飞秒激光制瓣与机械板层刀制瓣的LASIK术后临床疗效的比较

Comparison of femtosecond laser or a mechanical microkeratome to create corneal flaps in LASIK for myopia

摘要:

目的：比较飞秒激光制瓣的LASIK(Femto-LASIK)与经典的机械板层刀制瓣的准分子激光原位角膜磨镶术两种手术方式矫治近视患者的安全性、有效性及术后视觉质量的区别。

方法：回顾性病例对照研究，选取2016-07/2017-06在襄阳市中心医院飞秒激光中心进行板层刀制瓣-LASIK(62例124眼)或Femto-LASIK(58例116眼)手术的近视患者120例240眼。测量两种不同制瓣术式中制作的角膜瓣厚度以及术后视力、屈光状态及角膜地形图参数和像差等并进行比较。

结果：所有患者角膜瓣均制作成功，并且都顺利地完成了手术，术中及术后无明显的并发症发生。术后两组间患者的裸眼视力、屈光度差异无统计学意义(P>0.05)。术中Femto-LASIK组制作的角膜瓣厚度与预设差值小于板层刀制瓣-LASIK组(t=26.67，P<0.01)，且球差、彗差和总高阶像差增幅均小于板层刀制瓣-LASIK组(t=-4.16、-4.92、-22.19，均P<0.01)。板层刀制瓣-LASIK组和Femto-LASIK术后角膜表面规则指数(SRI)分别为0.31±0.09、0.25±0.04，二者比较差异有统计学意义(t=6.59，P<0.01)。

结论：飞秒激光制作角膜瓣比板层刀制瓣较为精确，并且术后角膜的像差相对较小，飞秒激光制瓣可提供相对较好的视觉质量，但是这两种制瓣方式术后患者的裸眼视力和屈光状态无明显差异。

Abstract:

AIM: To compare the clinical effect, safety and visual outcome after laser in situ keratomileusis(LASIK)using femtosecond laser or a mechanical microkeratome.

METHODS: By retrospective study, 120 cases(240 eyes)of myopia patients had refractive surgery from July 2016 to June 2017. There were 62 cases(124 eyes)were treated with traditional LASIK, and 58 cases(116 eyes)were treated with LASIK using femtosecond laser to create corneal flaps. Visual acuity,corneal flap thickness and aberration were evaluated at 1, 6 and 12mo.

RESULTS: The corneal flap was successfully made in all patients, and the operation was successfully completed. There were no obvious complications during and after the operation. There were no statistical differences between the two groups about visual acuity or refractive error after operation(P>0.05). However,the result of corneal flap thickness in the Femto-LASIK was better than the result in the traditional LASIK(t=26.67, P<0.01). In addition, the added values of spherical aberration, coma aberration and total higher-order aberrations in the Femto group were smaller than those in the traditional group(t=-4.16, -4.92, -22.19; P<0.01). The post operative surface regularity index(SRI)of traditional LASIK was higher than that of Femto-LASIK(0.31±0.09 vs 0.25±0.04; t=6.59, P<0.01).

CONCLUSION: Femtosecond laser made corneal flap is more accurate than lamellar knife flap. Aberrations of femtosecond laser flap LASIK surgery are smaller than the traditional LASIK.Femto-LASIK may provide relatively better visual quality. However, both of the different surgery can result in satisfactory visual acuity.