准分子激光上皮瓣下角膜磨镶术治疗中高度循规性散光

目的：观察及比较准分子激光上皮瓣下角膜磨镶术（laser-assisted subepithelial keratectomy, LASEK）和准分子激光原位角膜磨镶术（laser in situ keratomileusis，LASIK）治疗中高度角膜循规性散光的疗效。方法：137例206眼中高度角膜循规性散光患者（主观验光散光度数与角膜地形图显示角膜散光度数相差小于0.5D）随机分为2组，LASEK组61例94只眼，术前角膜散光度3.556±0.784D（-2.25～-5.00D），LASIK组76例112眼，术前角膜散光度3.592±0.680D（-2.50～-5.00D）。LASEK组角膜上皮瓣及LASIK组角膜瓣蒂部均位于角膜上方12点处。术后随访6～12月，观察患者角膜散光度数及角膜散光轴的变化。结果：LASEK组术后3d内有71眼（75.5%）出现轻度不适。LASEK组术后1月内有6眼出现角膜上皮下雾状混浊（haze），均为0.5级。术后6个月两组角膜散光度数与术前相比明显下降，分别下降了（3.306±0.817）D，（2.996±0.497）D，两组比较差异有统计学意义（P<0.01）。散光轴向无明显改变。结论：LASEK治疗中高度角膜循规性散光安全、有效，且效果好于LASIK。

Laser-assisted subepithelial keratectomy for correction of moderate and high rule-shift astigmatism

Objective： To investigate and compare the response of laser-assisted subepithelial keratectomy (LASEK) and laser in situ keratomileusis（LASIK） for moderate and high rule-shift astigmatism. Methods： One hundred and thirty-seven patients (206 eyes) with corneal myopic astigmatism in with rule-shift were randomly divided into LASEK and LASIK groups. All were followed up for 6 to 12months after laser ablation. At 6months after operation, the changes of corneal astigmatism and astigmatic axis were studied. Results： Six months after operation, the postoperative corneal astigmatism was （0.215±0.130）D in LASEK group and （0.572±0.195）D in LASIK group, which was reduced by （3.306±0.817）D and（2.996±0.497）D, respectively. There was a significant difference between them, while the corneal astigmastic axis was not significantly changed. Conclusion： Compared to LASIK, LASEK is a better method for improvement of moderate and high rule-shift astigmatism.