飞秒激光和微型角膜板层刀制作角膜瓣术后瓣厚度比较

目的 通过比较飞秒激光和微型角膜刀在准分子激光原位角膜磨镶术中制作角膜瓣的特点,评价飞秒激光制作角膜瓣技术的可预测性、均匀性、精准性.方法 前瞻性临床病例对照研究.将2013年6～9月间行LASIK手术的近视眼患者分成两组,A组为飞秒激光制瓣组,共56例110只眼;B组为微型角膜刀制瓣组共55例108只眼,所有手术均由同一术者完成.取随访资料完整者,飞秒激光制瓣组50例（98眼）,微型角膜刀制瓣组49例（98眼）进行分析.比较两组术前及术后1周、1月、3月裸眼视力（UCVA）、最佳矫正视力（BCVA）、角膜瓣多点厚度.统计学处理采用SPSS 17.0软件.结果 （1）两组病例术前资料比较无明显差异（P＞0.05）.（2）术后UCVA：两组间比较无明显差异（P＞0.05）.（3）术后BCVA：两组间比较无明显差异（P＞0.05）.（4）角膜瓣厚度测量：术后1个月使用光学相干断层分析仪（Topcon,Japan）测量两组病例角膜瓣厚度.A组飞秒激光组结果显示在水平子午线角膜瓣中央平均厚度为（108.65±8.23）μm,鼻侧旁中央（2.0 mm处）平均厚度为（108.34±7.26）μm,鼻侧周边（4.0 mm处）平均厚度为（113.28±6.38）μm,颞侧旁中央（2.0 mm处）平均厚度为（109.47±6.27）μm,颞侧周边（4.0 mm处）平均厚度为（113.86±9.63）μm.经统计学分析,角膜瓣平均厚度与预设厚度相符合（P＞0.05）,角膜瓣水平子午线平均角膜厚度无差异（P＞0.05）.B组角膜刀组结果显示在水平子午线角膜瓣中央平均厚度为（134.29±7.45）μm,鼻侧旁中央（2.0 mm处）平均厚度为（144.38±6.29） μm,鼻侧周边（4.0 mm处）平均厚度为（140.60±11.37）μm,颞侧旁中央（2.0 mm处）平均厚度为（134.18±4.25）μm,颞侧周边（4.0 mm处）平均厚度为（141.26±11.68） μm;经统计学分析,角膜瓣平均厚度厚于预设厚度（P＜0.05）,并且角膜瓣水平经线平均角膜厚度有差异（P?

Study on the Application of Corneal Flap Technique Which Produced by Femtosecond Laser in LASIK

Objective To estimate the predictability, uniformity and accuracy of corneal flap technique which produced by femtosecond laser in LASIK procedure for the treatment of myopia and its influence on the postoperative visual quality, comparing with the corneal flap made by microkeratome. Methods Prospective clinical case - control study. All the myopia surgery patients from June to September in 2012 were divided into 2 groups： Group A including 56 cases（110 eyes） ; Group B including 55 cases （108 eyes） . All the surgery was accomplished by the same surgeon. The UCVA and BCVA, corneal flap thickness, contrast sensitivity and highorder aberration were compared between groups both preoperatively and at 1 and 3 months postoperatively. SPSS 17.0 software was used for statistical analysis. Results （1）Both groups had no statistical difference in preoperative data（P 〉0.05）. （2）Postoperative UCVA： no significant differences between the two groups（P 〉 0.05）. （3） Postoperative BCVA： no significant differences between the two groups（ P 〉 0.05 ）. （4） Flap thickness was measured in both groups using OCT （Topcon, Japan） at one month postoperatively. The average results in horizontal meridian showed in group A was central thickness （ 108.65 ± 8.23 ） μm, nasal paracentral （ 108.34 ±7.26）μm, nasal periphery（113.28 ± 6.38）μm, temporal paracentral（109.47 ± 6.27）ttm, and temporal periphery （113.86 ± 9.63）μm respectively. The average flap thickness was coincident with the preset thickness and the uniformity of flap was good（P 〉0.05）. The average results in horizontal meridian showed in groupBwas central thickness（134.29± 7.45）μm, nasal Paracentral（144.38± 6.29）μm, nasa periphery（140.60 ± 11.37）μm, temporal paracentral （ 134.18± 4.25 ）μm, temporal periphery （ 141.26± 11.68 ） btm respectively. The average flap thickness was thicker than preset thickness and the uniformity of flap was bad（P 〈 0.05）. Conclusions （1） Co