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目的探讨超薄角膜瓣的准分子激光原位角膜磨镶术(LASIK)和准分子激光角膜上皮瓣下磨镶术(LASEK)在治疗中央角膜厚度<500μm的高度近视眼时的有效性和安全性。方法随机使用超薄瓣LASIK和LASEK两种方法治疗近视度数>-6·00D、角膜厚度为450~500μm的近视眼患者。其中超薄瓣LASIK组23人39只眼,近视度数为-6·00~-9·50D,平均-7·51D。LASEK组19人37只眼,近视度数为-6·00~-11·50D,平均为-7·50D。分别于治疗后1、3、6、12个月检查并记录裸眼视力、矫正视力、等值球镜度、角膜上皮下雾状混浊(haze)程度等并进行比较。结果超薄瓣LASIK组术后反应较轻,LASEK组角膜上皮完整时间平均为4d,术后裸眼视力超薄瓣LASIK组恢复较快,在术后1、3、6、12个月裸眼视力在1·0以上者分别占64·1%、87·2%、87·2%和79·3%,LASEK组分别为37·8%、75·7%、67·6%和71·4%。等值球镜度在±0·50D之间者超薄瓣LASIK组为48·7%、51·3%、61·5%、82·8%,LASEK组为51·4%、45·9%、45·9%和57·1%。术中、术后无发生严重并发症,超薄瓣LASIK组并发症主要为角膜瓣细小条纹和过矫,LASEK组并发症主要为屈光回退和轻微的haze。结论超薄瓣LASIK在治疗高度近视的安全性和有效性方面与LASEK相同,而治疗后的稳定性优于LASEK,患者的满意率更高。
Objective To investigate the efficacy and safety of ultra-thin corneal flap excimer laser in situ keratomileusis (LASIK) and excimer laser epithelial keratomileusis (LASEK) in the treatment of high myopia with central corneal thickness <500 μm and safety. Methods Two methods, LASIK and LASEK, were used to treat patients with myopia with myopia> -6.00D and corneal thickness of 450-500μm. The ultrathin flap LASIK group of 23 39 eyes, myopia was -6.00 ~ -9.50D, an average of -7.51D. LASEK group 19 eyes 37 eyes, myopia was -6.00 ~ -11 · 50D, with an average of -7 · 50D. The uncorrected visual acuity, corrected visual acuity, spherical equivalent, corneal haze, etc. were examined and recorded at 1, 3, 6 and 12 months after treatment. Results The postoperative response to ultrathin flap LASIK was mild. The average corneal epithelial length in LASEK group was 4 days. The postoperative visual acuity ultra thin flap LASIK group recovered quickly. The visual acuity of naked eye at 1, 3, 6, 12 months after operation 1.0% or more accounted for 64.1%, 87.2%, 87.2% and 79.3%, respectively, while those in LASEK group were 37.8%, 75.7%, 67.6% and 71.4% respectively, . The spherical equivalent magnitudes were between ± 0.50D in the LASIK group and 48.7%, 51.3%, 61.5% and 82.8% in the LASIK group, 51.4% and 45.9 in the LASEK group %, 45.9% and 57.1% respectively. There were no serious complications during and after surgery. The complications of ultrathin flap LASIK group were mainly small streaks and overcorrection of corneal flap. The main complications of LASEK group were refractive regression and slight haze. Conclusions The ultrathin flap LASIK is the same as LASEK in the treatment of high myopia, but its stability after treatment is better than that of LASEK. The patients’ satisfaction rate is higher.