角膜胶原交联联合准分子激光原位角膜磨镶术(LASIK)矫正屈光不正的临床观察

目的 观察角膜胶原交联加固联合准分子激光原位角膜磨镶术(laser-assisted in situ keratomileusis,LASIK)矫正屈光不正的疗效.方法 选取在我院行LASIK的患者为研究对象,其中行角膜胶原交联加固术联合LASIK治疗(治疗组)50例(100眼),行单纯LASIK治疗(对照组)50例(100眼),术后1周、1个月、3个月、6个月、12个月随访,对手术前后视力、屈光度、角膜内皮细胞计数、角膜透明度及术后角膜胶原交联线等进行研究.结果 两组裸眼视力均≥术前最佳矫正视力.术后各时间点屈光度治疗组与对照组比较差异均有统计学意义(均为P ＜0.05);治疗组术后12个月与术后1个月屈光度比较差异无统计学意义(t=0.021,P=0.070),对照组术后12个月与术后1个月比较差异有统计学意义(t=4.857,P =0.010).治疗组术后各时间点角膜内皮细胞计数与术前比较差异无统计学意义(F=1.163,P =0.327).治疗组术后早期均发生了角膜前基质轻度混浊.术后1个月治疗组角膜胶原交联线厚度为210.00～ 340.00(270.48±37.80) μm,约占角膜中央厚度的63％.治疗组均未发生与角膜瓣相关的并发症,对照组出现角膜瓣皱褶者3眼,角膜瓣移位者1眼.结论 角膜胶原交联加固术联合LASIK矫正屈光不正可以获得良好的术后裸眼视力,屈光度稳定,无角膜内皮细胞的丢失,术后早期出现角膜前基质轻度混浊均不响患者视力,术后效果好.

Clinical observation of corneal collagen cross-linking and laser-assisted in situ keratomileusis for refractive error

Objective To observe the clinical outcomes of corneal collagen cross-linlIng (CLX) and laser-assisted in situ keratomileusis (LASIK) for refractive error.Methods Together 100 patients (200 eyes) with myopia and/or astigmatism who underwent LASIK were admitted from December 2015 to January 2016,and divided into treatment group (50 patients,100 eyes),in which patient received CXL-LASIK,and control group (50 patients,100 eyes),in which the controls were given LASIK alone.Then the optical variables,including visual acuity,diopter,cornea endothelium cell counting,corneal transparency,corneal collagen cross-linking line,were examined and analyzed before operation and 1 week,1 month,3 months,6 months and 12 months after opera tion.Results As for postoperative time points,the uncorrected visual acuity after operation was better than the best corrected visual acuity before surgery in the two groups,but the differences in diopter between the two groups were statistically significant (all P ＜ 0.05).There was no significant difference in diopter 1 month and 12 months postoperatively in the treatment group (t =0.021,P =0.070),while its difference in the control group 1 month and 12 months postoperatively(t =4.857,P =0.010).The differences of the cornea endothelium cell counting in the treatment group between before and after surgery were not statistically significant (F =1.163,P =0.327).Moreover,slightly opacification apPeared in anterior corneal stromal in the early stage after surgery in the treatment group,and the average thickness of corneal collagen cross-linking line was 210.00-340.00 (270.48 + 37.80) μm 1 month postoperatively,accounting for 63％ of the central cornea thickness.There were not flap-related complications in the treatment group,but the control group had corneal flap wrinkle in 3 eyes and displacement in 1 eye in the controls.Conclusion Corneal collagen cross-linlIng and laser-assisted in situ keratomileusis for refractive error can obtain better outcomes,including sound uncorrected visual acuity and stable diopter after surgery,without the loss of the corneal endothelial cells.