Epi-LASIK矫治中低度近视临床应用疗效观察  

Clinical efficacy of Epi-LASIK for low to moderate myopia

作　　者：李学军 兰志辉 刘利莉 郭冉阳 马竑 李茜 马姝颖[2] 

机构地区：[1]河北省张家口市第四医院眼科,075000 [2]河北北方学院附属第一医院超声科,河北省张家口市075000

出　　处：《眼科新进展》2009年第9期681-684,共4页Recent Advances in Ophthalmology

基　　金：河北省医学实用技术跟踪项目基金资助(编号:GL200726)~~

摘　　要：目的评价机械法准分子激光角膜上皮瓣下磨镶术(epipolis laser in situ keratomileusis,Epi-LASIK)治疗中低度近视的临床应用疗效。方法选择90例(179眼)中低度近视患者,平均术前等效球镜度数为(-3.74±1.46)D(-1.00～-7.25D),平均角膜厚度(549±32)μm,以自动微型角膜上皮刀制作上皮瓣,激光术后戴角膜接触镜,定期观察直到上皮完全恢复,并于术后1个月、3个月、6个月、12个月进行随访,观察角膜上皮愈合特点、术后疼痛反应、Haze程度、裸眼视力、屈光度、对比敏感度和上皮瓣并发症情况。结果175眼(97.76%)制作完好的角膜上皮瓣,直径8～9mm。2眼(1.12%)上皮瓣游离,2眼(1.12%)上皮瓣不完整。术后第1天,上皮瓣透明124眼(69.27%),轻度水肿51眼(28.49%),中度水肿4眼(2.23%)。取角膜接触镜后168眼(93.85%)角膜上皮愈合良好,11眼(6.15%)有轻微刺激症状。术后3个月,13眼(7.26%)Haze0.5级,术后6个月5眼(2.79%)Haze0.5级。术后3个月152眼(84.92%)等效球镜屈光度数为-0.50～+1.00D,在预期值内;21眼(11.73%)最佳矫正视力提高1行。术后1a,168眼(93.85%)的术眼恢复角膜透明,余可见隐约的Haze痕迹;术眼的平均屈光度(-0.18±0.38)D(-1.00～+0.63D),其中83.52%的术眼在0.50D以内(98.71%在1.00D以内),1眼术前-7.25D近视患者出现-1.25D屈光回退,余患者屈光状态稳定。结论Epi-LASIK对于中低度近视具有良好的安全性和有效性,术后角膜刺激症状轻、上皮愈合好,无明显Haze和屈光回退发生,有效视力恢复迅速,有很高的临床应用价值,但对-7.00D以上的近视患者的远期疗效仍需更长时间随访观察。Objective To evaluate the clinical efficacy of epipolis laser in situ keratomileusis（Epi-LASIK） for the treatment of low to moderate myopia. Methods Ninety low to moderate myopic patients （ 179 eyes）, whose preoperative spherial equivalence was （ - 3.74 ± 1.46） D （ - 1.00 D to - 7.25 D） and average cornea thickness was （549 ±32 ） μm, were chosen. All enrolled eyes were operated with automatic minikeratome to make epithelial flap. Corneal contact lens were worn after laser, and regular observation was taken until epithelium totally recovered. All patients were followed up at 1 month,3 months,6 months,12 months after surgery. The healing characteristics of corneal epithelium, postoperative symptoms, the situations of Haze, naked visual acuity, diopter, contrast sensitivity and complications of epithelial flaps were observed, Results About 175 eyes（97.76% ） had whole corneal epithelial flaps and the diameters were 8 nun to 9 mm,2 eyes（ 1.12% ） had free flaps and 2 eyes（ 1.12% ） had incomplete flaps. At 1 day after surgery,corneal flaps were transparent in 124 eyes（ 69.27% ）, with mild edema in 51 eyes（28.49% ） and with moderate edema in 4 eyes（2.23% ）. After corneal contact lens removed,the corneal epithelium healed well in 168 eyes （93.85%） and there was minor irritation in 11 eyes （6.15%）. At 3 months after surgery, 13 eyes （7. 26% ） had Haze at 0.5 level and 5 eyes （2.79%） at 6 months. The refractive spherical equivalence was -0.50 D to ＋1.00 D in 152 eyes （84.92%） at 3 months after surgery, which was in the expected value. Best corrected visual acuity of 21 eyes （ 11.73% ） improved 1 line. At 1 year after surgery,168 eyes （93.85%） had transparent cornea, and ambiguous Haze was also seen at other eyes. The average diopter was （-0.18＋0.38）D （ -1.00 D to ＋0.53 D）,andthe diopter of 83.52% of eyes was within 0. 50 D,98.71% within 1.00 D. Only 1 eye with the diopter of -7.25 D before surgery was with the refractive regression of -

关 键 词：准分子激光 机械法准分子激光角膜上皮瓣下磨镶术 中低度近视 随访研究 

分 类 号：R778.1[医药卫生—眼科]