飞秒激光制瓣与机械刀制瓣LASIK术后角膜皱褶和移位发生的比较  

Comparison of corneal flap striae and displacement after LASIK with microkeratome and femtosecond laser

作　　者：渠敏[1] 薛江平 贺瑞[1] Qu Min;Xue Jiangping;He Rui(Department of Excimer Laser, Shanxi Eye Hospital, Taiyuan 030002, China;Department of Medical, Shanxi Eye Hospital, Taiyuan 030002, China)

机构地区：[1]山西省眼科医院准分子激光科,太原030002 [2]山西省眼科医院医教科,太原030002

出　　处：《中华眼外伤职业眼病杂志》2019年第7期486-491,共6页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的对机械刀制瓣与飞秒激光制瓣LASIK引起的术后早期角膜瓣皱褶和移位发生的比较。方法回顾性分析2016年1月至2017年1月收治的5 792例LASIK的临床资料。患者随机分为两组:A组飞秒激光制瓣组和B组机械刀制瓣组。选取术后早期无明显外伤史而出现Ⅱ级以上角膜瓣皱褶和移位患者作为研究对象,比较两组之间发生率以及可能的原因。结果A组共3 358例,其中出现角膜瓣皱褶和移位15例,发生率0.45%;B组共2 434例,其中出现角膜瓣皱褶和移位22例,发生率0.90%,两组差异有统计学意义(χ^2=4.647,P=0.031)。A组移位者术前等效球镜度为(-7.71±1.38)D,B组移位者为(-5.56±1.90)D,A组移位者近视度高于B组移位者(t=-3.99,P=0.0003)。A组移位者角膜瓣厚度为(83.80±4.74)μm,B组移位者角膜瓣厚度为(92.32±6.39)μm。两组移位者角膜瓣厚度分别与各组相应正常者角膜瓣厚度相比差异无统计学意义(t=0.34,P=0.73;t=-0.38,P=0.71)。结论角膜瓣皱褶和移位发生率与术前患者的屈光度及术式有关,与角膜瓣厚度无相关性,飞秒激光制瓣LASIK更具有良好的瓣稳定性。Objective To compare the early corneal flap striae and displacement between mechanical microkeratome and femtosecond laser for laser in-situ keratomileusis (LASIK). Methods The data of 5 792 cases with LASIK from Jan. 2016 to Jan. 2017 were analyzed retrospectively. All cases were randomly divided into two groups: group A received flap made by femtosecond laser in 3 358 cases and group B received flap made by mechanical microkeratome in 2 434 cases. Patients with flap striae and displacement above grade Ⅱ without obvious trauma history in the early postoperative periods were selected as research objects, the incidence rate and causes were compared between the two groups. Results The corneal flap striae and displacement occurred in 15 eyes (0.45 %) in group A and 22 eyes (0.90 %) in group B. The difference was statistically significant (χ^2=4.647, P=0.031). The spherical equivalent of patients with corneal flap striae and displacement before surgery was (-7.71±1.38)D in group A and (-5.56±1.90)D in group B (t=-3.99, P=0.0003). The mean corneal flap thickness of patients with corneal flap striae and displacement was (84.29±5.78)μm in group A and (93.96±7.47)μm in group B. The difference of corneal flap thickness in two groups were not statistically significant between the displacement cases and the normal cases (t=0.34, P=0.73;t=-0.38, P=0.71). Conclusion The rate of corneal flap striae and displacement is related to the preoperative refraction and surgical method, but is not significant correlation with the thickness of the corneal flap. Femtosecond LASIK flaps represent significant improvement in predictability with implications for safety.

关 键 词：角膜磨镶术 准分子激光(LASIK) 制瓣 飞秒激光 制瓣 机械刀 皱褶 角膜瓣 移位 角膜瓣 

分 类 号：R779.63[医药卫生—眼科]