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[摘要]
目的:探讨去瓣准分子激光上皮下角膜磨镶术(LASEK)治疗高度近视的远期疗效。
方法:随机选择在我院行LASEK治疗、术后随访达5a的高度近视患者209例277眼。将其按屈光度两组:组Ⅰ<-9.00D(115例145眼),组Ⅱ≥-9.00D(94例132眼)。术后1、5d,1wk,1、3、6mo,1、2、5a对其症状、裸眼及矫正视力、屈光状态、角膜并发症、眼压等情况进行随诊观察。
结果:去瓣LASEK术后5d,所有患者角膜上皮均愈合。96.3%患者术后1~3d以上出现眼磨痛、畏光、流泪、异物感等刺激症状,但都可耐受。术后5a裸眼视力:组Ⅰ≥1.0者为131眼(90.3%),≥0.8者为145眼(100%); 组Ⅱ≥1.0者为104眼(78.8%),≥0.8者为119眼(90.2%),≥0.6者为129眼(97.7%),<0.6者3眼(2.3%)。屈光度:术后6mo两组屈光度趋于稳定,术后5a与术后6mo比较差异无统计学意义(P>0.05),术后各时间点与术前比较差异均有统计学意义(P<0.01)。两组术后屈光度有向近视回退的趋势,但两组术中、术后均无严重并发症,其并发症主要为haze、屈光回退和高眼压。
结论:去瓣LASEK能安全、有效地矫正高度近视,但对超高度近视患者应持谨慎态度。
[Key word]
[Abstract]
AIM: To evaluate the long-term outcomes of free-flap laser subepithelial keratomileusis(LASEK)for treatment of high myopia.
METHODS: Two hundred and nine patients(277 eyes)with high myopia were treated with free-flap LASEK in our hospital, each patient was followed up for 5a. Patients were divided into two groups including groupⅠwith high myopia(<-9.00D, 145 eyes of 115 cases)and groupⅡ(≥-9.00D, 132 eyes of 94 cases). All patients were evaluated at 1, 5d, 1wk, 1, 3, 6mo, 1, 2 and 5a after surgery. The postoperative irritation, uncorrected and corrected visual acuity, refractive status, corneal complications, intraocular pressure were observed and analyzed.
RESULTS: On the fifth day after surgery, all epithelial flaps were nearly transparent and 96.3% patients had postoperative irritation symptom such as wear eye pain, photophobia, tearing, foreign body sensation but all could tolerate. Five years after operation, 131 eyes(90.3%)had uncorrected visual acuity(UCVA)of ≥1.0, 145 eyes(100%)≥0. 8 in group Ⅰ; 104 eyes(78. 8%)had UCVA of ≥1.0, 119 eyes(90.2%)≥0. 8, 129 eyes(97.7%)≥0. 6 and 3 eyes(2. 3%)<0.6 in group Ⅱ. The diopter tended to be stable in both groups after 6mo and there was no statistically significant difference after 6mo and 5a(P>0. 05), but there was statistical significance difference between each time point of postoperative and preoperative(P<0.01). The two groups had refraction regression, but had no serious intraoperative and postoperative complications, the main complications included haze, refractive regression and high intraocular pressure.
CONCLUSION: Free-flap LASEK is one of methods to treat eyes with high myopia safely and effectively, but should be cautious for super-high myopia.
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