飞秒激光制瓣LASIK与前弹力层下LASIK矫正远视散光的效果比较

Comparison of femtosecond laser assisted LASIK and sub-Bowman keratomileusis in the correction of hyperopia with astigmatism

目的比较飞秒辅助准分子激光原位角膜磨镶术（Fs—LASIK）及前弹力层下激光角膜磨镶术（SBK）矫正远视散光的效果。方法设计前瞻性病例系列。研究对象：Fs—LASIK矫正远视散光27眼及SBK矫正远视散光者27眼，远视度为＋1．50-＋6．50D，散光数＋1．00-＋6．00D。分别于手术前和手术后6个月检查视力、屈光状态、眼前段、眼底、眼压、角膜厚度、角膜地形图和同视机双眼视功能。结果至术后6个月，平均残余屈光度为（旬．314-0．68）D，88．1％的术眼屈光度在±0．75D以内，91．5％的术眼裸眼远视力达到0．4及以上，裸眼近视力达到0．5及以上。术眼屈光度等效球镜度术前为＋1．50-＋6．50D，Fs—LASIK术后降到-0．124-0．56D，SBK术后降低到-1．00±0．64D。近视力术前为0．16～0．25，Fs—LASIK术后提高到0．56±0．12；SBK术后提高到0．45-4-0．23；手术前后的屈光度差异均有统计学意义，两种手术方式术后戴框架眼镜时三级视功能较术前明显增加（P〈0．05）。结论Fs—LASIK和SBK矫治远视散光，不仅可提高裸眼视力，而且可通过减小双眼间的屈光差异，增加双眼物像的融合，改善立体视功能。这两方面Fs—LASIK术后比SBK术后恢复快，两者差异有统计学意义。Fs—LASIK比SBK更有效，两者差异有统计学意义。

Objective To compare the efficacy of femtosecond laser assisted LASIK （Fs-LASIK） and sub-Bowman-keratomileusis （SBK） for patients with hyperopia and astigmatism. Methods A prospective study was designed. Twenty-seven eyes receiving Fs-LASIK and 27 eyes receiving SBK for the correction of hyperopia with astigmatism were enrolled in this study. The hyperopia of all patients were （ ＋ 1.50 - ＋ 6.50） D, and astigmatism were （ ＋ 1.00 - ＋ 6.00） D. The visual acuity, refraction, ocular anterior segment, fundus, intraocular pressure, corneal thickness, corneal topography and binocular visual function were measured before and 6 months after the surgery. Results Six months after the surgery, the average residual refractive error was （ -0.31 -＋ 0.68 ） D. The percentage of the patients whose refraction was within -＋ 0.75 D was 88.1%, and the percentage of the patients with uncorrected distant visual acuity better than 0.4 and uncorrected near vision better than O. 5 was 91.5%. The refractive spherical equivalent degree of hyperopic astigmatism in patients with Fs-Lasik surgery reduced to post operative （ - 0.12 - - 0.42 ） D, and （ - 1.00 ＋-0.64） D in patients with SBK surgery. The near vision improved from preoperative （0.16 0.25 ） to （0.56 -＋ 0.12） in patients with Fs-LASIK, and increased to （0.45 ＋- 0.23 ） in patients with SBK. The differences were statistically significant in diopter changes between preoperation and postoperation （ P 〈 0.05 ）. The fusion and far stereopsis was improved in patients with glasses after the two kinds of surgery （ P 〈0. 05 ）. Conclusion Femtosecond assisted LASIK and SBK surgery for hyperopic astigmatism can improve uncorrected visual acuity, and improve binocular image fusion and stereopsis through reducing the refractive difference of two eyes. The Fs-LASIK is more effective than SBK with quicker recovery.