超薄角膜瓣与普通角膜瓣的准分子激光原位角膜磨镶术(LASIK)的对比研究

Comparative Study and Analyses of Clinical Results between Ultra Thin-flap and Thick-flap of LASIK

目的通过观察制作超薄角膜瓣的准分子激光角膜原位磨镶术与制作普通角膜瓣的准分子激光原位角膜磨镶术(laser in situ keratomlleusis,LASIK)对术后角膜像差的影响,并对结果进行对比分析,探讨超薄角膜瓣对LASIK手术效果的影响。方法对笔者医院80例近视患者共计160眼,其中制作超薄角膜瓣后行LASIK手术的40例,设为超薄瓣组,制作普通角膜瓣后行LASIK手术的40例,设为普通瓣组。另外,在各组里面按照近视度数不同,分为超薄瓣A组(≤-6.00D)及超薄瓣B组(>-6.00D);普通瓣A组(≤-6.00D)及普通瓣B组(>-6.00D),术后1个月时进行检查,同时与各组中患者手术前的视力及球差、慧差、总体像差(RMS)、高阶像差(RMSH)及低阶像差(RMSL)进行比较。结果在手术前后的比较中,术后超薄瓣组和普通瓣组中球差、慧差、总体像差(RMS)、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,超薄瓣组手术前后的球差、慧差、总体像差(RMS)的增加值与中低度近视普通瓣组相比,差异无统计学意义(P>0.05);在高度近视范围内,超薄瓣组与普通瓣组的球差、慧差、总体像差(RMS)、低阶像差(RMSL)及高阶像差(RMSH)的增加值比较,差异无统计学意义(P>0.05)。结论制作超薄瓣和制作普通角膜瓣的LASIK手术,术后视力及视觉效果并没有明显的区别,但制作超薄瓣对于中高度近视的安全性更高,所以其值得临床应用和推广。

Objective To investigate the effectiveness of the corneal wave-front aberration through comparing Ultra Thin-Flap with Thick-Flap of LASIK （Laser in Situ Keratomlleusis）. Methods Eighty cases of 160 eyes, 40 of which underwent Ultra Thin-Flap group,another 40 cases with thick-flap group, meanwhile according to the different degrees of myopia,each group was divided into Ultra thin-flapA group（≤ -6.00D） and ultra thin-flap B group（〉-6.00D）, and thick-flap A group（≤ -6.00D） and Thick-Flap B group. We compared the two groups of patients before and first month after surgery, include vision and visual quality, spherical aberration, coma, total aberration RMS, low order aberrations RMS, higher order aberrations RMS. Results The spherical aberration, coma, total aberration RMS, low order aberrations and higher order aberrations RMS increased more significantly compared with preoperative （P〈0.01） in both ultra thin-flap group and thick-flap group month after surgery. Between the low myopia group（≤ -6.00D） and high myopia group（〉-6.00D）, the spherical aberration, coma, total aberration RMS, low order aberrations and higher order aberrations RMS had no significient difference compared with two group（P〉0.05）. Conclusion The visions and visual quality of ultra thin-flap group were not better than which in the Thick-Flap group postoperative, and ultra thin-flap with LASIK is more safety and effectively thanThick-Flap.