去上皮瓣的Epi-LASIK治疗中高度近视的短期效果

 目的 观察去瓣机械法上皮下准分子屈光手术（Epi-LASIK）治疗中高度近视的短期效果。设计 回顾性病例系列。 研究对象 2008年4月至2010年11月邢台市眼科医院连续行Epi-LASIK手术的中高度近视患者213例，其中术中去除角膜上皮瓣者（去瓣组）110例，保留角膜上皮瓣者（传统组）103例。方法  回顾并比较两组患者术前术后视力、屈光状态以及术后疼痛程度、Haze发生率、高阶像差和对比敏感度。随访6个月。主要指标 术后疼痛程度、Haze发生率、高阶像差和对比敏感度。结果 术前等效球镜度去瓣组与传统组差别无统计学差异（t=1.62，P=0.11）。术后去瓣组上皮愈合时间（3.51±0.48天）比传统组（4.91±0.68天）快（t=17.25，P=0.0000）。去瓣组术后第3天和第5天疼痛程度比传统组轻（Z=11.89，P=0.000；Z=10.34，P=0.000）。术后6个月等效球镜两组无差别（t=17.25，P=0.21）。术后6个月去瓣组Haze发生率（2.0%）低于传统组（9.6%）（Z=2.06，P=0.04）；两组高阶像差均较术前增加（t=-8.05，P=0.00；t=-8.92，P=0.00）。术后6个月眩光对比敏感度在高频区（18cpd）去瓣组（1.21±0.13 ）优于传统组（1.15±0.12）（t=2.18，P=0.03）。结论 去除角膜上皮瓣可以加快Epi-LASIK术后角膜上皮的恢复，缩短疼痛时间，减少Haze形成，获得更好的视觉质量。（眼科，2012，21：65-68）

Short-term outcome of off-flap Epi-LASIK for moderate to high myopia

Objective To observe short-term outcome of off-flap Epi-LASIK for moderate to high myopia.Design Retrospective case series.Participants The study included 203 patients,who had underwent Epi-LASIK in Xingtai Eye Hospital from April 2008 to November 2010.One hundred and ten patients underwent off-flap Epi-LASIK was defined as off-flap group,and 103 patients underwent on-flap Epi-LASIK was defined as traditional group.Methods The uncorrected distance visual acuity(UDVA),refractive status,pain status,level of haze,high degree aberration,and contrast sensitivity function(CSF) were compared between the two groups.All the patients had been followed up for 6 months.Main Outcome Measures Pain status,level of haze,high degree aberration and contrast sensitivity.Results No significant differences in the mean preoperative spherical equivalent between two groups(t=1.62,P=0.11).Compared with the traditional group,the off-flap group had rapider reepithelialization(t=17.25,P=0.00),and less pain at 3 days(Z=11.89,P=0.000) and 5 days(Z=10.34,P=0.000) after operation.Six months after surgery,there was no significant differences in the mean spherical equivalent between groups(t=17.25,P=0.21).Compared with traditional group,the off-flap group had lower level of haze(Z=2.06,P=0.04).Wavefront aberration increased significantly from baseline in both groups(t=-8.05,P=0.00;t=-8.92,P=0.00).Contrast sensitivity function with glare at 18 cpd was better in the off-flap group(1.21±0.13) than in off-flap group(1.15±0.12)(t=2.18,P=0.03).Conclusions Comparing with on-flap Epi-LASIK,off-flap Epi-LASIK offers a rapider visual recovery,comparable pain,a lower level of haze formation,and better visual quality.