameter corneal flap as the big flap group,and 8. 3- 8. 8 mm diameter corneal flap as the small flap group. Visual acuity,higher-order aberrations,contrast sensitivity and glare contrast sensitivity were compared between the two groups at 6 month postoperatively. Four hundred forty-one eyes of 222 patients were included,and 212 eyes of 107 patients were defined as the big flap group,and 229 eyes of 115 patients as the small flap group. Results Six months postoperatively,the visual acuity of the big flap group was 1. 03 ± 0. 11,and the small flap group was 1. 04 ± 0. 13（ P〈0. 05）; SE of the big flap group was（ 0. 44 ± 0. 54） D,the small flap group was（ 0. 34 ± 0. 47） D（ P〈0. 05）; The coma aberration of the big flap group was 0. 26 ± 0. 10,and the small flap group was 0. 32 ± 0. 11（ P〈0. 05）. The glare contrast sensitivity at the spatial frequency of 18. 0 c·d- 1of the big flap group was lower than that of the small flap group（ P 0.05）. Conclusion On the FS-LASIK surgery,the clinical outcome of big flaps is better than that of small flaps.