两种准分子激光手术治疗超高度近视的对比研究

目的:比较准分子激光上皮瓣下角膜磨镶术(laser-assisted subepithelial keratectomy,LASEK)与准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)在超高度近视及近视散光矫正中的临床疗效(有效性、安全性、可预测性、稳定性及手术后并发症).方法:应用Allegretto Wavelight -Wave 1007型准分子激光机对超高度近视及近视散光患者(术前等值球镜屈光度≥10.0 D)分别行LASIK和LASEK,其中LASEK组62人106只眼,LASIK组38人59只眼.比较两组术前与术后6个月、12个月的屈光状态、裸眼视力、戴镜最佳矫正视力、手术后并发症等.结果:术后LASEK与LASIK屈光矫正结果平均等值球镜(mean spherical equivalent,,MSE)分别为(-1.32±1.66)D和(-1.02±0.85)D,12月时LASEK与LASIK分别为(-1.57±1.09) D和(-1.19±0.87) D,差异无统计学意义.术后1周及1个月时LASIK组裸眼视力(uncorrected visual acuity, UCVA)好于LASEK组,术后3个月和6个月时,两组趋于相同,术后12个月LASEK组稍好于LASIK组,但差异无统计学意义(P=0.075).术后12月时UCVA≥1.0的百分比LASEK组与LASIK组分别为47.8%和52.5%,差异无统计学意义.术后6个月、12个月最佳矫正视力在Snellen视力表上变化的百分比两组差异无统计学意义.术后12个月等值球镜屈光度在±0.5D及±1.0D范围内的百分比两组差异无统计学意义.LASEK组术后疼痛不适较LASIK组明显且持续时间长.两组均无严重术后并发症发生.结论:LASEK和 LASIK手术对超高度近视的矫正均获得较好的临床疗效.

Comparison of laser in situ keratomileusis and laser-assisted subepithelial keratectomy for myopia more than -10.00 diopters

OBJECTIVE: To compare the visual and refractive outcomes of laser in situ keratomileusis (LASIK) and laser-assisted subepithelial keratectomy (LASEK) in the treatment of severe myopia. METHODS: LASEK and LASIK were respectively performed on 165 eyes of 100 patients with super high myopia by using the Allegretto Wavelight-Wave 1,007 excimer laser, of which 10(6) eyes (62 patients) were treated with LASEK and 59 eyes (38 patients) with LASIK. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), remaining refractive error, corneal haze and complications were followed up in both groups for 12 months. RESULTS: At the end of 6 months and 12 months no significant statistic difference between LASEK and LASIK group in the clinical outcomes of refractive corrections (mean spherical equivalent, MSE). At the end of 1 week and 1 month postoperatively, UCVA in the LASIK eyes was better than in LASEK eyes. At the end of 3, 6, 12 months, it was almost the same in these two groups. The percentage of eyes with UCVA better than 1.0 (47.8% in LASEK, 52.5% in LASIK) was higher in LASEK group. There was no significant difference between the two groups in the percentage of eyes losing one or more lines of BSCVA in Snellen visual acuity chart. At the end of 12 months, the mean SE was within +/-0.5D of emmetropia in 9 eyes (13.2%) in the LASEK group and 11 eyes (18.6%) in the LASIK group and within +/-1.0D of emmetropia in 36 eyes (52.9%) in the LASEK group and 28 eyes (47.5%) in the LASIK group, respectively, the between-group differences were not statistically significant (P>0.05). There were more complaints of postoperative pain and discomfort after LASEK procedure. No severe vision threatening complications in these two groups were found. CONCLUSION: Both LASIK and LASEK are safe and effective in treating eyes with severe myopia.