LASEK和TransPRK及FS-LASIK术后角膜屈光力及视觉质量比较

目的:比较准分子激光上皮下角膜磨镶术(LASEK)、经上皮准分子激光角膜切削术(TransPRK)、飞秒激光制瓣的准分子激光原位角膜磨镶术(FS-LASIK)三种角膜屈光手术术后角膜屈光力及视觉质量。方法:回顾性研究。选取2021-01/2022-12在我院择期行角膜屈光手术的232例464眼患者作为研究对象,根据患者选择手术方式不同分为LASEK组70例140眼、TransPRK组76例152眼、FS-LASIK组86例172眼。比较三组患者术前,术后1、3 mo时裸眼视力(UCVA)、视觉质量、生物力学稳定性、泪膜破裂时间(BUT)、泪液分泌试验(SⅠt)及生活质量变化情况。结果:术后1、3 mo三组患者裸眼视力较术前均改善,全角膜总高阶像差、球差、水平彗差、垂直彗差均升高,生物学稳定性均降低(均P<0.05)。术后3 mo, TransPRK组、LASEK组生物学稳定性均高于FS-LASIK组(均P<0.05),TransPRK组生活质量评分较LASEK组及FS-LASIK组高(P<0.05)。手术前后三组患者BUT、SⅠt比较均无差异(均P>0.05)。结论:LASEK、TransPRK、FS-LASIK三种角膜屈光手术治疗屈光不正疗效确切,在改善裸眼视力和提高视觉质量方面结果相似,但TransPRK、LASEK较FS-LASIK具有更稳定的生物力学性能,且TransPRK组在改善患者生活质量方面具有更好的效果。

How long does the recovery of corneal sensitivity in different corneal regions take after LASEK?

AIM:To determine the corneal sensitivity recovery period after laser-assisted sub-epithelial keratectomy(LASEK)refractive surgery and investigate the effects of ablation depth on it.METHODS:In this study examinations were performed on 90 right eyes of 90 people(34 males and 56 females)with an age range of 20-35 and an average of 22.26±3.8 years old.A sensation of 5 corneal regions,including the center and 4 mid-peripheral regions,i.e.,nasal,inferior,temporal,and superior,each at a distance of 2 mm from the center of the cornea were measured with a Cochet-Bonnet esthesiometer device in 3-time points including before LASEK,1 and 3mo after the surgery,respectively.LASEK was performed on individuals with stabilized myopia of -1.00 to -7.00 diopters and astigmatism of less than 2.00 diopters.Furthermore,the individuals were divided into three groups regarding ablation depth.RESULTS:The highest level of corneal sensitivity before surgery was related to the center of the cornea(59.1±7.76),and the highest level of corneal sensitivity loss was also related to this region.The sensation of all measured corneal regions significantly reduced 1mo postoperatively and returned to their preoperative levels 3mo after surgery(mean of 5 corneal regions in levels of preoperation:58.2±6.48,1mo postoperation:57.3±5.84,3mo postoperation:58.2±5.49;P<0.05).A significant relationship was found between ablation depth and corneal sensitivity changes in the center and temporal regions(P<0.05).CONCLUSION:Corneal sensitivity in myopia and low astigmatism decreases after LASEK and reaches the preoperative level within 3mo.The depth of ablation during surgery affected the recovery of corneal sensitivity.

准分子激光原位角膜磨镶术的护理体会

目的探讨对进行准分子激光原位角膜磨镶术的患者实行手术前后的个体化护理对疗效的影响。方法对3576例(共7076只眼接受LASEK手术)患者采取个体化的健康教育及心理护理,观察患者术中的配合,术后的心理反应以及疗效。结果术前充分准备,术中配合度好,加强自我护理的能力,预防了并发症的发生,加快了术后恢复,所有患者的裸眼视力均达到术前最佳矫正视力0.6～1.5。结论实施健康教育,能使病人减少心理应激反应,增强对手术的信心,使患者术中更好地配合,掌握自我保健知识和技能,从而提高手术的效果。