去瓣与留瓣Epi-LASIK治疗近视的临床对比观察

目的 比较去瓣与留瓣机械法准分子激光上皮瓣下角膜磨镶术（Epi-LASIK）治疗近视的临床结果.方法 前瞻性随机对照研究.26例（52眼）近视患者纳入本研究.每例患者随机选择在一眼行去上皮瓣Epi-LASIK（去瓣组）；对侧眼则行常规保留上皮瓣Epi-LASIK（留瓣组）.术后2h,1、3、5、12 d及1、3、6个月对患者进行随访.采用配对t检验比较术后等效球镜度和裸眼视力；采用Wilcoxon 秩和检验比较角膜上皮愈合百分比；采用卡方检验比较疼痛评分、haze分级及最佳矫正视力.结果 与留瓣组相比,去瓣Epi-LASIK组术后第5天裸眼视力较好（t=-2.636,P=0.014）;术后3d和5d角膜上皮愈合百分比较高（Z=-3.738、-3.589,P＜0.01）；术后5d疼痛评分较低（U=11.714,P=0.008）.两组术后1、3、6个月的等效球镜度及haze分级差异无统计学意义,术后3个月最佳矫正视力行数改变差异也无统计学意义.结论 去瓣Epi-LASIK治疗近视术后的屈光结果、最佳矫正视力及haze与留瓣Epi-LASIK类似,但其术后角膜上皮愈合更快,视力恢复更快.

Clinical comparison of off-flap Epi-LASIK and on-flap Epi-LASIK for correcting myopia

Objective To compare the clinical outcomes of eyes treated with off-flap epipolis laser in situ keratomileusis (Epi-LASIK) and contralateral eyes treated with on-flap Epi-LASIK for correcting myopia.Methods This prospective and randomized study enrolled 26 myopic patients who had undergone off-flap Epi-LASIK in one eye (off-flap group) and on-flap Epi-LASIK in the contralateral eye (on-flap group).Patients were followed up at 2 hours,1,3,5,and 12 days and 1,3 and 6 months after surgery.A paired samples t test,Wilcoxon signed ranks test or Pearson chi-square test were used to compare the two groups for uncorrected visual acuity (UCVA),spherical equivalent (SE),percentage of corneal epithelial healing,pain score,haze score and postoperative change in lines of best corrected visual acuity (BCVA).Results Compared to the on-flap group,outcomes for the off-flap group showed better UCVA at 5 days after surgery (t=-2.636,P=0.014),a higher percentage of corneal epithelial healing at 3 and 5 days after surgery (Z=-3.738,-3.589,P＜0.01),and lower scores for level of pain at 5 days after surgery (U=11.714,P=0.008).No significant between-group differences were found for SE and haze scores at 1,3 and 6 months after surgery,and the change in lines of BCVA at 3 months after surgery.Conclusion In comparison to on-flap Epi-LASIK, off-flap Epi-LASIK offers comparable refractive results, BCVA, and postoperative haze formation,but faster visual recovery and corneal epithelial healing.