SBK与Epi-LASIK治疗高度近视疗效比较

目的 探讨准分子激光前弹力层下角膜磨镶术(sub-Bowman keratomileusis,SBK)和机械法准分子激光上皮瓣下角膜磨镶术(epipolis laser in situ keratomileusis,Epi-LASIK)矫治高度近视的疗效.方法 对91例(182只眼)高度近视患者进行SBK或Epi-LASIK手术.其中53例(106只眼)行SBK术,38例(76只眼)行Epi-LASIK术.记录两组患者术后视力、残余屈光度、角膜上皮下. 雾状混浊(haze)情况,对结果进行统计学分析.结果 术后早期Epi-LASIK组有轻度或中度不适感.两组患者术后6个月经角膜地形图检查均无角膜扩张出现.术后1周时SBK组视力＞0.8眼数比例(77.4％)明显大于Epi-LASIK组(46.1％),两组比较差异有统计学意义(P＜0.05),术后早期SBK组较Epi-LASIK组视力恢复快;术后l、3、6个月SBK组视力≥0.8眼数比例(92.5％、95.3％、94.3％)与Epi-LASIK组(85.5％、94.7％、90.8％)比较差异无统计学意义(均为P＞0.05).术后1、3、6个月残余屈光度等效球镜SBK组[(-0.24±0A2)D、(-0.38±0.51)D、(-0.40±0A6) D]与Epi-LASIK组[(-0.32±0.40)D、(-0.44±0.60)D、(-0.52±0.55)D]比较差异无统计学意义(均为P ＞0.05).两组均无明显屈光回退发生.SBK组术后未见haze产生.Epi-LASIK组术后3个月2只眼出现0.5级haze,术后6个月haze消失.结论 SBK和Epi-LASIK矫正高度近视均安全、有效.SBK在早期视力恢复方面优于Epi-LASIK.     

Comparisons of morphologic characteristics between thin-flap LASIK and SBK

AIM: To compare the morphologic characteristics between thin-flap laser in situ keratomileusis (LASIK) and Sub-Bowman keratomileusis (SBK), and to evaluate the uniformity of flap and to explore the correlative factors of corneal flap thickness. METHODS: A prospective, randomized, comparative clinical study was performed in Department of Ophthalmology, West Hospital of China, Chengdu, Sichuan Province, China. Totally 59 patients 114 eyes underwent LASIK or SBK to correct myopia, 29 patients 57 eyes underwent SBK, 30 patients 57 eyes underwent LASIK. Anterior optical coherence tomography(OCT) was used to measure corneal flap thickness in all the patients 1 week after surgeries, 16 positions were set to be measured in each eye. Comparisons of flap thickness in each group and between 2 groups were evaluated. Correlative factors of flap thickness were evaluated. RESULTS: Coefficient of variation（CV, s/x ×%）in SBK group were lesser than that in LASIK group, t test showed there was significant statistical difference between 2 groups(P=0.000). Comparisons of the difference of 2 paired positions(temporal-nasal; superior-inferior) showed there were no significant differences in each group, but between 2 groups , there were statistical significance of value of difference (D-value) of superior and inferior positions between SBK and LASIK group(P=0.036). Linear regression analysis of correlative factors of flap thickness showed there were no statistic significances related to central corneal thickness(CCT)(P=0.060, t=1.921) and corneal curvature(P=0.083, t=1.766). CONCLUSION: SBK is better than LASIK in creating much uniform corneal flap. There was no evidence showing correlations between flap thickness and CCT or corneal curvature.     

虹膜定位联合波前像差引导前弹力层下角膜磨镶术治疗近视的临床疗效分析

目的分析虹膜定位联合波前像差引导前弹力层下角膜磨镶术（SBK）实行个体化切削手术治疗近视的临床疗效及安全性。方法近视患者行虹膜定位联合波前像差引导的SBK治疗者32例（64只眼）（试验组）,同期行常规SBK治疗的患者42例（84只眼）（对照组）,两组患者等效球镜-2.0 D～-8.0 D,术后随访6个月观察两术式的治疗效果。观察指标包括术后裸眼视力（UCVA）、屈光状态、裂隙灯检查、眼压、角膜地形图、波前像差、对比敏感度及角膜并发症。结果术后6个月两组所有患者UCVA≥1.0,较术前BCVA提高一行者分别为34.4%（22只眼）和19.0%（16只眼）,两组相比较差异有统计学意义（P〈0.05）;试验组和对照组患者术眼的残留屈光度球镜分别为（0.31±0.22）D和（0.44±0.29）D,两组比较差异有显著性（P〈0.05）;试验组残留散光为（0.12±0.07）D,小于对照组（0.24±0.05）D,两组比较差异有显著性（P〈0.05）;试验组和对照组患者等效球镜在±0.5 D以内者分别为29只眼（45.3%）和20只眼（23.8%）,试验组明显多余对照组（P〈0.05）。试验组切削中心位于角膜中心0.2 mm以内为60只眼（93.8%）,对照组为67只眼（79.8%）,两组比较差异有显著性（P〈0.05）;两组患者术后高阶像差均较术前增高,试验组和对照组患者总高阶像差的RMS分别为0.418±0.26和0.651±0.37,试验组明显小于对照组（P〈0.05）;高频对比敏感度（12cd/deg和18cd/deg）试验组为1.347±0.274和1.094±0.289,明显高于对照组1.239±0.212和0.896±0.251（P〈0.05）;术中和术后两组患者均无严重并发症;术后试验组满意度高于对照组（P〈0.05）。结论虹膜定位联合波前像差引导SBK治疗近视术后视力提高理想、残留屈光度低,高阶像差增加幅度少、视觉质量好,并发症少、安全性高,是近视患者的理想选择手术方式。     

飞秒激光和机械角膜刀在屈光手术中制作角膜瓣的比较

Background: To assess and compare the variations of LASIK flap created by the IntraLase femtosecond laser, Moria One Use-Plus SBK and the Moria M2 Single-Use 90μm-head microkeratome, using Anterior segment optical coherence tomography (Visante? OCT). Methods: 161 eyes of 81 consecutive patients were enrolled in this prospective study and randomized divided into three groups depending on the flap creation method: flap creation with the the IntraLase femtosecond laser (IntraLase group, 59 eyes), with the Moria One Use-Plus SBK (SBK group , 44 eyes) and with the Moria M2 Single-Use 90μm-head microkeratome (M2SU90 group, 58 eyes). Nominal flap thickness was 110 μm for all patients and for the three devices. One month after surgery, Visante? OCT was used to measure flap thickness at 20 locations on each cornea and the results were assessed for uniformity, regularity and accuracy. Results: At one month after surgery, the mean central flap thickness was 111.18±3.33 μm in the IntraLase group, 113.85±8.07 μm in the SBK group and 117.96±13.14 μm in the M2SU90 group, respectively. The flap regularity in the IntraLase group and the SBK group were better, showing an almost planar configuration, than the meniscus-shaped flaps in the M2SU90 group. The maximum deviation from the intended flap thickness (110 μm) was 6.15 μm in the IntraLase group, 10.36 μm in the SBK group and 19.75 μm in the M2SU90 group, respectively. A differences greater than 20 μm was observed in 0.42% of measurements in the IntraLase group; 2.95% of measurements in the SBK group and 21.12% of measurements in the M2SU90 group. Conclusions: The flap created by the IntraLase femtosecond laser and Moria One Use-Plus SBK are more uniform; more regular; and more accurate than those created by the Moria M2 Single-Use 90μm-head microkeratome. The first two methods can make precise flaps for Sub-Bowman Keratomileusis.     

前弹力层下激光角膜磨镶术中负压吸引圆环与椭圆环对角膜散光的影响

目的 探讨前弹力层下激光角膜磨镶术(SBK)手术中运用负压吸引圆环与椭圆环对患者术后角膜散光的影响.方法 回顾性病例对照研究.收集2011年3月在四川大学华西医院近视激光中心行SBK患者51例(102眼),在制作角膜瓣时,分别采用圆环和椭圆环,其中圆环组23例,椭圆环组25例,另外3例左右眼分别使用圆环与椭圆环,圆环眼纳入圆环组,椭圆环眼纳入椭圆环组.OrbscanⅡ角膜地形图检查患者术前、术后水平及垂直方向角膜曲率,并计算患者术前、术后散光值.采用独立样本t检验进行统计分析.结果 术后1周,圆环组角膜散光值为(-0.84±0.71)D,椭圆环组角膜散光值为(-0.90±0.54)D,两组之间差异无统计学意义.排除术中矫正散光值的影响,术前与术后1周角膜散光值差值椭圆环组为(0.58±0.77)D,圆环组为(0.57±0.76)D,两组差异无统计学意义.所有病例术中术后均未出现游离瓣、不全瓣、纽扣瓣等角膜瓣并发症,术后角膜愈合过程也未出现层间异物、瓣溶解、感染等严重影响视力的并发症.结论 相对传统负压吸引圆环来说,SBK手术中负压吸引椭圆环不会引起角膜散光值增加或降低.     

Comparisons of morphologic characteristics between thin-flap LASIK and SBK

AIM: To compare the morphologic characteristics between thin-flap laser in situ keratomileusis (LASIK) and Sub-Bowman keratomileusis (SBK), and to evaluate the uniformity of flap and to explore the correlative factors of corneal flap thickness. METHODS: A prospective, randomized, comparative clinical study was performed in Department of Ophthalmology, West Hospital of China, Chengdu, Sichuan Province, China. Totally 59 patients 114 eyes underwent LASIK or SBK to correct myopia, 29 patients 57 eyes underwent SBK, 30 patients 57 eyes underwent LASIK. Anterior optical coherence tomography(OCT) was used to measure corneal flap thickness in all the patients 1 week after surgeries, 16 positions were set to be measured in each eye. Comparisons of flap thickness in each group and between 2 groups were evaluated. Correlative factors of flap thickness were evaluated. RESULTS: Coefficient of variation（CV, s/x ×%）in SBK group were lesser than that in LASIK group, t test showed there was significant statistical difference between 2 groups(P=0.000). Comparisons of the difference of 2 paired positions(temporal-nasal; superior-inferior) showed there were no significant differences in each group, but between 2 groups , there were statistical significance of value of difference (D-value) of superior and inferior positions between SBK and LASIK group(P=0.036). Linear regression analysis of correlative factors of flap thickness showed there were no statistic significances related to central corneal thickness(CCT)(P=0.060, t=1.921) and corneal curvature(P=0.083, t=1.766). CONCLUSION: SBK is better than LASIK in creating much uniform corneal flap. There was no evidence showing correlations between flap thickness and CCT or corneal curvature.     

LASIK、SBK和LASEK对角膜高阶像差的影响

目的探讨于不同深度角膜基质面进行的近视矫正性激光角膜切削对人眼角膜高阶像差的影响。方法前瞻性队列研究。行准分子激光原位角膜磨镶术（LASIK）54例（106只眼）,前弹力层下角膜磨镶术（SBK）80例（159只眼）,准分子激光角膜上皮下磨镶术（LASEK）16例（32只眼）,采用眼前节扫描仪（Allegretto Oculyzer）搜集这些患者手术前后的眼前节数据,转换得到角膜像差数据（以Zernike多项式形式表示高阶像差）。对数据采用方差分析;chisq：Kruskal-Wallis检验。结果术后所有眼裸眼视力〉0.8。三组手术后测量角膜垂直彗差（Z3-1）、水平彗差（Z31）、彗差（Z33）、球差（Z40）值较术前的差异均存在统计学意义;三种手术后角膜垂直彗差（Z3-1）和球差（Z40）变化随时间变化有统计学差异。结论 LASIK和SBK及LASEK手术均会增加角膜高阶像差,但超薄瓣手术（SBK）和表面切削术（LASEK）对角膜高阶像差的影响低于标准的LASIK手术。     

小牛血去蛋白提取物眼用凝胶与卡波姆眼用凝胶对SBK后角膜上皮修复疗效的比较

目的探讨小牛血去蛋白提取物眼用凝胶与卡波姆眼用凝胶在准分子前弹力层下角膜磨镶术（sub-Bow-man’s keratomileusis,SBK）后对角膜上皮损伤修复作用的情况,为指导术后用药提供依据。方法连续选取2012-05～06月在广州军区武汉总医院准分子激光中心拟行SBK的近视患者23例（46眼）,采用随机双盲方法,将患者左右眼随机分别纳入小牛血去蛋白提取物眼用凝胶组和卡波姆眼用凝胶组。术前查双眼最佳矫正视力等准分子手术常规术前检查,术后即刻随机点两种眼用凝胶,术后当日依据患者主诉症状制定的评分标准记录评分,术后第一天查双眼裸眼视力（uncorrectedvisual acuity,UCVA）、泪膜破裂时间（breakup time,BUT）、角膜荧光素钠（fluorescein sodium,FS）染色及依据患者主诉症状制定的评分标准记录评分,对比两种药物对SBK术后角膜上皮损伤修复的差异。结果所有患者术后均感双眼异物感明显,小牛血去蛋白提取物眼用凝胶组术后舒适度优于卡波姆眼用凝胶组;术后第一天UCVA、BUT、角膜FS染色,两组差异无统计学意义;依据患者主诉症状制定的评分标准进行评分,术后当日、术后第一天,两组差异无统计学意义（P〉0.05）,但两组术后第一天反应均较术后当日轻。结论 SBK术后短期应用小牛血去蛋白提取物眼用凝胶及卡波姆眼用凝胶在改善术后刺激症状,促进角膜上皮愈合,改善患者术后眼干不适症状方面未见明显差异。