SBK和LASEK手术治疗高度近视的疗效和对眼表的影响

Clinical Effect of SBK and LASEK in Correcting High Myopia&Impact on Tear Film Stability and Ocular Surface

目的观察准分子激光前弹力层下角膜磨镶术(Bowman keratomileusis,SBK)和准分子激光上皮下角膜磨镶术(laser epithelial keratomileusis,LASEK)矫正高度近视的临床效果和对眼表的影响。方法前瞻性试验研究,选取2018年3月至2019年6月,高度近视患者110例212只眼,按照手术方式不同分为SBK组患者67例130只眼和LASEK组患者43例82只眼。术后1、3和6个月,比较两组患者视力和屈光度,进一步分析两组泪膜稳定性包括泪膜破裂时间(tear break-up time,BUT)、泪液分泌实验(SchirmerⅠtest,SIT)、角膜荧光素染色(Fluorescein stain test,FL)分数改变,采用眼表疾病指数量表(Ocular Surface Disease Index,OSDI)评价干眼指数的变化,同时观察术后并发症发生情况。结果术后1、3和6个月,两组间视力和残留屈光度比较,差异无统计学意义(P>0.05)。术后6个月两组BUT,SIT和FL分数与术前比较,差异无统计学意义(P>0.05);两组BUT,SIT和FL分数术后6个月分别与术后1、3个月比较,差异具有统计学意义(P<0.05)。术后1、3个月两组OSDI干眼评分比较,差异具有统计学意义(P<0.05);术后6个月比较差异无统计学意义(P>0.05)。两组术后无严重并发症发生。结论LASEK和SBK手术治疗高度近视可以获得了良好的视力并且屈光度数稳定,术后泪膜稳定性和眼表状态恢复快,是两种安全有效的治疗方法。

Objective To explore the clinical effect of Sub Bowman keratomileusis(SBK)and laser epithelial keratomileusis(LASEK)in correcting high myopia and their impact on tear film stability and ocular surface.Methods Totally 110 patients(212 eyes)with high myopia treated during the period from Mar.2018 to Jun.2019 were selected as the research subjects.They were divided into the SBK group and LASEK group by surgical methods,67 cases(130 eyes)in the SBK group and 43 cases(82 eyes)in the LASEK group.The normal vision acuity and residual diopter were compared between the two groups.The influence on the stability of tear film and score of Ocular Surface Disease Index(OSDI)were observed and compared between the two group.Results There was no significant difference in vision acuity and residual diopter between two groups(P>0.05)1,3 and 6 months after the operation.In addition,the differences between the two groups in BUT,SIT and FL were not remarkable.For both groups,the BUT,SIT and FL obtained 6 months after the operation were statistically different from those obtained 1 and 3 months after the operation(P<0.05).There was no significant difference between the two group in scores of OSDI before and 1,3 and 6 months after the operation(P>0.05).Conclusions SBK and LASEK are equally safe and effective in correcting high myopia.For the two methods,no apparent difference exists in postoperative tear film stability and ocular surface.