飞秒激光与机械板层刀制瓣的SBK手术效果比较

目的对比分析飞秒激光(瑞士Femto-LDV飞秒激光)与机械刀(法国MORIA OUP)制作角膜瓣的SBK手术的有效性、预测性、安全性、稳定性。方法 2010年1～4月成都康桥眼科医院门诊完成的SBK手术病例2000眼(球镜-1.00～9.75 D,柱镜0～2.75 D),根据制瓣方式分为飞秒激光组和板层刀组各1000眼,所有手术均采用VISX S4(美国AMO公司)行基质切削,且都由同一手术医师完成。比较两组术前及术后1天、1周、1月、3月、6月的裸眼视力(UCVA)、术后屈光度、术后最佳矫正视力(BCVA)及丢失,并分析各组屈光稳定性和术后并发症。结果预测性:两种手术均具有良好的预测性,但术后1天时飞秒激光组优于角膜板层刀组;有效性:术后1天UCVA达到或超过术前BCVA的比例,飞秒激光组为95.5%,明显高于机械刀组的91.2%,差异有统计学意义(P<0.05)。但术后1周、1月、3月、6月两组间差异均无统计学意义(P>0.05);术后6月视力超过BCVA一排以上的比例,飞秒激光组为21.5%,明显高于机械刀组的15%,差异有统计学意义(P<0.05);稳定性和安全性:术后6月BCVA丢失在2排以上者飞秒激光组为0眼,机械刀组有3眼。结论飞秒激光制作角膜瓣的SBK手术有较快的视力恢复,更好的术后视力,更高的安全性,但对于术后晚期视力稳定性和角膜生物力学变化情况,仍需长期观察。

Comparison of Femtosecond laser and microkeratome for corneal flap making in sub-Bowman's keratomileusis

Objective To compare and analyze the effectiveness,predictability,safety and stability of sub-Bowman＇s keratomileusis（SBK）with corneal flap created by Femtosecond laser and microkeratome respectively.Methods We reviewed 1000 patients（2000 eyes）treated by SBK to correct myopiasph.：-1.0～9.75 diopter（D）,cylinder： 0～2.75 D] in out-patient department of Kangqiao Hospital of Chengdu from Jan.2010 to Apr.2010.The patients were divided into Femtosecond laser group（1000 eyes）and microkeratome group（1000 eyes）.Uncorrected visual acuity（UCVA）,diopter,postoperative best corrected visual acuity（BCVA）,lost of BCVA,refractive stability and complications of the two groups after operation（1 day,1 week,1 month,3 month,6 month）were compared with those before operation.Results Both two operations had good predictability,but the Femtosecond laser group had better manifestation 1 day after operation.UCVA of 95.5%of the cases in Femtosecond laser group reached or exceeded preoperative BCVA 1 day after operation,while 91.2%of the cases in microkeratome group did.There was significant difference between the two groups（P0.05）.But there were no significant differences between the two groups in other postoperative visits（1 week,1 month,3 months,and 6 months）.About 21.5%of the cases in Femtosecond laser group could see one more line on eye chart 6 months after operation,while 15%of the cases in microkeratome group could.There was significant difference between the two groups（P0.05）.No patient in Femtosecond laser group lost more than two lines（eye chart）of vision 6 months after operation,while in microkeratome group,the number was 3 cases.Conclusions SBK with corneal flap created by Femtosecond laser is safety and has a quick and good postoperative visual acuity.We still need long-term observation about the stability of visual acuity and changes in corneal biomechanics.