去上皮瓣LASEK与飞秒激光辅助LASIK矫治中低度近视的比较
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摘要
目的比较去上皮瓣准分子激光上皮下角膜磨镶术(LASEK)与飞秒激光辅助准分子激光原位角膜磨镶术(FS-LASIK)治疗中低度近视患者术后的效果。方法选择拟行近视矫正手术的低中度近视患者103例(103眼),LASEK组51例(51眼),FS-LASIK组52例(52眼)。比较2组患者在术前和术后1个月、3个月裸眼视力(UCVA)、最佳矫正视力(BCVA)、残余等效球镜度(SE)、总高阶像差、球差、彗差、三叶草相差等指标的变化。结果在术后1、3个月2组UCVA、BCVA差异均无统计学意义;术后1个月LASEK组SE较FS-LASIK组升高(P<0.05),但术后3个月差异无统计学意义。LASEK组和FS-LASIK组术后1个月、3个月总高阶像差、球差均较术前增加(P<0.05);FS-LASIK组彗差术后1个月较术前增加(P<0.05),术后3个月恢复至术前水平,LASEK组彗差术后1个月、3个月与术前相比差异无统计学意义。FS-LASIK组术后1个月全眼总高阶像差和彗差均较去上皮瓣LASEK组升高(P<0.05);术后3个月2组差异无统计学意义。结论去上皮瓣LASEK术式矫正近视术后早期可达到与FS-LASIK相近水平,尤其适用于低中度近视患者。
Objective To compare the therapeutic effect of epithelial flap removed laser subepithelial keratomileusis(LASEK) and femtosecond laser assisted LASIK(FS-LASIK) in the treatment of moderate and low myopia.Methods A total of 103 patients(103 eyes) of low and moderate myopia were selected, 51 patients(51 eyes) were treated with LASEK and 52 patients(52 eyes) were treated with FS-LASIK. Data of uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), residual equivalent spherical degree(SE), total high-order aberrations(HOAs), spherical aberration, coma and trefoil were examined before operation and 1 month and 3 months after operation, and compared between two groups of patients.Results There were no significant differences in UCVA and BCVA 1 month and 3 months postoperatively between the two groups. SE shifted to myopia direction in LASEK group compared with that of FS-LASIK group 1 month postoperatively(P<0.05), but reached a similar level 3 months after surgery. The HOAs and spherical aberration were significantly increased 1 month and 3 months postoperatively compared with those before operation in LASEK and FS-LASIK groups(P<0.05). Coma was significantly increased 1 month postoperatively in FS-LASIK group and returned to thepreoperative level 3 months postoperatively, while it remained at baseline 1 month and 3 months postoperatively in the LASEK group. The HOAs and coma were significantly higher 1 month postoperatively in FS-LASIK group compared to those of LASEK group(P<0.05), while they reached a similar level 3 months postoperatively.Conclusion The therapeutic effect of epithelial flap removed LASEK can reach a level equal to FS-LASIK at the early stage after surgery. It is a good selectable choice for patients with low to moderate myopia.
Objective To compare the therapeutic effect of epithelial flap removed laser subepithelial keratomileusis(LASEK) and femtosecond laser assisted LASIK(FS-LASIK) in the treatment of moderate and low myopia.Methods A total of 103 patients(103 eyes) of low and moderate myopia were selected, 51 patients(51 eyes) were treated with LASEK and 52 patients(52 eyes) were treated with FS-LASIK. Data of uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), residual equivalent spherical degree(SE), total high-order aberrations(HOAs), spherical aberration, coma and trefoil were examined before operation and 1 month and 3 months after operation, and compared between two groups of patients.Results There were no significant differences in UCVA and BCVA 1 month and 3 months postoperatively between the two groups. SE shifted to myopia direction in LASEK group compared with that of FS-LASIK group 1 month postoperatively(P<0.05), but reached a similar level 3 months after surgery. The HOAs and spherical aberration were significantly increased 1 month and 3 months postoperatively compared with those before operation in LASEK and FS-LASIK groups(P<0.05). Coma was significantly increased 1 month postoperatively in FS-LASIK group and returned to thepreoperative level 3 months postoperatively, while it remained at baseline 1 month and 3 months postoperatively in the LASEK group. The HOAs and coma were significantly higher 1 month postoperatively in FS-LASIK group compared to those of LASEK group(P<0.05), while they reached a similar level 3 months postoperatively.Conclusion The therapeutic effect of epithelial flap removed LASEK can reach a level equal to FS-LASIK at the early stage after surgery. It is a good selectable choice for patients with low to moderate myopia.
引文
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[3]王佼佼,王丽晶,韩茜.不同准分子激光角膜屈光手术后视觉质量比较[J].中国实用医药,2014,9(36):95-96.Wang JJ,Wang LJ,Han Q.Comparison of visual quality after different excimer laser corneal refractive surgery[J].China Prac Med,2014,9(36):95-96.
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[5]Jun I,Kang DSY,Arba-Mosquera S,et al.Comparison between Wavefront-optimized and corneal Wavefront-guided Transepithelialphotorefractive keratectomy in moderate to high astigmatism[J].BMC Ophthalmol,2018,18(1):154.doi:10.1186/s12886-018-0827-x.
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[8]Sarayba MA,Ignacio TS,Binder PS,et al.Comparative study of stromal bed quality by using mechanical,IntraLase femtosecond laser 15-and 30-kHz microkeratomes[J].Cornea,2007,26(4):446-451.
[9]Zhu X,Zou L,Yu M,et al.Comparison of postoperative visual quality after SMILE and LASEK for high myopia:A 1-year outcome[J].PLoS One,2017,12(8):e0182251.doi:10.1371/journal.pone.0182251.eCollection 2017.
[10]Li SM,Zhan S,Li SY,et al.Laser-assisted subepithelial keratectomy(LASEK)versus photorefractive keratectomy(PRK)for correction of myopia[J].Cochrane Database Syst Rev,2016,(2):CD009799.doi:10.1002/14651858.CD009799.pub2.
[11]Salom?o MQ,Wilson SE,et al.Femtosecond laser in laser in situ keratomileusis[J].J Cataract Refract Surg,2010,36(6):1024-1032.doi:10.1016/j.jcrs.2010.03.025.
[12]Ren Y,Liang K,Jiang Z,et al.Changes of corneal high-order aberrations after femtosecond laser-assisted in situ keratomileusis changes of corneal high-order aberrations after femtosecond laserassisted in situ keratomileusis[J].Medicine(Baltimore),2018,97(18):e0618.doi:10.1097/MD.0000000000010618.
[13]Al-Zeraid FM,Osuagwu UL.Induced higher-order aberrations after laser in situ keratomileusis(LASIK)performed with wavefront-guided intralase femtosecond laser in moderate to high astigmatism[J].BMC Ophthalmol,2016,(16):29.doi:10.1186/s12886-016-0205-5.
[14]Bottos KM,Leite MT,Aventura-Isidro M,et al.Corneal asphericity and spherical aberration after refractive surgery[J].J Cataract Refract Surg,2011,37(6):1109-1115.doi:10.1016/j.jcrs.2010.12.058.
[15]姚佩君,李美燕,赵婧,等.全飞秒小切口透镜取出术矫正高度近视术后像差初步分析[J].中国眼耳鼻喉科杂志,2015,15(6):399-402.Yao PJ,Li MY,Zhao J,et al.Analysis of spherical myopia[J].Chinese Journal of Nasolaryngology,2015,15(6):399-402.
[16]Chen X,Wang Y,Zhang J,et al.Comparison of ocular higher order aberrations after SMILE and Wavefront-guided Femtosecond LASIK for myopia[J].BMC Ophthalmology,2017,17(1):42-50.doi:10.1186/s12886-017-0431-5.
[2]王彬,季元元.飞秒激光与机械角膜刀制瓣LASIK术后视觉质量的比较观察[J].中国继续医学教育,2017,9(16):136-138.Wang B,Ji YY.Comparative observation of visual quality after femtosecond laser and mechanical corneal LASIK[J].Chinese Continuing Medical Education,2017,9(16):136-138.
[3]王佼佼,王丽晶,韩茜.不同准分子激光角膜屈光手术后视觉质量比较[J].中国实用医药,2014,9(36):95-96.Wang JJ,Wang LJ,Han Q.Comparison of visual quality after different excimer laser corneal refractive surgery[J].China Prac Med,2014,9(36):95-96.
[4]Kuryan J,Cheema A,Chuck RS.Laser-assisted subepithelial keratectomy(LASEK)versus laser-assisted in-situ keratomileusis(LASIK)for correcting myopia[J].Cochrane Database Syst Rev,2017,(2):CD011080.doi:10.1002/14651858.CD011080.pub2.
[5]Jun I,Kang DSY,Arba-Mosquera S,et al.Comparison between Wavefront-optimized and corneal Wavefront-guided Transepithelialphotorefractive keratectomy in moderate to high astigmatism[J].BMC Ophthalmol,2018,18(1):154.doi:10.1186/s12886-018-0827-x.
[6]邓蒙蒙,尹连荣.准分子激光角膜表层屈光手术发展历程[J].中国中医眼科杂志,2015,25(6):453-456.Deng MM,Yin LR.Development history of excimer laser corneal surface refractive surgery[J].Chinese Journal of Ophthalmology,2015,25(6):453-456.
[7]Tran DB,Sarayba MA,Bor Z,et al.Randomized prospective clinical study comparing induced aberrations with IntraLase and Hansatome flap creation in fellow eyes:potential impact on wavefront-guided laser in situ keratomileusis[J].J Cataract Refract Surg,2005,31(1):97-105.doi:10.1016/j.jcrs.2004.10.037.
[8]Sarayba MA,Ignacio TS,Binder PS,et al.Comparative study of stromal bed quality by using mechanical,IntraLase femtosecond laser 15-and 30-kHz microkeratomes[J].Cornea,2007,26(4):446-451.
[9]Zhu X,Zou L,Yu M,et al.Comparison of postoperative visual quality after SMILE and LASEK for high myopia:A 1-year outcome[J].PLoS One,2017,12(8):e0182251.doi:10.1371/journal.pone.0182251.eCollection 2017.
[10]Li SM,Zhan S,Li SY,et al.Laser-assisted subepithelial keratectomy(LASEK)versus photorefractive keratectomy(PRK)for correction of myopia[J].Cochrane Database Syst Rev,2016,(2):CD009799.doi:10.1002/14651858.CD009799.pub2.
[11]Salom?o MQ,Wilson SE,et al.Femtosecond laser in laser in situ keratomileusis[J].J Cataract Refract Surg,2010,36(6):1024-1032.doi:10.1016/j.jcrs.2010.03.025.
[12]Ren Y,Liang K,Jiang Z,et al.Changes of corneal high-order aberrations after femtosecond laser-assisted in situ keratomileusis changes of corneal high-order aberrations after femtosecond laserassisted in situ keratomileusis[J].Medicine(Baltimore),2018,97(18):e0618.doi:10.1097/MD.0000000000010618.
[13]Al-Zeraid FM,Osuagwu UL.Induced higher-order aberrations after laser in situ keratomileusis(LASIK)performed with wavefront-guided intralase femtosecond laser in moderate to high astigmatism[J].BMC Ophthalmol,2016,(16):29.doi:10.1186/s12886-016-0205-5.
[14]Bottos KM,Leite MT,Aventura-Isidro M,et al.Corneal asphericity and spherical aberration after refractive surgery[J].J Cataract Refract Surg,2011,37(6):1109-1115.doi:10.1016/j.jcrs.2010.12.058.
[15]姚佩君,李美燕,赵婧,等.全飞秒小切口透镜取出术矫正高度近视术后像差初步分析[J].中国眼耳鼻喉科杂志,2015,15(6):399-402.Yao PJ,Li MY,Zhao J,et al.Analysis of spherical myopia[J].Chinese Journal of Nasolaryngology,2015,15(6):399-402.
[16]Chen X,Wang Y,Zhang J,et al.Comparison of ocular higher order aberrations after SMILE and Wavefront-guided Femtosecond LASIK for myopia[J].BMC Ophthalmology,2017,17(1):42-50.doi:10.1186/s12886-017-0431-5.