角膜瓣蒂在上方与鼻侧的LASIK远期疗效比较

Comparison of Long-term Effects of LASIK with Upper andNasal Corneal Flaps

[目的]探讨角膜瓣蒂在上方的准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)治疗近视的远期效果。[方法]选用旋转式角膜刀制作上方蒂角膜瓣LASIK 418例(804眼),用平推式角膜刀制作鼻侧蒂角膜瓣LASIK 108例(202眼),对两组蒂部不同位置的角膜瓣进行疗效比较。[结果]术后2年裸眼视力上方和鼻侧蒂组分别为(5.01±0.15)和(5.00±0.13),两组无明显差异(P>0.05)。与制作角膜瓣有关的并发症发生率上方蒂组低于鼻侧蒂组,切缘出血上方蒂组大大减少(P<0.005),干眼症发生率术后早期上方蒂组高于鼻侧蒂组,3月后两组均降低并无明显差异(P>0.05)。[结论]上方和鼻侧蒂组均具有良好的术后效果,远期随访2年两组无明显差异,但在角膜瓣稳定性上,上方蒂优于鼻侧蒂。

[Objective] To evaluate the long-term effects of laser in situ keratomileusis (LASIK) with upper pedicle of corneal flaps on the correction of myopia. [Methods] LASIK were performed on 804 eyes of 418 cases with upper pedicle (UP) of corneal flap using rotating microkeratome and on 202 eyes of 108 cases with nasal pedicle (NP) of corneal flap using oscillating microkeratome . The effects were compared between 2 groups based on the pedicle positions of corneal flaps. [Results J The uncorrect-ed postoperative visual acuities of UP group and NP group were (5. 01±0. 15) and (5. 00±0. 13) repec-tively, after 2 years , there was no significant difference between them ( P > 0. 05) . In UP group, the incidence of complications which related to corneal flaps was lower , and the rate of bleeding in the cut edge was also much lower ( P < 0. 005). But the rate of dry eye syndrome (DES) during early phase of operation was higher. After 3 months , the rate of DES was lower and the difference between 2 groups was not significant. [Conclusion] LASIK operations with UP and NP are both effective, and there is no significant difference between them in two years follow-up period. However the UP group is superior to the NP group on the operative stability of corneal flap.