超薄瓣准分子激光原位角膜磨镶术与准分子激光角膜上皮瓣下磨镶术治疗薄角膜高度近视眼的临床研究

目的探讨超薄角膜瓣的准分子激光原位角膜磨镶术(LASIK)和准分子激光角膜上皮瓣下磨镶术(LASEK)在治疗中央角膜厚度<500μm的高度近视眼时的有效性和安全性。方法随机使用超薄瓣LASIK和LASEK两种方法治疗近视度数>-6·00D、角膜厚度为450~500μm的近视眼患者。其中超薄瓣LASIK组23人39只眼,近视度数为-6·00~-9·50D,平均-7·51D。LASEK组19人37只眼,近视度数为-6·00~-11·50D,平均为-7·50D。分别于治疗后1、3、6、12个月检查并记录裸眼视力、矫正视力、等值球镜度、角膜上皮下雾状混浊(haze)程度等并进行比较。结果超薄瓣LASIK组术后反应较轻,LASEK组角膜上皮完整时间平均为4d,术后裸眼视力超薄瓣LASIK组恢复较快,在术后1、3、6、12个月裸眼视力在1·0以上者分别占64·1%、87·2%、87·2%和79·3%,LASEK组分别为37·8%、75·7%、67·6%和71·4%。等值球镜度在±0·50D之间者超薄瓣LASIK组为48·7%、51·3%、61·5%、82·8%,LASEK组为51·4%、45·9%、45·9%和57·1%。术中、术后无发生严重并发症,超薄瓣LASIK组并发症主要为角膜瓣细小条纹和过矫,LASEK组并发症主要为屈光回退和轻微的haze。结论超薄瓣LASIK在治疗高度近视的安全性和有效性方面与LASEK相同,而治疗后的稳定性优于LASEK,患者的满意率更高。

Clinical study of ultrathin flap LASIK and LASEK for the treatment of high myopia with thin cornea

OBJECTIVE: To explore the efficacy and safety of the ultrathin flap LASIK and LASEK for the treatment of high myopia with central corneal thickness below 500 microm. METHODS: Ultrathin flap LASIK and LASEK were randomly selected to treat high myopic patients with corneal thickness between 450 and 500 microm. 39 cases of 23 patients with average spherical equivalent of -7.51D (range from -6.00 to -9.50D) were treated with ultra thin flap LASIK, and 37 cases of 19 patients with average SE of -7.50D (range from -6.00 to -10.75D) were treated with LASEK. The uncorrected visual acuity, best corrected visual acuity, spherical equivalent, intraocular pressure, haze were examined and recorded 1, 3, 6 and 12 months postoperatively. RESULTS: Postoperative reaction was mild in LASIK patients, who showed a quick recovery in UCVA, whereas LASEK patients needed average 4 days to re-epithelization. At 1, 3, 6, 12 months postoperatively, the percentage of UCVA above 1.0 was 64.1%, 87.2%, 87.2% and 79.3% in LASIK patients and 37.8%, 75.7%, 67.6% and 71.4% in LASEK patients respectively. The percentage of spherical equivalent between +/- 0.50D was 48.7%, 51.3%, 61.5%, 82.8% in LASIK patients and 51.4%, 45.9%, 45.9%, 57.1% in LASEK respectively. There was no severe complications that implicate the BSCVA occurred in-operation and postoperatively. The main complications in LASIK group was corneal flap striae and overcorrection, regression and mild haze in LASEK group. CONCLUSION: Ultrathin flap LASIK had the similar efficacy and safety with LASEK in the treatment of high myopia with thin CCT, but the stability of results and satisfaction from the patients was superior to LASEK.