CAJ | 학술논문

背景准分子激光角膜表层屈光手术与准分子激光角膜板层切削术相比,前者无基质瓣的相关并发症,是目前矫正屈光不正较好的手术方式.角膜上皮瓣的保留与否及其对术后角膜上皮愈合时间、视力恢复等方面的影响受到关注.目的比较去上皮瓣和留上皮瓣机械法准分子激光上皮瓣下角膜磨镶术( Epi-LASIK)治疗高度近视的疗效.方法采用配对对照研究设计.收集高度近视患者30例60眼行EpiLASIK,术中患者右眼采用去上皮瓣Epi-LASIK,左眼采用留上皮瓣Epi-LASIK,术后随访期为1个月.对术后1、3、5d术眼的刺激症状进行评分,观察去上皮瓣组和留上皮瓣组角膜愈合时间及裸眼视力；术后1个月对两种术式的裸眼视力、屈光状态、最佳矫正视力及haze分级情况进行比较.结果术后第1天去上皮瓣组与留上皮瓣组的角膜刺激症状评分分别为3.13±0.43和3.30±0.47,差异无统计学意义(t=-l.54,P＞0.05)；术后第3天分别为1.20±0.75和3.47±0.51,二者比较差异有统计学意义(t=-17.95,P＜0.01).术后第1天去上皮瓣组与留上皮瓣组裸眼视力分别为0.59±0.12和0.58±0.11,术后第5天分别为0.69±0.08和0.67±0.09,二者比较差异均无统计学意义(t=0.39、0.84,P＞0.05)；但术后第3天去上皮瓣组裸眼视力明显好于留上皮瓣组(0.66±0.10 vs 0.26±0.07),二者比较差异有统计学意义(t=18.21,P＜0.05)；术后1个月两组裸眼视力分别为0.89±0.23、0.95±0.22,二者比较差异无统计学意义(t=-l.90,P＞0.05)；2个组术后1个月平均等效球镜分别为(- 1.03±0.45)D和(- 1.07±0.38)D,二者比较差异无统计学意义(t=-0.31,P＞0.05).术后去上皮瓣组角膜上皮愈合时间平均为(2.58±0.49)d,留上皮瓣组为(3.98±0.74)d,二者比较差异有统计学意义(t=-11.36,P＜0.01).去上皮瓣组haze为0级和0.5级者分别为27眼(90.00％)和3眼(10.00％),留上皮瓣组分别为26眼(86.66％)和4眼(13.33％),二者比较差异无统计学意义(x2=0.003,P＞0.05).两组术眼均未出现l级以上haze.结论留上皮瓣Epi-LASIK及去上皮瓣Epi-LASIK矫治高度近视短期疗效均好且安全,具有良好的可预测性.但去上皮瓣有利于减轻患者术后角膜刺激反应,加快上皮愈合和视力恢复. 揹景準分子激光角膜錶層屈光手術與準分子激光角膜闆層切削術相比,前者無基質瓣的相關併髮癥,是目前矯正屈光不正較好的手術方式.角膜上皮瓣的保留與否及其對術後角膜上皮愈閤時間、視力恢複等方麵的影響受到關註.目的比較去上皮瓣和留上皮瓣機械法準分子激光上皮瓣下角膜磨鑲術( Epi-LASIK)治療高度近視的療效.方法採用配對對照研究設計.收集高度近視患者30例60眼行EpiLASIK,術中患者右眼採用去上皮瓣Epi-LASIK,左眼採用留上皮瓣Epi-LASIK,術後隨訪期為1箇月.對術後1、3、5d術眼的刺激癥狀進行評分,觀察去上皮瓣組和留上皮瓣組角膜愈閤時間及裸眼視力；術後1箇月對兩種術式的裸眼視力、屈光狀態、最佳矯正視力及haze分級情況進行比較.結果術後第1天去上皮瓣組與留上皮瓣組的角膜刺激癥狀評分分彆為3.13±0.43和3.30±0.47,差異無統計學意義(t=-l.54,P＞0.05)；術後第3天分彆為1.20±0.75和3.47±0.51,二者比較差異有統計學意義(t=-17.95,P＜0.01).術後第1天去上皮瓣組與留上皮瓣組裸眼視力分彆為0.59±0.12和0.58±0.11,術後第5天分彆為0.69±0.08和0.67±0.09,二者比較差異均無統計學意義(t=0.39、0.84,P＞0.05)；但術後第3天去上皮瓣組裸眼視力明顯好于留上皮瓣組(0.66±0.10 vs 0.26±0.07),二者比較差異有統計學意義(t=18.21,P＜0.05)；術後1箇月兩組裸眼視力分彆為0.89±0.23、0.95±0.22,二者比較差異無統計學意義(t=-l.90,P＞0.05)；2箇組術後1箇月平均等效毬鏡分彆為(- 1.03±0.45)D和(- 1.07±0.38)D,二者比較差異無統計學意義(t=-0.31,P＞0.05).術後去上皮瓣組角膜上皮愈閤時間平均為(2.58±0.49)d,留上皮瓣組為(3.98±0.74)d,二者比較差異有統計學意義(t=-11.36,P＜0.01).去上皮瓣組haze為0級和0.5級者分彆為27眼(90.00％)和3眼(10.00％),留上皮瓣組分彆為26眼(86.66％)和4眼(13.33％),二者比較差異無統計學意義(x2=0.003,P＞0.05).兩組術眼均未齣現l級以上haze.結論留上皮瓣Epi-LASIK及去上皮瓣Epi-LASIK矯治高度近視短期療效均好且安全,具有良好的可預測性.但去上皮瓣有利于減輕患者術後角膜刺激反應,加快上皮愈閤和視力恢複.
배경 준분자격광각막표층굴광수술여준분자격광각막판층절삭술상비,전자무기질판적상관병발증,시목전교정굴광불정교호적수술방식.각막상피판적보류여부급기대술후각막상피유합시간、시력회복등방면적영향수도관주.목적 비교거상피판화류상피판궤계법준분자격광상피판하각막마양술( Epi-LASIK)치료고도근시적료효.방법 채용배대대조연구설계.수집고도근시환자30례60안행EpiLASIK,술중환자우안채용거상피판Epi-LASIK,좌안채용류상피판Epi-LASIK,술후수방기위1개월.대술후1、3、5d술안적자격증상진행평분,관찰거상피판조화류상피판조각막유합시간급라안시력；술후1개월대량충술식적라안시력、굴광상태、최가교정시력급haze분급정황진행비교.결과 술후제1천거상피판조여류상피판조적각막자격증상평분분별위3.13±0.43화3.30±0.47,차이무통계학의의(t=-l.54,P＞0.05)；술후제3천분별위1.20±0.75화3.47±0.51,이자비교차이유통계학의의(t=-17.95,P＜0.01).술후제1천거상피판조여류상피판조라안시력분별위0.59±0.12화0.58±0.11,술후제5천분별위0.69±0.08화0.67±0.09,이자비교차이균무통계학의의(t=0.39、0.84,P＞0.05)；단술후제3천거상피판조라안시력명현호우류상피판조(0.66±0.10 vs 0.26±0.07),이자비교차이유통계학의의(t=18.21,P＜0.05)；술후1개월량조라안시력분별위0.89±0.23、0.95±0.22,이자비교차이무통계학의의(t=-l.90,P＞0.05)；2개조술후1개월평균등효구경분별위(- 1.03±0.45)D화(- 1.07±0.38)D,이자비교차이무통계학의의(t=-0.31,P＞0.05).술후거상피판조각막상피유합시간평균위(2.58±0.49)d,류상피판조위(3.98±0.74)d,이자비교차이유통계학의의(t=-11.36,P＜0.01).거상피판조haze위0급화0.5급자분별위27안(90.00％)화3안(10.00％),류상피판조분별위26안(86.66％)화4안(13.33％),이자비교차이무통계학의의(x2=0.003,P＞0.05).량조술안균미출현l급이상haze.결론 류상피판Epi-LASIK급거상피판Epi-LASIK교치고도근시단기료효균호차안전,구유량호적가예측성.단거상피판유리우감경환자술후각막자격반응,가쾌상피유합화시력회복.
Background Compare with the lamellar laser refractive surgery,the laser slip on the surface operation is a better method in the correct of refractive error without the flap-related complications.However,whether to remain corneal epithelial flap and its influence for epithelial healing and visual restoration are still under investigation.Objective The aim of this study was to compare the short-term clinical efficacy of epipolis laser insitu keratomileusis (Epi-LASIK) and flap-free Epi-LASIK for correction of refractive error in high myopia.Methods The paired control design was adopted.Sixty eyes of consecutive 30 patients with high myopia were collected in this study.The written consent form was obtained from each patients prior to operation.Regular EpiLASIK was performed in the right eyes and the flap-free Epi-LASIK was carried out in the left eyes.Patients were followed-up for one month.The postoperative ocular irritation symptoms were scored,and the healing period of corneal epithelium and uncorrected visual acuity were examined at 1,3 and 5 days after operation.The naked visual acuity,diopter,best corrected visual acuity and the grading of haze were recorded and compared between the two groups at one month after operation.Results After surgery,the scores of corneal irritation were 3.13 ±0.43 and 3.30±0.47on the first day,showing insignificant differences between these two groups (t =- 1.54,P＞0.05 ).However,there existed statistically significant difference in the scores of corneal irritation on the third day after operation between the two groups (t =- 17.95,P＜0.01 ).The average time of corneal epithelial healing were (2.58 ±0.49 ) days in the flapfree Epi-LASIK group and ( 3.98 ±0.74) days in Epi-LASIK group with the significant difference between them (t=-11.36,P＜0.01 ).There was no statistical difference in uncorrected visual acuity in the first day (0.59±0.12 vs 0.58±0.11,t=0.39,P＞0.05),the fifth day (0.69±0.08 vs 0.67±0.09,t=0.84,P＞0.05) and 1 month (t =-1.90,P＞0.05 ).No significant difference was seen in the diopter between the two groups in 1 month after surgery (-1.03±0.45 vs -1.07 ±0.38,t =-0.31,P＞0.05 ).The eye numbers of corneal haze for 0 grade were 27 ( 90.00％ ) and over the 0.5 grade were 3 ( 10.00％ ) in flap-free Epi-LASIK group respectively,and those of corneal haze for 0 grade were 26(86.66％ ) and above the 0.5 grade were 4 (13.33％) in Epi-LASIK group respectively,showing a considerably difference between the two groups (x2 =0.0031,P＞0.05).Conclusions Both the flapfree or reserved epithelial Epi-LASIK allow the safe and effective correction of refractive error in high myopia,showing good predictability and stability in short term.Flap-free Epi-LASIK can relieve the corneal irritation symptom and accelerate the healing of corneal epithelium and recovery of visual acuity.