单眼行LASIK或LASEK术后疗效观察

目的:探讨单眼行准分子激光原位角膜磨镶术(laserin situkeratomileusis,LASIK)或准分子激光上皮下角膜磨镶术(laser epithelial keratomileusis,LASEK)治疗单眼近视所致屈光参差的效果。方法:采用对单眼等效球镜度>-2.50D的近视性屈光参差患者62例,进行单眼LASIK或LASEK手术。术眼及非术眼手术前后平均屈光度、屈光参差度数、最佳矫正视力和裸眼视力进行评价,术后随访6~24mo。结果:术眼术前平均等值球镜度数为-3.66(-2.50~-6.25)D,术后减少至-0.62(0.00~-1.00)D。LASIK或LASEK对平均等值球镜改变为-3.38(-2.50~-5.50)D。术前两眼平均屈光参差为-3.25(-2.50~-6.25)D,术后减少至-0.85(0.00~-1.75)D。术前术后最佳矫正视力(BCVA)范围均为0.6~1.0,平均最佳矫正视力从术前0.8提高到1.04;术后裸眼视力≥1.0者59眼,平均裸眼视力从术前的0.1提高至术后的1.0。非术眼术前平均等值球镜度数为-0.85(+0.25~-1.50)D,术后平均等值球镜度数为-1.85(-0.50~-3.50)D,平均裸眼视力从术前的0.5术后下降至0.1。结论:单眼LASIK或LASEK治疗近视性屈光参差虽然能提高患眼的最佳矫正视力和裸眼视力,解除单眼近视、散光所致的屈光参差对眼镜或角膜接触镜不能耐受的痛苦,而且对恢复双眼单视功能具有积极意义,但是同时我们也发现术后非术眼有近视加深的趋势,而且非术眼原近视度数越高近视加深越快越多。     

PRK术中应用低浓度丝裂霉素治疗低中度近视

目的：评价PRK术中应用低浓度(0.02g/L)丝裂霉素(PRK+LMMC)30s治疗低、中度近视眼术后疗效。

方法：选取我院接受屈光性角膜切削术(PRK)治疗的30例57眼低、中度近视患者,术中应用0.02g/L的MMC 30s,将术后6mo的随访结果与同期接受准分子激光原位角膜磨镶术(LASIK)治疗的疗效进行比较。

结果：术后6mo,PRK+LMMC治疗组等值球镜屈光度0.210D、等值球镜屈光度在±0.50D范围内的发生率71.9%、裸眼视力≥1.0者77.2%,平均最佳矫正视力1.19±0.18; LASIK治疗组等值球镜屈光度-0.017D,等值球镜屈光度在±0.50D范围内的发生率70.1%,裸眼视力≥1.0者72.7%,平均最佳矫正视力1.16±0.19,两组比较差异均无统计学意义(P>0.05)。术后6mo,PRK+LMMC治疗组没有出现超过1级的haze,所有眼最佳矫正视力均好于术前。LASIK治疗组1眼因角膜上皮植入使最佳矫正视力较术前下降3行,其余眼最佳矫正视力均好于术前。

结论：PRK术中应用0.02g/L的MMC 30s治疗低、中度近视同LASIK具有同样的视力结果,避免了LASIK瓣的并发症,不失为一个可取的手术程序。     

角膜屈光手术治疗成人弱视的疗效分析

目的:观察角膜屈光手术治疗成人屈光不正性弱视的疗效。方法:对53例76眼成人屈光不正性弱视患者行角膜屈光手术治疗,其中38眼行LASIK手术,32眼行薄瓣LASIK手术,6眼行LASEK手术。随访观察12mo,回顾性分析其疗效。结果:患者术前屈光度球镜-13.50～+3.00(平均-7.33±3.36)D,散光-4.25～+2.00(平均-1.40±0.92)D,最佳矫正视力平均0.57±0.06。术后1mo,裸眼视力平均0.64±0.16,与术前最佳矫正视力有显著性差异(P<0.05)。术后12mo,裸眼视力进一步提高,平均0.72±0.20,与术前最佳矫正视力有显著性差异(P<0.05),与术后1mo裸眼视力比较,有显著性差异。术后视力高于术前最佳矫正视力者43眼(57%)。术后视力与术前最佳矫正视力相同者33眼(43%)。结论:准分子激光角膜屈光手术治疗成人弱视,疗效可靠,可有效提高患者视力。     

激光性角膜手术与眼内屈光手术矫治超高度近视眼

目的:评价及探讨矫治超高度近视眼的各类屈光手术的有效性、稳定性和安全性。方法:随机选择临床中观察到的超高度近视患者行各类屈光手术者108眼,近视范围-10.00～-24.50D,术前屈光度平均为(-12.25±1.53)D,散光平均为(-1.52±0.55)D;手术方式的选择:(1)I组52眼,行LASIK术:(2)II组23眼,行透明晶状体超声乳化摘除加后房型人工晶状体植入术。(3)III组33眼行有晶状体眼虹膜固定型人工晶状体植入术。术后随访观察平均6mo,主要观察术后裸眼视力、最佳矫正视力、屈光度、眼压及眼前段、眼底情况。结果:三组术后裸眼视力均比术前提高,术后裸眼视力≥0.5者分别是42眼(80.8%),20眼(87.0%),28眼(84.8%),术后屈光度分别为(-2.10±2.38)D,(-1.75±1.33)D,(0.83±1.16)D,主要并发症I组术后6mo黄斑出血1眼,II组术后15mo视网膜脱离1眼,III组平均角膜内皮细胞丢失率为4.5%。结论:对于超高度近视,晶状体性屈光手术效果优于LASIK术。对超高度近视行屈光手术,要根据患者年龄,眼部情况,手术医师的技术等,选择安全、有效、稳定性好的手术。     

智慧型光斑LASIK治疗近视临床分析

目的:探讨智慧型光斑LASIK治疗近视或近视散光可预测性、稳定性、有效性及术后残留屈光度危险因素分析。方法:回顾性分析2008-10/2009-10在我中心行LASIK病例,术前最佳矫正视力(BCVA)≥0.8,随访时间>1mo,球镜<-10.00D纳入统计分析病例,共768例。按激光切削模式及屈光度分组,对术后裸眼视力,术后1,3,6mo;1a残留等效球镜,屈光回退患者术前术后数据行统计学分析。结果:10例BCVA术后未达术前;预测性:术后常规组98.0%SE<0.50D,99.2%SE<1.00D;波前组97.4%SE<0.50D,99.3%SE<1.00D;术后残留屈光度,常规组:1mo:-0.01±0.10D;3mo:-0.02±0.20D;6mo:-0.07±0·31D;1a:-0.15±0.38D。波前组:1mo:-0.01±0.08D;3mo:-0.01±0.09D;6mo:-0.03±0.15D;1a:-0.08±0.19D;视力改变,常规组:0±0.05,波前组:0.01±0.04。23例术后残留屈光度危险因素分析,术后残留球镜与年龄,术前球镜有关,术后球镜=1.355-0.034年龄+0.142术前球镜;术后残留柱镜与术前柱镜,术前中央角膜厚度有关,术后柱镜=3.489+0.238术前柱镜-0.007术前中央角膜厚度。结论:智慧型光斑LASIK预测性,稳定性,有效性均较好,波前像差引导LASIK在预测性及有效性方面更优,两种术式均有较好的稳定性;术后残留球镜危险因素:年龄、术前球镜,术后残留柱镜危险因素:术前柱镜、术前中央角膜厚度。     

钬激光角膜热成形术的疗效分析

目的:评价钬激光角膜热成形术(LTK)治疗轻度远视的疗效、安全性和并发症。方法:我们的研究对年龄>45岁的患者12例18只轻度远视眼行Ho:YAG激光LTK术治疗,能量密度65J/cm~2,平均随访2a。结果:患者年龄45～65(平均55.25±10.12)岁,术前屈光度+0.50～+2.25(平均+1.30±0.58)D,术前裸眼视力0.44±0.23,术后屈光度得以全部矫正,术后1mo,没有屈光回退,术后3mo,4眼屈光回退+0.25D。术后6mo,剩余屈光度在±0.50D和±1.00D以内的百分率分别为83%,89%,已矫屈光度和预矫屈光度符合率较好。之后存在屈光回退趋势,2a后屈光回退减缓。最佳视力出现在术后2wk内,以后裸眼视力开始回退。术前裸眼视力>1.0者为0,术后1mo,裸眼视力均较术前有非常显著的提高。术后3mo,裸眼视力达1.0者14眼(78%)。术后2a,裸眼视力达1.0者10眼(56%)。结论:Ho:YAG激光LTK术对轻度远视有效。临床观察证实此手术方法简单、安全,见效快以及并发症少等优点,为治疗轻度远视的手术方方法之一,但尚需长期观察其屈光稳定性。     

LASIK治疗远视疗效分析

目的 探讨准分子激光原位角膜磨镶术治疗远视的临床疗效.方法 对25例48只眼远视患者进行准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK),术前等效球镜屈光度为+1.00-+8.00D(+4.20±2.00)D,术后随访一年.结果 术后第1天.裸眼远视力与术前最佳矫正视力相当或下降≤2行,随时间推移远视力逐渐上升.术后1年,裸眼远视力≤0.5为25例48只眼(100%),裸眼远视力≥1.0为13例26只眼(52.0%),平均裸眼远视力0.85±0.28.裸眼近视力≥0.5为25例48只眼(100%),裸眼近视力≥1.0为19例38只眼(76%),平均裸眼近视力0.90±0.26.术后1年,屈光度-0.50-+0.50D占83.2%,+0.50-+1.00D占12.6%,+1.00-+2.40D占6.6%,平均屈光度(+0.75±1.55)D.术中术后无严重并发症.结论 采用LASIK治疗远视具有良好安全性、有效性和可预测性.     

超高度近视LASIK术后的屈光回退

目的探讨准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)矫正超高度近视的准确性、预测性、稳定性及有效性.方法 LASIK矫正超高度近视-10.1～-26.0 D,平均(-13.9±3.4)D 124例193眼,按术前预矫等值球镜分别观察术后1年的屈光度,术前最佳矫正视力及术后裸眼视力.结果术后1年屈光回退率与性别、年龄、切削方式无关(P＞0.05),而是随着术前预矫度数的增加而增加.术前预矫屈光度越高,屈光回退程度越明显.术后平均裸眼视力达0.6以上.结论超高度近视LASIK术后准确性、预测性及稳定性均较差,但由于其具有有效性,我们可以积极地为患者实施此项手术.     

LASIK治疗近视性屈光参差性弱视

目的 评价准分子激光原位角膜磨镶术(laser in situ keratomileusis;LASIK)治疗近视性屈光参差性弱视的临床疗效.方法 用LASIK手术矫正8位近视性屈光参差性弱视患者,比较手术前后屈光不正的度数和立体视锐度的改变,并将术前的最佳矫正视力和术后第1天,第3天,第10天的裸眼视力以及6～9个月随访的裸眼视力和最佳矫正视力进行比较和分析.结果 术前屈光度数高眼的屈光不正的等效球镜平均为(-10.06±1.50)D,术后该眼屈光不正的等效球镜平均为(0.19±0.32)D.手术前后立体视锐度差别有统计学意义(z=-2.207,P=0.027).术前屈光度数高眼矫正视力和术后该眼矫正视力相比,差别有统计学意义(F=11.431;P=0.000).结论 LASIK手术能安全,有效地减少近视性屈光参差,提高患者的视力和立体视功能.     

Q值调整的准分子激光原位角膜磨镶术治疗近视临床观察

目的:评价目标Q值=-0.9引导的准分子激光原位角膜磨镶术(LASIK)治疗近视的临床疗效。方法:应用美国雷赛LSX准分子激光机(5.3版),采用AstraPro Planner2.2Q个体化软件,术中目标Q值设定为-0.9,行LASIK手术共治疗53例(106眼)近视患者,同时随机选取2005年常规LASIK手术患者51例(102眼)做为对照组。观察手术前及术后6mo的视力、屈光度、As-tramax角膜地形图测量的Q值的变化(瞳孔中心4.5mm直径范围),并进行分析。结果:在Q值优化组,术前裸眼视力为0.11±0.05,平均等效球镜(SE)为-6.57±1.81D(-3.49~-11.80D),术前Q值为-0.14±0.15(-0.56~0.26),术后6mo裸眼视力为1.14±0.15,平均等效球镜(SE)为0.37±0.58D,术后Q值为0.20±0.40(-0.80~1.48)。标准切削对照组:术前裸眼视力为0.13±0.06,平均等效球镜(SE)为-5.99±2.53D(-1.44~-12.31D),术前的Q值为-0.16±0.14(-0.50~0.21),术后裸眼视力为1.13±0.20,平均等效球镜为-0.46±0.87D,术后Q值为0.56±0.45(-0.53~2.03)。所有术眼术中术后未见威胁视力的并发症发生。两组术后裸眼视力无显著性差异,但是Q值优化组术后Q值显著低于对照组。结论:应用美国雷赛SLX型(5.3版)激光机,AstraProPlanner2.2Q个体化软件,进行目标Q值为-0.9引导的LASIK个体化切削术治疗近视安全、疗效确切、稳定,效果满意。Q值优化的LASIK较常规切削可减少术后Q值的增加,更好的维持角膜表面生理形态。     

超高度近视准分子激光原位角膜磨镶术后屈光回退的临床观察

目的 了解超高度近视行准分子激光原位角膜磨镶术(LASIK)后的屈光回退情况,并探讨影响其回退的主要因素.方法 选择近视度数>-9.00 D的近视眼患者行LASlK.根据切削光区直径不同分为2组.Ⅰ组:单区切削组,切削区直径6.5 mm或6.0 mm,共36眼;Ⅱ组:多区切削组,切削区直径≤6.0 mm,分6.0、5.5、5.0、4.5 mln等多个区,共36眼.分别记录术前、术后第1、3、6、12个月的视力,屈光度,眼压,角膜厚度等情况,分析术后屈光回退与诸多因素之间的关系.结果 术后第12个月最佳矫正视力大于等于术前者,Ⅰ组35眼,Ⅱ组34眼,两组差异无统计学意义(P>0.05).屈光同退Ⅰ组4眼,Ⅱ组16眼,两组差异有统计学意义(P<0.001).结论 LASIK治疗超高度近视安全、有效,但要考虑术后屈光回退.手术切削区的大小是影响超高度近视术后屈光回退的重要因素,必要时可部分矫正屈光力,以免出现术后并发症.(中国眼耳鼻喉科杂志,2011,11:146-148)     

盐酸卡替洛尔眼液预防超高度近视LASIK术后屈光回退的临床观察

探讨盐酸卡替洛尔滴眼液在预防超高度近视准分子激光原位角膜磨镶术（LASIK）术后早期屈光回退中的作用。 方法：超高度近视患者行LASIK治疗者68例136眼,随机分成试验组和对照组,所有患者术后第1d开始用1g/L氟米龙、1g/L玻璃酸钠和1g/L普拉洛芬滴眼液3次/d,1wk后试验组停用1g/L氟米龙滴眼液并且加用20g/L盐酸卡替洛尔滴眼液,术后1mo试验组和对照组患者均停用1g/L玻璃酸钠以外的其他滴眼液,术后随访6mo观察两术式的治疗效果。 结果：术后3,6mo试验组患者裸眼视力≥1.0者、屈光度和对照组比较差异有显著性（P＜0.05);术后1wk;1,3,6mo试验组眼压按时间点经重复测量方差分析比较两组差异有显著性（P＜0.02);术后1mo试验组和对照组患者前房深度比较差异有显著性（P＜0.05);术后3,6mo试验组患者角膜屈光力、角膜后表面Diff值和对照组比较差异有显著性（P＜0.05)。 结论：对于超高度近视患者,LASIK术后早期应用盐酸卡替洛尔滴眼液能预防屈光回退,使患者获得更持久的效果,但远期效果需进一步观察。     

高度轴性近视白内障术后屈光状态与生存质量的关系

目的分析术前戴镜和不戴镜高度轴性近视白内障患者术后屈光状态与生存质量的关系，探讨该群体术后适宜的屈先状态。方法研究对象来自2004年5月至2005年1月间，因高度轴性近视白内障在温州医学院眼视先医院行白内障超声乳化摘除合并人工晶状体植入手术的住院患者73例（102眼），眼轴〉26．00mm、屈光力〉-6．00D。所有手术均由同一资深医师完成。术后1个月随访患者，手术前后行常规裂隙灯检查，眼底检查，裸眼远视力、最佳矫正视力、近视力、屈光力、角膜曲率及生存质量（quality of life，QOL）调查。研究中的QOL问卷包含4个方面的内容：①视远功能相关的问题。②视近功能相关的问题。③平素生活、娱乐及社交活动的能力。④白内障相关的症状。将患者分为术前戴镜和不戴镜两组，根据术后1个月屈先状态分亚组，Ⅰ组：0．75-1．50D，Ⅱ组：-1．625- -2．875D，Ⅲ组：-3．00- -7．50D。结果术后患眼远视力、最佳矫正视力、近视力比术前均有显著性提高，差异均有显著性：术前戴镜者和不戴镜者在术后视近QOL提高方面差异有显著性，其他各方面差异均无显著性。术前戴镜者在视近QOL提高方面，Ⅰ组QOL增加率低于Ⅲ组．差异有显著性；不戴镜者中Ⅰ组QOL增加率明显低于Ⅱ组，差异有显著性。结论高度轴性近视白内障患者术前戴镜者术后保留-3．00D以上的近视为宜，而术前不戴镜者术后保留-1．625- -2．875D的屈光状态为宜：预留术后屈先度数时，需要综合考虑患者的生活习惯、职业、文化程度等因素。     

角膜屈光力超过47D的LASIK手术后2a观察

目的:初步评定角膜屈光力超过47D近视眼进行LASIK手术的安全性、有效性、预测性与稳定性.方法:研究组系用PENTACAM地形图检查角膜前表面屈光力超过47D共30例50眼(其中角膜前表面符合部分亚临床期圆锥角膜条件的12眼,但后表面高度正常)的LASIK手术患者;另设30例50眼术前屈光度,最佳矫正视力(BCVA)与研究组无显著差异,但角膜屈光力小于47D的近视眼作LASIK手术作为对照组.对比观察手术后1,3,6mo;1,2a的裸眼视力、最佳矫正视力、术后屈光度与角膜地形图;其中角膜地形图对比内容有:前表面中央半径2mm内的最大屈光力平均值,角膜平均屈光力,中央岛效应;后表面屈光力变化,术后最佳矫正视力丢失(BSCVA)情况,记录术后并发症情况.结果:研究组与对照组在手术后1,3,6mo;1,2a的裸眼视力、最佳矫正视力和术后屈光度无明显差异;角膜地形图与术前相比:中央半径2mm内的最大屈光力平均值和角膜平均屈光力均明显好转,且与近视度数减低值相符;两组术后出现中央岛效应的眼数相同;两组角膜后表面屈光力较术前无明显变化,且均无1例角膜膨隆症出现.结论:观察单纯角膜屈光力超过47D或仅角膜前表面部分符合亚临床期圆锥角膜标准,但后表面高度正常的近视眼作LASIK手术在2a内是有较好的安全性、有效性、预测性与稳定性.远期影响尚待观察.     

Laser in situ keratomileusis versus laser-assisted subepithelial keratectomy for the correction of high myopia

PURPOSE: To compare the visual and refractive outcomes of laser in situ keratomileusis (LASIK) and laser-assisted subepithelial keratectomy (LASEK) in the treatment of high myopia. SETTING: Institute of Vision Research, Department of Ophthalmology, College of Medicine, Yonsei University, and Balgeunsesang Ophthalmology Clinic, Seoul, South Korea. METHODS: Four hundred seventy eyes of 240 patients with manifest refraction spherical components greater than -6.00 diopters (D) were assigned to 2 groups: 324 eyes (167 patients) were treated with LASIK and 146 eyes (73 patients), with LASEK. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), remaining refractive error, corneal haze, and complications were followed in both groups for 12 months. RESULTS: At 12 months, the mean spherical equivalent (SE) was within +/-0.50 D of emmetropia in 205 eyes (63.3%) in the LASIK group and 81 eyes (55.5%) in the LASEK group and within +/-1.00 D in 261 eyes (80.6%) and 104 eyes (71.2%), respectively. The UCVA was 20/25 or better in 269 LASIK eyes (83.0%) and 111 LASEK eyes (76.0%). There was more than a 1-line loss of BSCVA in 4 LASIK eyes (1.2%) and 21 LASEK eyes (14.3%). The between-group differences in SE, magnitude of cylinder, UCVA, and haze were statistically significant (P<.05). CONCLUSIONS: Both LASIK and LASEK were safe and effectively treated eyes with high myopia. Laser in situ keratomileusis provided superior results in visual predictability and corneal opacity.     

Visual performance after interface haemorrhage during laser in situ keratomileusis

AIM: To study the visual performance in eyes with interface haemorrhage during laser assisted in situ keratomileusis (LASIK). METHODS: Case records of 20 patients, who had bleeding from the limbal vessels in one eye during LASIK (group 1) and uncomplicated surgery in the fellow eye (group 2) were studied. The parameters evaluated were uncorrected visual acuity (UCVA) best corrected visual acuity (BCVA), spherical equivalent of refraction (SEQ), contrast sensitivity, and glare acuity preoperatively and at 1, 3, and 6 months postoperatively. RESULTS: The mean preoperative SEQ in group 1 and 2 eyes was -5.79 (2.3) D and -5.27 (1.68) D, respectively. The mean decimal UCVA at 6 months after LASIK in group 1 and 2 eyes were 0.6 (0.2) and 1.0 respectively (p<0.001). The mean decimal BCVA at 1 week after LASIK in group 1 and 2 eyes were 0.89 (0.04) and 1.0 respectively (p<0.05). However, all eyes had a BCVA of 6/6 at 1, 3, and 6 months after LASIK. The mean contrast sensitivity values preoperatively in group 1 and 2 eyes were 161.3 (8.7) and 172 (68.2) respectively. There was a significant decrease in group 1 at 6 months (102 (60.5) (p<0.01)) compared to group 2. The decimal glare acuity preoperatively in group 1 and 2 eyes was 0.95 (0.11) and 0.89 (0.12), respectively. It decreased significantly in group 1 (0.7) (0.1 (p<0.01)) compared to group 2 at the 6 month follow up. CONCLUSION: Occurrence of intraoperative interface haemorrhage may affect the visual performance following LASIK surgery.     

LASIK术后迟发性弥漫性板层角膜炎

目的:回顾性分析LASIK术后迟发性弥漫性板层角膜炎的病因。方法:2005-01/2007-10到我院行LASIK手术治疗并连续进行观察的近视患者,分为甲、乙两组。LASIK术中所用板层角膜刀、刀头甲组用诗乐氏消毒,乙组采用高压消毒。结果:LASIK术后各时期,甲、乙组的裸眼视力、眼压差异无统计学意义(P>0.05)。甲组患者术后1mo4眼(0.25%)发生弥漫性板层角膜炎(diffuse lamellar keratitis,DLK),全部为Ⅰ期;术后3mo56眼(3.54%)发生DLK,其中Ⅰ期41眼(73.21%),Ⅱ期15眼(26.79%);术后6mo10眼(0.63%)发生DLK,全部为Ⅰ期;术后1a3眼(0.19%)发生DLK,全部为Ⅰ期。乙组患者各时期均未见DLK发生。结论:诗乐氏可能导致LASIK术后迟发性弥漫性板层角膜炎。     

激光角膜上皮瓣下磨镶术和激光原位角膜磨镶术治疗中高度近视的对比研究

目的比较激光角膜瓣下磨镶术(LASEK)和激光原位角膜磨镶术(LASIK)治疗中高度近视的临床效果. 方法中高度近视患者198例(394只眼).其中LASEK手术治疗93例(184只眼), LASIK手术治疗105例(210只眼). 结果术后1天,LASIK 组28 %裸眼视力达到1.0,LASEK组无1例裸眼视力达到1.0.术后1周、1、3、6月裸眼视力大于或等于1.0者,两组比较差异无显著性 (P=0.36,P=0.58,P=0.44,P=0.64).角膜地形图分析平均角膜中央屈光力与周边屈光力的差异,LASEK组(0.69)明显小于LASIK组(2.62).结论 LASEK手术矫正中高度近视均有良好的治疗效果,是一种安全、有效、预测性好的屈光手术.     

Influence of flap thickness on results of laser in situ keratomileusis for myopia

PURPOSE: To study whether flap thickness influences laser in situ keratomileusis (LASIK) results. METHODS: This comparative, non-randomized, retrospective study comprised 421 LASIK eyes (233 patients) with spherical equivalent refraction between -0.60 and -6.00 diopters (D). Laser in situ keratomileusis was performed with the Moria One manual microkeratome and the Chiron Technolas 217C laser. Depending on the flap thickness, the eyes were divided into three groups (group 1, flap thickness < or =100 microm; group 2, flap thickness > 100 microm and < 130 microm; and group 3, flap thickness > or = 130 pm). For each group uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity, residual spherical equivalent refraction, and keratometric power (D) were measured 1 day, 1 week, 1 month, and 6 months after LASIK. Complications, retreatment, and correlation between flap thickness and preoperative corneal thickness and keratometric power were also analyzed. RESULTS: One month postoperatively, UCVA was > or = 20/20 in 76% (96 eyes), 56% (79 eyes), and 61% (93 eyes) of eyes in the three group, respectively (P = .015). One month postoperatively, UCVA was > or = 20/25 in 88% (111 eyes), 76% (108 eyes), and 76% (116 eyes) of eyes in the three groups, respectively (P = .015). Complication rate and retreatment rate were not statistically different among the groups. At 6-month follow-up, no statistically significant differences were noted in UCVA between the groups. Significant correlations between flap thickness and preoperative corneal thickness (P < .0001) and between flap thickness and preoperative keratometric power (P < .05) were found. CONCLUSION: Patients with flaps < or = 100 pm had better functional results at 1 month than those with thicker flaps. It may be important to perform LASIK with thin flaps to save corneal tissue in the stromal bed.     

Comparison between LASEK with mitomycin C and LASIK for the correction of myopia of -7.00 to -13.75 D

PURPOSE: To compare laser epithelial keratomileusis (LASEK) and LASIK for the correction of high myopia. METHODS: A prospective, single-masked study was conducted. Patients treated with LASEK to correct myopia > or = -7.00 diopters (D) (spherical equivalent manifest refraction) with a cylinder < or = -3.50 D (LASEK group) were compared to patients treated with LASIK (LASIK group) using the same excimer laser (Technolas 217C). Mitomycin C (MMC) 0.02% was applied for 1 minute in all LASEK-treated eyes. RESULTS: A total of 228 consecutive eyes were included in the study (114 in each group, matched for preoperative refraction). The mean preoperative spherical equivalent manifest refraction was -8.72 +/- 1.20 D in the LASEK group and -8.74 +/- 1.20 D in the LASIK group (range: -7.00 to -13.75 D) (P = .9). Uncorrected visual acuity (UCVA) was significantly lower in LASEK eyes 1, 7, and 30 days postoperatively (P = .0001 for each comparison). No significant differences were found at 3 months postoperatively in UCVA (P = .3), best spectacle-corrected visual acuity (BSCVA) (P = .2), or in the safety (P = .6) and efficacy (P = .8) indices. Uncorrected visual acuity was 1.0 or better in 34.2% of LASEK eyes and 44.7% of LASIK eyes. Spherical refraction was +0.25 +/- 0.6 D after LASEK and -0.06 +/- 0.5 D after LASIK (P = .0001). Sixty-eight percent of LASEK eyes and 79% of LASIK eyes were within +/- 0.50 D of intended refraction. No LASEK eye versus 7 LASIK eyes lost 2 lines of BSCVA. Eight LASEK eyes gained 2 or more lines of BSCVA versus 1 LASIK eye. CONCLUSIONS: Visual improvement after LASEK with intraoperative MMC was significantly slower than after LASIK. Visual outcomes (UCVA, BSCVA, and safety and efficacy indices) 3 months after surgery were similar with both techniques for the correction of high myopia. Ten percent more eyes after LASIK were within +/- 0.50 D of intended refraction.