LASEK和TransPRK及FS-LASIK术后角膜屈光力及视觉质量比较

Comparison of corneal refractive power and visual quality after LASEK, TransPRK or FS-LASIK

摘要:

目的：比较准分子激光上皮下角膜磨镶术(LASEK)、经上皮准分子激光角膜切削术(TransPRK)、飞秒激光制瓣的准分子激光原位角膜磨镶术(FS-LASIK)三种角膜屈光手术术后角膜屈光力及视觉质量。

方法：回顾性研究。选取2021-01/2022-12在我院择期行角膜屈光手术的232例464眼患者作为研究对象，根据患者选择手术方式不同分为LASEK组70例140眼、TransPRK组76例152眼、FS-LASIK组86例172眼。比较三组患者术前，术后1、3 mo时裸眼视力(UCVA)、视觉质量、生物力学稳定性、泪膜破裂时间(BUT)、泪液分泌试验(SⅠt)及生活质量变化情况。

结果：术后1、3 mo 三组患者裸眼视力较术前均改善，全角膜总高阶像差、球差、水平彗差、垂直彗差均升高，生物学稳定性均降低(均P<0.05)。术后3 mo，TransPRK组、LASEK组生物学稳定性均高于FS-LASIK组(均P<0.05)，TransPRK组生活质量评分较LASEK组及FS-LASIK组高(P<0.05)。手术前后三组患者BUT、SⅠt比较均无差异(均P>0.05)。

结论：LASEK、TransPRK、FS-LASIK三种角膜屈光手术治疗屈光不正疗效确切，在改善裸眼视力和提高视觉质量方面结果相似，但TransPRK、LASEK较FS-LASIK具有更稳定的生物力学性能，且TransPRK组在改善患者生活质量方面具有更好的效果。

Abstract:

AIM:To compare the corneal refractive power and visual quality after three kinds of corneal refractive surgery: laser subepithelial keratomileusis(LASEK), transepithelial photorefractive keratectomy(TransPRK)and femtosecond laser assisted in situ keratomileusis(FS-LASIK).

METHODS: Retrospective study. A total of 232 patients(464 eyes)who underwent elective corneal refractive surgery in our hospital from January 2021 to December 2022 were selected as the study subjects. They were divided into the LASEK group of 70 cases(140 eyes), TransPRK group of 76 cases(152 eyes), and FS-LASIK group of 86 cases(172 eyes)according to the different surgical choices made by the patients. Uncorrected visual acuity(UCVA), visual quality, biomechanical stability, tear film break-up time(BUT), Schirmer Ⅰ test(SⅠt)and quality of life were compared among the three groups at 1 and 3 mo postoperatively.

RESULTS: The UCVA of the three groups significantly improved at 1 and 3 mo postoperatively, the total high-order aberrations, spherical aberration, horizontal coma, and vertical coma of the entire cornea were significantly increased, while the biomechanical stability in all three groups were significantly reduced(all P<0.05). At 3 mo postoperatively, the biomechanical stability in the TransPRK and LASEK groups were higher than those of the FS-LASIK group(all P<0.05), and the TransPRK group had higher quality of life scores than the LASEK group and FS-LASIK group(P<0.05). Furthermore, there was no significant difference in preoperative or postoperative BUT and SⅠt among the three groups(all P>0.05).

CONCLUSION:In the treatment of ametropia, LASEK, TransPRK and FS-LASIK all have certain effects, and have similar results in improving UCVA and increasing visual quality. However, TransPRK and LASEK have more stable biomechanical properties than FS-LASIK, and have better efficacy in improving patients' quality of life.