飞秒激光制瓣LASIK及Trans-PRK矫正高度近视对角膜曲率及角膜后表面高度的影响

目的 探讨飞秒激光制瓣辅助下的准分子激光原位角膜磨镶术（FS-LASIK）及经上皮准分子激光屈光性角膜切削术（Trans-PRK）矫正-8.00 D以下高度近视对患者的角膜曲率及角膜后表面高度的影响。设计 前瞻性比较性病例系列。研究对象 23例行FS-LASIK手术及24例行Trans-PRK手术的-8.00 D以下高度近视患者。方法 于术前，术后1、3、6、12个月随访，用Pentacam眼前节分析仪测量角膜曲率及角膜后表面高度。主要指标 角膜曲率、角膜后表面高度。结果 两组患者术后各时间点角膜曲率均较术前降低（P均＜0.05）；组间比较显示Trans-PRK组K1值在术后6个月及12个月时间点比FS-LASIK组高（P均<0.05），其余时间点角膜曲率值组间比较无差异。FS-LASIK组术后6个月角膜曲率K1（t=1.921，P=0.066），K2（t=1.199，P=0.239）较前一时间点无明显降低，变化趋于稳定；Trans-PRK组术后3个月角膜曲率K1（t=1.199，P=0.239），K2（t=1.922，P=0.063）较前一时间点无明显降低，趋于稳定。两组患者术后各时间点角膜后表面均较术前略增高（P均＜0.05）；各时间点两组患者分别进行比较，Trans-PRK组患者角膜后表面高度均数均小于FS-LASIK组，除第3个月（P=0.150）外，其余各时间点组间比较差异有统计学意义（P均＜0.05）。结论 FS-LASIK与Trans-PRK手术均能有效用于-8.00 D以下高度近视的治疗，但Trans-PRK手术对患者角膜曲率及角膜后表面高度的影响更小，经过12个月随访显示恢复效果更佳，因此Trans-PRK手术更适用于-8.00 D以下高度近视患者。（眼科， 2020, 29： 123-127）

The effect of femtosecond laser-assisted LASIK and Trans-PRK on corneal curvature and corneal posterior surface height in high myopia

Objective To analyze the effect of femtosecond laser-assisted in situ keratomileusis(FS-LASIK)and trans-epithelial photorefractive kerectomy(Trans-PRK)on corneal curvature and corneal posterior surface height in high myopias.Design Prospective comparative case series.Participants 23 cases of FS-LASIK and 24 cases of Trans-PRK in high myopia patients within-8.00 D.Methods The corneal curvature and corneal posterior surface height were measured and analyzed with Pentacam analyzer before the surgery and 1,3,6 and 12 months after the surgery.Main Outcome Measures The corneal curvature and corneal posterior surface height.Results There were significant decreases in corneal curvature from both groups in different times after operation(all P<0.05).There were no significant differences in the corneal curvature that were compared between the two groups,except the 6 month and 12 month,in which K1 of Trans-PRK group were higher than FS-LASIK group(P<0.05).Meanwhile,there was no significant increase in corneal curvature at 6 months after operation in the FS-LASIK group,and no significant increase in corneal curvature at 3 months after surgery in the Trans-PRK group.The mean height of the posterior corneal surface in the Trans-PRK group was smaller than that in the LASIK group in different times(all P<0.05)except the 3 month(P=0.150).Conclusion Both FS-LASIK and Trans-PRK are safety used in the treatment of high myopia within-8.00 D.However,the Trans-PRK is more effective and safer for high myopia within-8.00 D,and with less effect on corneal curvature and posterior corneal surface height,and better recovery after 12 months follow-up.Therefore,Trans-PRK surgery is more suitable for patients with high myopia within-8.00 D.