Epi-LASIK治疗中高度近视术后视觉质量的临床研究

Clinical study of visual performance after Epi-LASIK for moderate to high myopia

摘要:

目的:研究机械法准分子激光角膜上皮瓣下磨镶术(Epi-LAS1K)矫治中、高度近视对视觉质量的影响。方法:回顾分析采用Epi-LAS1K手术矫治中、高度近视并随访1a的病例128例256眼的临床资料。患者根据术前等效球镜分为3组:A组:<-3.00D,均值-2.11±0.35D(30例60眼);B组:-3.00D～-6.00D,均值-4.93±0.68D(46例92眼);C组:>-6.00D,均值-8.45±1.62D(52例104眼)。手术采用美国AMO公司AmadeusⅡ自动角膜板层刀制作上皮瓣,以德国ZEISS公司MEL80型准分子激光仪进行激光切削,术后配戴绷带式角膜接触镜7d,术后随访时间为1,7d;1,3,6mo;1a,研究术后视力和屈光状态、高阶像差及haze形成情况。结果:术后随访1a,A组58眼(97%)的UCVA>1.0,B组87眼(95%)的UCVA>1.0,C组89眼(86%)的UCVA>1.0;A组60眼(100%)等效球镜屈光度数在预期值的±1.00D内,B组92眼(100%)等效球镜屈光度数在预期值的±1.00D内,C组7眼(7%)等效球镜屈光度数大于预期值的±1.00D。术后高阶像差较术前增大(P<0.05),B组与C组各时间点与A组相比无统计学意义。A组术后1mo有3眼(5%)的患者有0.5级haze,术后3mo有1眼(2%)的患者有0.5级haze,术后6mo到1a,所有患者均无明显haze;B组术后1mo有6眼(7%)的患者有0.5级haze,术后3mo有4眼(4%)的患者有0.5级haze,术后6mo～1a,所有患者均无明显haze;C组术后1mo有10眼(10%)的患者有0.5级haze,2眼(2%)的患者有Ⅰ级haze,术后3mo有8眼(8%)的患者有0.5级haze,2眼(2%)的患者有Ⅰ级haze,术后6mo有5眼(5%)的患者有0.5级haze,术后1a所有患者均无明显haze。结论:Epi-LAS1K手术术后具有视力恢复满意,haze程度轻等优点,是治疗中、高度近视的一种安全、有效的手术方式。

Abstract:

AIM:To evaluate the clinical results of visual performance after epipolis laser in situ keratomileusis (Epi-LASIK) for moderate to high myopia. METHODS: This retrospective study comprised 256 eyes of 128 patients who underwent Epi-LASIK for the correction of moderate to high myopia. Patients were divided into three groups according to spherical equivalent refraction: group A: <-3.00D,mean-2.11±0.35D, 30 patients(60 eyes);group B: -3.00～-6.00D,mean -4.93±0.68D,46 patients(92 eyes);group C: >-6.00D,mean -8.45±1.62D,52 patients(104 eyes). Epi-LASIK was performed with an automatically epikeratome (Amadeus Ⅱ, AMO,America) and the MEL80 (Carl Zeiss Meditec, Jena, Germany) excimer laser. After laser ablation, the epithelial sheet was repositioned and a therapeutic contact lens was applied to the cornea immediately for 7 days. The enrolled patients were followed up at 1day,7days,1month, 3, 6, and 12 months postoperative intervals. The postoperative vision, refraction,wavefront aberration and haze formation were investigated. RESULTS: One year after the treatment, uncorrective visual acuity(UCVA) of 58 eyes(97%) >1.0 in group A, UCVA of 87 eyes(95%) >1.0 in group B, UCVA of 89 eyes(86%) >1.0 in group C; Spherical equivalent refraction was within 1.00D of attempted refraction in 60(100%) eyes in group A; Spherical equivalent refraction was within 1.00 D of attempted refraction in 92(100%) eyes in group B; Spherical equivalent refraction exceeded±1.00 D of attempted refraction in 7(7%) eyes in group C. Higher order aberration increased signifcantly postoperatively in B and C vs. group A(P<0.05). In group A: grade 0.5 haze was found in 3 eyes(5%)at 1 month postoperatively and in 1 eye(2%)at 3 months postoperatively, all other eyes had no haze; In group B: grade 0.5 haze was found in 6 eyes(7%)at 1 month postoperatively and in 4 eyes(4%)at 3 months postoperatively, all other eyes had no haze; In group C: grade 0.5 haze was found in 10 eyes(10%)at 1 month postoperatively and in 8 eyes(8%)at 3 months postoperatively and in 5 eyes(5%)at 6 months postoperatively, gradeⅠ haze was found in 2 eyes(2%)at 1 month and 3 months postoperatively, all other eyes had no haze.CONCLUSION: One-year visual,refractive,wavefront aberration and haze formation results after Epi-LASIK suggest that it is a safe and effcient method for the correction of moderate to high myopia.