飞秒激光制瓣与准分子激光磨镶术治疗角膜相对较薄的高度近视的疗效比较

目的比较飞秒激光制瓣前弹力层下角膜磨镶术（Sub—Bowman＇s keratomileusis，SBK）与准分子激光上皮下角膜磨镶术（1aser subepithelial keratomileusis，LASEK）治疗角膜相对较薄的高度近视的临床疗效。方法随机选择中央角膜厚度480～520μm且近视等值球镜度（sperical equivalent，SE）（-6．00～-10．00）D的患者90例。分为：A组，飞秒激光制瓣SBK组患者59例118只眼，SE平均（-7．20±0．80）D。B组，LASEK组患者31例62只眼，SE平均（-7．31±0．96）D。观察两组术后眼部刺激症状及角膜恢复情况，术后裸眼视力（uncorrectedvisualacuity，UCVA）、最佳矫正视力（bestcorrectedvisualacuity，BCVA）、SE及并发症发生情况。结果A组术后反应轻，角膜恢复快于B组。术后1周A组裸眼视力（1．06±0．11）优于B组（0．73±0．20）。但术后1、3、6和12个月两组裸眼视力差异无显著意义。两组术后BCVA与术前比较无明显变化。A组无角膜上皮下雾状混浊（haze），B组有少量haze出现。在术后各期SE在±0．50～±1．00D的眼数A组均大于B组，术后6个月以后两组均有不同程度的屈光回退，B组明显高于A组。结论飞秒激光制瓣SBK与LASEK是治疗角膜相对较薄高度近视安全有效的方法。飞秒激光制瓣SBK术后视力恢复快，且预测性和稳定性优于LASEK。

Clinical Comparative Study on Therapeutic Effects of Femtosecond Laser SBK and LASEK on High Myopia with Relatively Thin Cornea

Objective To compare the visual and refractive outcomes of femtosecond laser Sub-Bowman＇s keratomileusis （SBK） and laser subepithelial keratomileusis （LASEK） in treating high myopia with relatively thin cornea.Methods Altogether 90 patients of high myopia whose sperical equivalent （SE） ranged from - 6. 00 D to - 10. 0 D with central corneal thickness between 480 and 520 p.m were selected randomly. These patients were divided into two groups. In Group A, 59 patients （118 eyes） with an average SE of （ -7. 20 ±0. 8） D were treated with femtosecond laser SBK. In Group B, 31 patients （62 eyes） with an average SE of （ -7. 31 ±0. 96） D were treated with LASEK. The postoperative reaction, uncorrected visual acuity （UCVA）, best corrected visual acuity （BCVA）, SE and complication of these patients were examined. Results The postoperative reaction was milder in Group A than in Group B. The UCVA was （1.06± 0. 11 ） in Group A L week after the operation, which was significantly higher than （0. 73 ±0. 20）, the UCVA in Group B. Nevertheless, the postoperative UCVA in two groups at Month 1, 3, 6 and 12 showed no statistical difference. Compared with the preoperative BCVA, the postoperative BCVA of two groups kept unchanged. Haze did not appear in Group A. Mild haze was found in Group B. Group A had more eyes of SE be- tween ~ 0.50 D and ~ 1.00 D than Group B after the operation at each time point. Refractive regression occurred to some extent in both groups 6 months later. The occurrence rate was greater in Group B than in Group A. Conclusions Both femtosecond laser SBK and LASEK are safe and effective in treating high myopia eyes with relatively thin cornea. With femtosecond laser SBK, visual acuity will recover faster than with LASEK. Moreover, femtosecond laser SBK is better than LASEK in predictability and stability.