经上皮准分子激光角膜切削术与准分子激光上皮瓣下角膜磨镶术治疗中高度近视的疗效对比  

Outcomes After Transepithelial Photorefractive Keratectomy and LaserAssisted Subepithelial Keratectomy for Moderate to High Myopia

作　　者：李瑾瑜[1] 张日平[1] 孙丽霞[1] 王贤[1] 刘彩霞[1] LI Jin-yu;ZHANG Ri-ping;SUN Li-xia;WANG Xian;LILT Cai-xia(Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong,Shantou 515031,China)

机构地区：[1]汕头大学.香港中文大学联合汕头国际眼科中心,广东汕头515041

出　　处：《汕头大学医学院学报》2018年第4期214-217,共4页Journal of Shantou University Medical College

基　　金：广东省医学科学研究基金资助项目(B2014291)

摘　　要：目的:评估经上皮准分子激光角膜切削术(TransPRK)和准分子激光上皮瓣下角膜磨镶术(LASEK)两种方法治疗中高度近视的疗效。方法:连续收集我院行表面切削手术的138例患者,分为TransPRK组(80例)和LASEK组(58例),两组病人均使用阿玛仕准分子激光系统的消像差模式进行切削治疗。随访3个月,观察术后上皮愈合时间、术后第1天疼痛评价、裸眼视力、最佳矫正视力、屈光度、角膜上皮下雾状混浊(Haze)情况及角膜光密度的变化。采用SPSS13.0统计软件对数据进行分析。结果:TransPRK组在术后上皮愈合时间和疼痛评分方面均优于LASEK组(P<0.05)。两组间术后1、3个月等效球镜度无差异,而TransPRK组术后3个月等效球镜比LASEK组更趋远视化(P=0.04)。两组术后裸眼视力逐渐提高(P<0.001,P=0.001),术后1周TransPRK组裸眼视力好于LASEK组(P=0.07),其余时点两组未见差异;最佳矫正视力两组均呈现出术后1个月稍下降,到3个月时恢复至术前水平的变化趋势(P<0.001,P<0.05),而组间比较未见统计学意义。术后1、3个月两组间Haze的分布未见统计学意义。两组角膜光密度术后1个月均较术前增加,至术后3个月恢复到术前水平(P=0.042,P=0.033),组间对比也未见统计学意义。结论:TransPRK术后上皮愈合更快,疼痛轻微,早期视力恢复也更快,而到术后3个月时两组在视力、屈光度、Haze和角膜光密度方面疗效相当。Objective: To compare the outcomes of trans-epithelial photorefractive keratectomy(TransPRK)and laser-assisted subepithelial keratectomy(LA SEK) for the moderate to high myopia. Methods: 138 patients with moderate to high myopia underwent surface ablation(80 for TransPRK, 58 for LA SEK). Cornea epithelial healing time, pain score, visual acuity, manifest refraction, haze and cornea density were analyzed, which were evaluated to 3 months postoperatively. Results: The epithelial healing time and pain score were better in TransPRK group(P<0.05). It was similar in spherical equivalent at 1 st month and 3 rd month post-operation(P =0.796、P = 1.0) in two groups, but more hyperopic in TransPRK group at 3 rd month(P = 0.04). In both groups,there were significant improvement in uncorrected visual acuity(UCVA) from 1 week to 3 months(P<0.001,P = 0.001), and the UCVA was better in TransPRK group than LA SEK group at 1 st week(P = 0.07). The best corrected visual acuity(BCVA) in both groups were decreased at 1 st month and improved to the same level as pre-operation at 3 rd month(P<0.001, P<0.05). There was also no significant difference in Haze between two groups post-operation. The change of cornea density was matched with the BCVA, decreased at 1 st month and improved to the same level as pre-operation at 3 rd month(P = 0.042, P = 0.033), and it was similar between two groups. Conclusion: Both TransPRK and LA SEK are effective procedures to correct moderate to high myopia.Patients undergoing TransPRK experience were more quickly visual recovery, faster epithelial healing and less pain. Both procedures had no difference in visual outcomes 3 months postoperatively.

关 键 词：经上皮准分子激光角膜切削术 准分子激光上皮瓣下角膜磨镶术 中高度近视 

分 类 号：R778[医药卫生—眼科]