TPRK与FS-LASIK矫正近视散光疗效的比较

目的 观察比较经上皮准分子激光角膜切削术（TPRK）与飞秒激光制瓣的准分子激光原位角膜磨镶术（FS-LASIK）矫正近视散光的疗效及视觉质量。方法 前瞻性研究。连续收集2016年1-12月在北京协和医院眼科行准分子激光治疗近视患者120例（240眼）,其中接受TPRK手术60例（TPRK组）,FS-LASIK手术60例（FS-LASIK组）。术前及术后1年检查裸眼视力（UCVA）、球镜度及柱镜度。采用国家眼科研究所屈光生命质量（NEI-RQL）调查问卷对2组术后总体评价、术后与术前最佳矫正时的视觉质量及视觉症状进行比较。视力及屈光度比较采用独立样本t检验,视觉质量评分采用Wilcoxon秩和检验。结果 术后3 d,FS-LASIK组较TPRK组UCVA更佳（86.7% vs. 39.2%,χ²=12.80,P=0.007）,而术后1个月至随访结束TPRK组与FS-LASIK组UCVA差异并无统计学意义。TPRK组与FS-LASIK组总体满意度均为96.7%,91.7%的患者如再次选择还愿意选择手术替代眼镜,其中白天远视力优于术前是最显著项目,夜间眩光、视近阅读评分较低,男性夜视力差的比例多于女性（χ²=10.68,P=0.046）;近处阅读疲劳女性患者比例多于男性（χ²=11.32,P=0.002）。结论 TPRK与FS-LASIK术后长期视觉质量并无明显差异,夜间眩光、视疲劳是准分子术后最常见的不适症状且存在性别差异。

A Comparative Study of Effect after Treatment with TPRK and FS-LASIK

Objective: To compare efficiency and vision quality after treatment with either transepithelial photorefractive keratectomy (TPRK) or femtosecond assisted laser in situ keratomileusis (FS-LASIK). Methods: This prospective study included 240 eyes of 120 patients at Peking Union Medical College Hospital from January to December 2016. One hundred twenty eyes of 60 patients underwent TPRK, 120 eyes of 60 patients underwent FS-LASIK. Uncorrected visual acuity (UCVA), spherical and cylindrical values, and spherical equivalent (SE) were recorded before surgery and 1 year after surgery; meanwhile, a general evaluation and a comparison of pre- and postoperative visual quality and symptoms were performed. A t test, Mann-Whitney U test and χ² test were used for statistical analysis. Results: At 3 d after surgery, UCVA in the FS-LASIK group was better than in the TPRK group (86.7% versus 39.2%) (χ²=12.80, P=0.007), but the difference in UCVA was not significant at 1, 3, 6 or 12 months. Patients reported that diurnal distance vision and quality of life improved most after surgery but they complained about glare and nocturnal vision, especially tiredness when staring at close objects, which was reflected in nocturnal and low nocturnal vision scores. Female patients complained most about tiredness when staring at close objects (χ²=10.68, P=0.046), while male patients complained most about poor nocturnal vision (χ²=11.32, P=0.002). Conclusions: There is no statistically significant difference between postoperative visual quality scores between the FS-LASIK group and TPRK group. Tiredness when staring at close objects and poor nocturnal vision are the most common postoperative problems.