三种角膜屈光手术矫正低中度近视效果的比较  

Comparison of the effects among three different corneal refractive surgeries for low and moderate myopia

作　　者：周继红[1,2] 刘龙[1] 高妍 郭秀花[1] 

机构地区：[1]首都医科大学公共卫生学院,北京100069 [2]北京爱尔英智眼科医院,100021

出　　处：《中华眼外伤职业眼病杂志》2016年第3期170-174,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的比较3种角膜屈光手术矫正低中度近视术后裸眼视力、及残留屈光度等。方法回顾性研究，非随机临床对照设计。纳入研究的3个组是：准分子激光角膜上皮下磨镶术（LASEK）组，261例（521只眼）；角膜刀制瓣准分子激光角膜原位磨镶术（MM—LASIK）组，1513例（3024只眼）；及飞秒激光制瓣准分子激光角膜原位磨镶术（FS—LASIK）组，1082例（2164只眼）。比较3个组术后12个月裸眼视力、残留屈光度、3mm高阶像差均方根值（HOARMS3）、5mm高阶像差均方根值（HOARMS5）等。术后裸眼视力、残留屈光度、HOARMS3及HOARMS5的观察采用单因素方差分析（ANOVA）。结果随诊12个月时，术后裸眼视力：MM—LASIK组与LASEK组之间差异无统计学意义（P=0．705），并均优于FS～LASIK组，差异有统计学意义（P=0．00，P=0．00）；术后残留屈光度：3组结果存在差异（F=4．36，P=0．01），MM—LASIK及FS—LASIK组低于LASEK组；HOARMS3由高到低为FS—LASIK组、MM—LASIK组及LASEK组；HOARMS5三组差异无统计学意义。结论三种角膜屈光手术矫正低中度近视均获得良好效果；随诊12个月时，术后残留屈光度较小及HOARMS3低者，利于术后裸眼视力的恢复；术后裸眼视力的恢复LASEK及MM—LASIK组均优于FS—LASIK组；MM—LASIK与FS—LASIK术后残留屈光度较小，LASEK组HOARMS3值最低。Objective To compare postoperative uncorrected visual acuity （UCVA） and residual diopters among three different corneal refractive surgeries for low and moderate myopia. Methods This is a retrospective study on non-randomized clinical trial without control group. The following three groups were involved in this trial： LASEK group, 261 patients （521 eyes） ; microkeratome-assisted flap creation LASIK （MM-LASIK） group, 1513 patients （3024 eyes） and the femtosecond laser-assisted flap creation LASIK （FS-LASIK） group, 1082 patients （2164 eyes）. Single factor analysis of variance was used to compare the postoperative UCVA, residual spherical equivalent （ S E ） , root mean aquare of high aberration for pupil diameter of 3ram and 5mm （HOA RMS3 and HOA RMS5 ） groups. Results After the follow-up of 12 months, the diftbrence in UCVA between MM-LASIK and LASEK group was not statistically significant （ P = 0. 705）. The UCVA in MM-LASIK and LASEK group were better than that in FS-LASIK group and the differences were statistically significant （F = 17. 08, P =0. 00）. The differences in postoperative residual S E among the three groups were statistically significant （ F = 4. 36, P = 0.01 ）. The residual SE in MM- LASIK and FS-LASIK group were lower than that in LASEK group. The descending order of HOA RMS3 was FS-LASIK group, MM-LASIK and LASEK group. There was no statistically significant difference in HOA RMS5 among three groups. Conclusion Three corneal refractive surgeries for correcting low to moderate myopia brought good results. Smaller postoperative residual SE and lower HOA RMS3 are beneficial to the recovery of postoperative UCVA. LASEK and MM-LASIK produced better visual acuity and less corneal aberrations compared to FS-LASIK. The value of HOA RMS3 in LASEK group was the smallest and the postoperative residual SE in LASEK group was the biggest.

关 键 词：准分子激光角膜上皮下磨镶术 准分子激光角膜原位磨镶术 角膜刀制瓣 飞秒激光制瓣 高阶像差均方根值 

分 类 号：R779.63[医药卫生—眼科]