超薄瓣LASIK与LASEK治疗临界角膜厚度高度近视的对比研究

目的比较超薄瓣LASIK与LASEK治疗中央角膜厚度≤520μm临界角膜厚度的高度近视的临床疗效。方法随机选择临界角膜厚度的高度近视患者60例120只眼分为两组,A组为超薄瓣LASIK组,30例60只眼,球镜度-6.00～10.00 D(平均-7.25 D),柱镜度0～2.50 D(平均-0.96 D);B组为LASEK组,30例60只眼,球镜度-6.00～10.00 D(平均-7.35 D),柱镜度0～2.75 D(平均-0.90 D)。分别于术后1周和1、3、6个月检查裸眼视力、矫正视力、等值球镜度、角膜上皮下雾状混浊(haze)程度、波前相差及并发症等。结果术后1周A组视力1.11±0.37,B组视力为0.76±0.36,差异有显著意义(P<0.01)。术后1、3和6个月A组UCVA分别为1.13±0.26、1.12±0.34和1.12±0.25,B组UCVA分别1.08±0.26、1.11±0.25和1.10±0.21,两组比较差异无显著意义(P>0.05)。术后6个月两组BCVA与术前比较无1例下降。A组无Haze,B组少量Haze出现。术后1周,1个月两组均表现为轻度过矫,差异无显著意义(P>0.05)。术后6个月两组均有不同程度屈光回退现象,B组回退(-0.16±0.53)D,A组回退(-0.14±0.49)D,两组比较差异无显著意义。术后1、3和6个月两组总高阶相差、垂直慧差、水平慧差和球差均方根值较术前增加,差异均有显著意义(P<0.05),B组总高阶相差增加倍数低于A组(P<0.05)。两组无明显并发症发生。结论超薄瓣LASIK与LASEK治疗临界角膜厚度的高度近视均是安全有效的方法,超薄瓣LASIK早期视力恢复快,LASEK视觉质量优于超薄瓣LASIK。

Comparative Study on Therapeutic Effects of Ultra Thin-Flap LASIK and LASEK on High Myopia with Thin Corneal of Critical Thickness

Objective To compare the visual and refractive outcomes of ultra thin-flap LASIK and LASEK in treating high myopia with thin corneal of critical thickness（central corneal thickness≤520 μm）. Methods High myopia patients with thin corneal of critical thickness were selected randomly and divided into two groups.In Group A,30 patients（60 eyes） whose preoperative spherical values ranged from-6.00 D to 10.00 D（averaged at-7.25 D） and astigmatism diopter from 0 D to 2.50 D（averaged at-0.96 D） were treated with ultra thin-flap LASIK.In Group B,30 patients（60 eyes） whose preoperative spherical values ranged from-6.00 D to 10.00 D（averaged at-7.35 D） and astigmatism diopter from 0 D to 2.75 D（averaged at-0.90 D） were treated with LASEK.The uncorrected visual acuity（UCVA）,best corrected visual acuity（UCVA）,SE,Haze degree,high wave front aberration and complication were examined and compared respectively on the 1st and 7th day and 1,3,and 6 months after the operation. Results The postoperative UCVA was 1.11±0.37 in Group A at 1 week,significantly higher than 0.76±0.36 in Group B（P0.05）.The postoperative BCVAs of the two groups were unchanged or improved at Month 6 and no declination was found in either case.Haze did not appear in Group A.Mild Haze,below degree Ⅱ,was found in Group B.At Month 6 postoperative,refractive regression occurred to some extent in both groups.The regressive degree stood at（-0.16±0.53） D in Group B and（-0.14±0.49） D in Group A（P〉0.05）.The postoperative root mean square values of higher order aberrations,vertical comas,horizontal comas and spherical aberrations at Month 1,3 and 6 were higher than those obtained preoperatively in both groups（for all,P〈0.05）.At Month 1,3 and 6 postoperative,the increase of high order aberration in the LASEK group was smaller than that in the LASIK group（for all,P〈0.05）.No obvious complication was found in both the groups. Conclusions Both ultra thin-flap LASIK and LASEK are safe and effective in treating high myopia eyes with thin corneal of critical thickness.Ultra-thin flap LASIK features faster visual recovery.For patients with higher myopia,better visual quality may be achieved with LASEK than with LASIK.