TransPRK与Epi-LASIK矫治薄角膜近视眼的临床疗效比较  

Comparison of clinical effectiveness between transepithelial PRK and Epi-LASIK for myopia with thin cornea

作　　者：侯杰[1] 雷玉琳[1] 郑秀云[1] 

机构地区：[1]济南市明水眼科医院,250200

出　　处：《中华实验眼科杂志》2015年第6期531-536,共6页Chinese Journal Of Experimental Ophthalmology

摘　　要：背景单一步骤的经角膜上皮的准分子激光屈光性角膜切削术（TransPRK）是一种新型的表层切削术，术后角膜上皮愈合快，术眼刺激性小，但关于TransPRK术后临床效果的动态性观察、角膜生物力学性能以及角膜后表面形态等的变化研究鲜见报道。目的评价TransPRK矫治薄角膜近视眼的手术效果及安全性，并与机械法准分子激光角膜上皮瓣下磨镶术（Epi-LASIK）进行比较。方法采用前瞻性非随机对照研究设计，收集2013年6-12月在济南市明水眼科医院拟行表层准分子激光手术的近视及近视散光患者93例93眼，均纳入右眼进行分析。术眼术前角膜厚度为460～500μm，其中TransPRK组46眼，Epi-LASIK组47眼，分别于术前及术后1周、1个月、3个月和6个月记录并比较2个组术眼的裸眼视力（UCVA）、屈光度、角膜上皮下雾状混浊（haze）程度、角膜生物力学参数、角膜后表面高度及Q值、角膜像差。结果TransPRK组术后不同时间点视力和屈光度变化的眼数分布与Epi-LASIK组的差异均无统计学意义（均P〉0．05）。术后6个月，TransPRK组UCVA≥1．0者占93．9％，屈光度在±1．00D以内者占90．9％，具有良好的安全性和稳定性。术后1个月haze最明显，TransPRK组有15眼出现haze，占32．6％，Epi-LASIK组有8眼出现haze，占17．4％，均在0．5级以下。TransPRK组haze的发生率略高于Epi-LASIK组，2个组间差异无统计学意义（X^2=2．841，P=0．092）。2个组间角膜滞后量（CH）值和角膜阻力因子（CRF）值的总体差异均无统计学意义（CH：F分组=0．000，P=0．999；CRF：F分组=0．110，P=0．741），但2个组术眼术后CH值和CRF值均明显下降，不同时间点的总体比较差异均有统计学意义（CH：F时间=103．658，P=0．000；CRF：F时间=132．008，P=0．000），其中术后不同时间点CH值和CRF值均较术前明显降低，差异均有统计学意义（均P〈0�Background Integrated transepithelial photorefractive keratectomy （TransPRK） is a new kind of surface ablation and has a fast reepithelialization and uncorrective visual acuity （UCVA） recovery as well as slighter postoperative pain, and epipolis laser in situ keratomileusis （Epi-LASIK） has been recognized to be an effective method for myopia. But there have been few studies to evaluate the dynamic change of the corneal biomechanical properties and posterior corneal elevation after TransPRK. Objective This study was to assess and compare the effectiveness and safety between TransPRK and Epi-LASIK for myopia with thin cornea. Methods This study was approved by Ethic Committee of Jinan Mingshui Eye Hospital, and written informed consent was obtained from each patient. In this prospective non-randomized controlled study, 93 right eyes of 93 myopic patients with the central corneal thickness 460 to 500 p.m were included in Jinan Mingshui Eye Hospital from June to December 2013 under the informed consent. The eyes were divided into TransPRK group for 46 eyes and Epi-LASIK group for 47 eyes. UCVA, manifest refraction, haze, corneal biomechanical properties, posterior corneal elevation, Q- value and corneal high order wavefront aberration were analyzed before and 1 week,1 month,3 months and 6 months after operation, respectively, and the examination results were compared between the two groups. Results There was no statistically significant difference in the eyes of postoperative UCVA and manifest refraction between the TransPRK group and the Epi-LASIK group at various time points （all at P〉0. 05 ）. Six months after surgery, the percentage of eyes with UCVA of 1.0 or better was 93.9% , and 90. 9% eyes exhibited the targeted refraction in ＋ 1.00 D in the TransPRK group. Corneal haze was most obvious 1 month after surgery in both groups, with the incidence of 32.6% （15/46） in the TransPRK group and 17.4% （8/47） in the Epi-LASIK group,but no significant difference was found in the eye numbers wit

关 键 词：近视/手术疗法 准分子激光/治疗用途 屈光性角膜切削术 角膜生物力学 角膜地形图 术后并发症 前瞻性研究 

分 类 号：R779.63[医药卫生—眼科]