飞秒辅助不同角膜瓣蒂位置的准分子激光角膜磨镶术治疗近视疗效比较

Comparison of the results with superior and nasal hinge of corneal flaps created by femtosecond laser-assisted LASIK for myopia

目的比较不同角膜瓣蒂位置飞秒准分子激光原位角膜磨镶术（FS-LASIK）治疗近视后的术后视力、像差及干眼程度。方法临床病例系列研究。对2014年5~12月在浙江大学医院附属第二医院眼科中心采取制作角膜瓣蒂右眼于鼻侧，左眼于上方的对照研究，比较在行飞秒准分子激光原位角膜磨镶术患者22例44只眼，平均年龄（20.82±3.46）岁。其中男性11例，女性11例，分别于术前、术后1周、术后1月、术后3月行视力、屈光度检查、波前像差检查，应用Oculus眼表综合分析仪客观评价泪河高度、非侵袭式第一次泪膜破裂时间、平均泪膜破裂时间，以及Schirmer I test和主观症状（McMonnies Questionnaire）评分。结果患者术后1周、术后1月、术后3月裸眼视力鼻侧蒂眼分别为5.050±0.086，5.096±0.084，5.109±0.111，上方蒂眼分别为5.036±0.090，5.052±0.116，5.082±0.130差异无统计学意义（P=0.610，0.166，0.457），残余屈光度鼻侧蒂眼分别为0.046±0.166，0.011± 0.053，0.068±0.220，上方蒂眼分别为0.014±0.121，0.046±0.227，0.034±0.178差异无统计学意义（P= 0.202，0.496，0.575），高阶像差鼻侧蒂眼分别为0.522±0.148，0.508±0.189，0.540±0.136，上方蒂眼分别为0.508±0.141，0.555±0.168，0.548±0.151差异无统计学意义（P=0.756，0.390，0.843）泪河高度鼻侧蒂眼分别为0.208±0.065，0.206±0.056，0.211±0.060，上方蒂眼分别为0.213±0.091，0.195± 0.059，0.216±0.067差异无统计学意义（P =0.850，0.530，0.760）非侵袭式第一次泪膜破裂时间鼻侧蒂眼分别为6.096±3.528，6.861±4.694，6.631±3.516，上方蒂眼分别为6.190±3.751，5.740±4.274，7.436±4.363差异无统计学意义（P=0.932，0.412，0.504）非侵袭式平均泪膜破裂时间鼻侧蒂眼分别为8.553± 3.486，8.838±5.104，9.130±4.047，上方蒂眼分别为7.986±3.676，8.284±4.384，9.130±4.047（P= 0.602，0.701，0.677）差异无统计学意义，Schirmer I test鼻侧蒂眼分别为13.140±8.768，15.140±9.213，13.410± 9.122，上方蒂眼分别为12.270±9.686，13.860±8.860，14.500±8.573（P=0.758，0.643，0.685）差异无统计学意义，McMonnies Questionnaire鼻侧蒂眼分别为7.950±2.952，8.140±2.624，6.631±3.516，上方蒂眼分别为为8.090±2.724，5.740±4.274，7.436±4.363（P =0.874，0.864，0.647）鼻侧蒂和上方蒂眼差异无统计学意义（P〉0.05）。结论飞秒准分子激光原位角膜磨镶术角膜瓣蒂位于鼻侧和上方对于术后视力、像差及干眼程度差异无统计学意义。

Objective To compare curative evaluation with superior and nasal hinge of corneal flaps on visual acuity, refraction, higher order aberration and dry eye after femtosecond laser-assisted LASIK for myopia. Methods A self contra-lateral eye study. A total of 22 patients （44 eyes） who had undergone femtosecond laser-assisted LASIK for myopia were enrolled in this study. Patients were divided into two groups based on the hinge positions of corneal flaps. Visual acuity, refraction, higher order aberration, height of tear meniscus, non-invasive tear break-up time （NIBUT）, McMonnies Questionnaire was recorded preoperatively and postoperatively at 1 week and 1 month and 3 months. Results No significant differences were observed in any of the parameters between left and right eyes at any time point （P 〉0.05）. Conclusions Different hinge positions of corneal flaps had no significant difference on visual acuity, refraction, higher order aberration, dry eye after femtosecond laser-assisted LASIK for myopia.