Epi-LASIK术中去除与保留角膜上皮瓣治疗高度近视的疗效研究  

Comparative study of removing or reserving the corneal epithelial flap on high myopia correction by Epi-LASIK

作　　者：李招娜[1,2] 吴欣怡[1] 胡明[2] 曹丽君[2] 刘蕾[2] 张亚丽[2] 

机构地区：[1]山东大学齐鲁医院眼科,济南250012 [2]济南市第二人民医院眼科,济南250001

出　　处：《山东大学学报（医学版）》2012年第4期106-109,114,共5页Journal of Shandong University:Health Sciences

基　　金：济南市科技局课题项目(200817022)

摘　　要：目的研究机械法准分子激光角膜上皮瓣下磨镶术(Epi-LASIK)中角膜上皮瓣的弃留对高度近视(≥-6.00 D)术后反应、效果及并发症的影响。方法选取40例欲行Epi-LASIK手术的高度近视患者80只眼,征得患者同意后,随机一眼行保留上皮瓣的Epi-LASIK手术(留瓣组),另一眼行丢弃角膜上皮瓣的Epi-LASIK手术(弃瓣组),术后均配戴亲水性角膜接触镜。观察术后第3、5天角膜刺激症状、角膜上皮愈合时间,对术后1周,1、6个月裸眼视力及1、6个月角膜haze进行评价及统计学分析。结果术后第3、5天弃瓣组的角膜刺激症状明显轻于留瓣组,差异有统计学意义(P<0.05);弃瓣组和留瓣组的角膜愈合时间分别为(2.96±0.51)d、(4.92±1.38)d,差异有统计学意义(P<0.05);术后1周,弃瓣组裸眼视力优于留瓣组,差异有统计学意义(P<0.05),术后1、6个月,两组裸眼视力对比均无显著差异(P>0.05);术后1、6个月,两组角膜haze差异有统计学意义(P<0.05)。结论 Epi-LASIK手术丢弃角膜上皮瓣虽然能减轻患者的角膜刺激症状,缩短上皮愈合时间,但同时增加了高度近视患者角膜haze的发生率,所以手术时应尽量保留角膜瓣。Objective To investigate the influence on postoperative response,effectiveness and complications of high myopia（≥-6.00D） by removing or reserving the corneal epithelial flap during epipolis laser in situ keratomileusis（Epi-LASIK）.Methods A series of 40 patients（80 eyes） with high myopia who would prospectively undergo Epi-LASIK in our centre were studied.After getting the agreement of each patient,one eye randomly had on-flap Epi-LASIK（on-flap group） and the other eye had off-flap Epi-LASIK（off-flap group）.All eyes wore bandage contact lens after operation.Corneal irritation symptoms and time of epithelial healing were observed at 3rd and 5th after operation.Naked visual acuity at the 1st week,1st and 6th month and postoperative corneal haze at the 1st and 6th month after Epi-LASIK were statistically compared between the two groups.Results There were fewer corneal irritation symptoms in the off-flap group on the 3rd and 5th day after the operation than in the on-flap group（P0.05）.The time of epithelial healing in the off-flap group and the on-flap group was（2.96±0.51） days and（4.92±1.38） days respectively,and there was significant difference between the two groups（P0.05）.At the first week after the operation,the naked visual acuity of the off-flap group was better than the on-flap group,and there was significant difference between the two groups（P0.05）.There was no statistical difference between the two groups in terms of naked visual acuity at the 1st and 6th month after the operation respectively（P0.05）.On the developing of corneal haze after the operation,there was statistical difference between the two groups at the 1st and 6th month（P0.05）.Conclusions Although the off-flap Epi-LASIK can relieve corneal irritation symptoms and shorten epithelial healing time,at the same time it can increase the development of corneal haze in patients with high myopia.So reserving the epithelial flap in high myopia patients is suggested.

关 键 词：角膜切削术 角膜上皮瓣 高度近视 上皮下激光 

分 类 号：R772.2[医药卫生—眼科] R-332[医药卫生—临床医学]