SMILE及LASEK治疗近视散光的临床对比研究  

Clinical comparative study of small incision lenticule extraction and laser-assisted subepithelial keratomileusis in correction of myopia astigmatism

作　　者：宋学英 李岳美 李庆和 胡长娥 齐绍文 

机构地区：[1]解放军第152医院眼科,河南省平顶山市467000 [2]平顶山学院医学院,河南省平顶山市467000

出　　处：《眼科新进展》2016年第10期970-972,共3页Recent Advances in Ophthalmology

摘　　要：目的对比研究SMILE及LASEK治疗近视散光患者的手术疗效。方法回顾性分析在我院手术的高度近视患者80例157眼,其中中度散光-1.00^-3.00 D 48例95眼、高度散光-3.00^-6.00 D 32例62眼。其中SMILE组(40例79眼)和LASEK组(40例78眼)。SMILE组采用小切口基质内透镜取出术,手术切口长度为2 mm,位于120°,角膜帽厚度均为120μm,透镜直径6.4~6.6 mm,帽直径为7.1~7.2 mm;LASEK组行LASEK,体积分数20%酒精浸泡20 s,保留角膜上皮瓣。观察术后1 d、1周、1个月、3个月、6个月两组裸眼视力、等效球镜、最佳矫正视力、残余残光度数及角膜地形图形态。结果 SMILE组和LASEK组相比,术后1个月、3个月、6个月裸眼视力达到术前最佳矫正视力的比例分别为93.7%(74/79)和89.7%(70/78)、92.4%(73/79)和88.5%(69/78)、91.1%(72/79)和87.2%(78/68),差异均无统计学意义(均为P>0.05);两组裸眼视力均无增加或减少两行及以上。两组的目标屈光度均为0,术后1个月等效球镜及残余散光差异均无统计学意义(均为P>0.05);术后3个月、6个月等效球镜及残余散光差异均有统计学意义(均为P<0.05)。术后角膜地形图形态:术后两组地形图都以圆形及椭圆形最多,分别为75.9%(60/79)、71.8%(56/78),差异无统计学意义(P>0.05)。结论 SMILE及LASEK治疗近视散光均有安全性、有效性,术后角膜形态良好,但SMILE的稳定性及精确性优于LASEK,更值得临床应用。Objective To observe the surgical results of myopia astigmatism with small incision lenticule extraction （SMILE） and laser-assisted subepithelial kemtomilensis （LASEK）. Methods A total of 157 eyes of 80 consecutive patients were enrolled in this retrospective study ,which included 95 eyes of 48 patients with moderate astigmatism and 66 eyes of 34 patients with high astigmatism, divided into 2 groups depending on the operation method：SMILE group and LASEK group. 79 eyes of 40 cases underwent femtosecond laser SMILE. Intnded cap diameters was 7.1 -7.2 mm,lenticule diameter was 6.4-6.6 ram,the thickness of cap was 120 tan, the side cutting was 2 mm. 78 eyes of dO cases underwent LASEK,20% alcohol solution soak for 20 seconds,preserved the flap of corneal epithelium. The results at 1 day,1 week,1 month,3 months and 6 months were observed. Postoperative best corrected visual acuity ,spherical equivalent refraction,postoperative uncorrected visual acuity,corneal topography were observed. Results The ratio of postoperative uncorrect- ed visual acuity at 1 month,3 months and 6 months of operation reached the preoperative best corrected visual acuity in SMILE group and LASEK group were 93.7% （74/79） and 89.7% （70/78）,92.4% （73/79） and 88.5% （ 69/78 ） ,91.1% （ 72/79 ） and 87.2% （78/68）, respectively,the difference was not statistically significant（ all P 〉 0.05 ）. Compared with LASEK group, the difference of the equivalent refraction and residual astigmatism at 1 month after operation in SMILE group was not statistically significant （ all P 〉 0.05 ）, and the difference of the equivalent refraction and residual astigmatism at 3 months and 6 months after operation were statistically significant（ all P 〈 0.05 ）. The corneal topography at 6 months after operation of two groups was mainly round and oval, respectively, the rate was 75.9% （ 60/79 ）, 71.8% （ 56/78 ）, the difference was not statistically significant （P 〉 0.05 ）. Conclusion It is both safe, effective

关 键 词：小切口基质内透镜取出术 准分子激光角膜上皮下磨镶术 近视散光 

分 类 号：R779.6[医药卫生—眼科]