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目的探讨微型角膜刀准分子激光角膜上皮瓣下磨镶术(Epi-LASIK)和准分子激光原位角膜磨镶术(LASIK)矫治高度近视的疗效。设计前瞻性、病例对照研究。研究对象62例(123眼)高度近视患者。方法对62例(123眼)高度近视患者进行Epi-LASIK(28例56眼)或LASIK(34例67眼)手术。由患者自行决定采用何种术式,对于角膜相对较薄者和从事职业存在角膜瓣风险者,医生推荐Epi-LASIK手术。观察术中术后并发症。记录两组患者术后1周、1、3、6个月裸眼视力(UCVA)、最佳矫正视力(BCVA)、屈光状态及总的高阶波前像差均方根(RMS)。主要指标UCVA、BCVA、屈光状态及总的高阶波前像差RMS值。结果术中、术后无严重并发症。术后1周Epi-LASIK组UCVA≥0.8眼数比例(46.4%)明显少于LASIK组(77.6%),差异有统计学意义(P=0.0003);术后1、3、6个月Epi-LASIK组UCVA≥0.8眼数比例(85.7%、94.6%、91.1%)与LASIK组(92.5%、95.5%、94.0%)差异无统计学意义(P=0.590、0.822、0.530)。两组术后的BCVA无一例下降。Epi-LASIK组术后1周、1、3、6个月等效球镜值在±0.50D以内的比例(42.9%、51.8%、60.7%、64.3%)与LASIK组(53.7%、59.7%、71.6%、73.1%)比较差异无统计学意义(P= 0.230、0.378、0.200、0.290)。两组术后的高阶像差RMS均较术前增大:Epi-LASIK组术后l、3、6个月的高阶像差RMS值(1.51±0.77)μm、(1.32±0.76)μm、(1.18±0.71)μm与术前(0.87±0.27)μm相比,差异均有统计学意义(P=0.016、0.019、0.026);LASIK组术后1、3、6个月的高阶像差RMS值(2.41±0.81)μm、(2.17±0.63)μm、(1.89±0.87)μm与术前(0.91±0.22)μm相比,差异亦均有统计学意义(P=0.011、0.008、0.006)。Epi-LASIK组对高阶像差的影响小于LASIK组:两组之间术后1、3、6个月高阶像差RMS比较差异均有统计学意义(P=0.039、0.035、0.033)。Epi-LASIK组Ⅰ级角膜上皮下雾状混浊(haze)2眼。结论Epi-LASIK矫正高度近视虽然视力恢复较LASIK慢,但能获得更好的视觉质量。(眼科,2007,16:336-339)
Objective To investigate the curative effect of Epi-LASIK and LASIK in treating high myopia. Design prospective, case-control study. The study included 62 patients (123 eyes) with high myopia. Methods Epi-LASIK (28 eyes, 56 eyes) or LASIK (34 eyes, 67 eyes) were performed in 62 eyes (123 eyes) with high myopia. At the discretion of the patient, which surgical procedure is used, the doctor recommends Epi-LASIK for those with a relatively thin cornea and those at occupational risk of having a corneal flap. Postoperative complications were observed. The uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refractive status, and total higher order wavefront anomaly (RMS) were recorded at 1 week, 1, 3 and 6 months after operation in both groups. The main indicators UCVA, BCVA, refractive state and the total RMS wavefront aberration. Results no intraoperative and postoperative complications. The ratio of UCVA≥0.8 (46.4%) in Epi-LASIK group at 1 week after operation was significantly lower than that in LASIK group (77.6%) (P = 0.0003). Epi- There was no significant difference between the LASIK group and the LASIK group (92.5%, 95.5%, 94.0%) for UCVA≥0.8 (85.7%, 94.6%, 91.1%) (P = 0.590,0.822,0.530). There was no decrease in BCVA after operation in both groups. Compared with the LASIK group (53.7%, 59.7%) in the Epi-LASIK group, the equivalent sphere values within ± 0.50D (42.9%, 51.8%, 60.7%, 64.3% , 71.6%, 73.1%), there was no significant difference (P = 0.230,0.378,0.200,0.290). The higher-order aberrations (RMSs) of the two groups were significantly higher than those before the operation: the higher-order aberrations (RMS) values (1.51 ± 0.77) μm and (1.32 ± 0.76) μm at 1, 3 and 6 months after operation in Epi-LASIK group , (1.18 ± 0.71) μm, compared with preoperative (0.87 ± 0.27) μm, the difference was statistically significant (P = 0.016,0.019,0.026); LASIK group 1,3,6 months after the high-order image The difference of RMS value was (2.41 ± 0.81) μm, (2.17 ± 0.63) μm, (1.89 ± 0.87) μm and 0.91 ± 0.22 μm respectively (P = 0.011,0.008,0.006 ). The Epi-LASIK group had less influence on higher-order aberrations than the LASIK group. There were significant differences in high-order aberrations RMS between the two groups at 1, 3, and 6 months postoperatively (P = 0.039,0.035,0.033). Epi-LASIK group Ⅰ corneal submucosal haze 2 eyes. Conclusion Epi-LASIK correction of high myopia Although vision recovery slower than LASIK, but can get better visual quality. (Ophthalmology, 2007,16: 336-339)