协和医学杂志

2013, (02)

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角膜板层刀制瓣和飞秒激光制瓣准分子激光原位角膜磨镶术临床效果比较
Comparison of Laser in situ Keratomileusis Flap Made by Femtosecond Laser and Mechanical Microkeratome

姜洋;金玉梅;李莹;王忠海;夏文薇;徐婧

摘要(Abstract):

目的:比较角膜板层刀制瓣准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)和飞秒激光制瓣LASIK的临床效果。方法:选取2011年7月至2012年7月在北京协和医院眼科治疗的近视患者300例600眼,其中接受角膜板层刀制瓣LASIK(M-LASIK组)和FEMTO LDV飞秒激光制瓣LASIK(F-LASIK组)各150例300眼。观察手术后1个月内角膜瓣愈合、视力、干眼的3项客观指标[泪膜破裂时间(tear film break-up time,BUT)、泪液分泌试验和角膜荧光染色(fluorescein staining,FS)评分]、角膜地形图和主观症状的问卷评估。结果:两组术后角膜瓣均一期愈合,F-LASIK组有1只眼术后第1天角膜瓣细皱,冲洗后好转;所有眼均达到手术前预期矫正视力。术后1个月两组角膜地形图角膜曲率值K1、K2均较术前明显减小 (P<0.05),两组之间比较差异无统计学意义(P>0.05)。与术前相比,术后1个月两组BUT、泪液分泌试验结果均明显下降,FS评分明显增加(P<0.05)。术后1个月F-LASIK组BUT明显高于M-LASIK组(P=0.045),泪液分泌试验、FS评分两组间差异无统计学意义(P>0.05)。F-LASIK组主观症状的评分总和明显低于M-LASIK组(Z=-0.989,P=0.043);满意度明显高于M-LASIK组(Z=-2.316,P=0.021)。结论:传统角膜板层刀制瓣LASIK和现代FEMTO LDV飞秒激光制瓣LASIK均可以使患者获得良好的术后视力及生活视觉质量,而飞秒激光制瓣术后满意度更高,且可以减少术后干眼的发生。
Objective:To compare the effect of laser in situ keratomileusis (LASIK) surgery after flap creation with a femtosecond laser and a mechanical microkeratome. Methods:Totally 300 eyes of 150 cases after FEMTO LDV femtosecond laser LASIK surgery (F-LASIK group) and 300 eyes of 150 cases after mechanical microkeratome LASIK surgery (M-LASIK group) were included from our department from July 2011 to July 2012. Uncorrcted visual acuity,dry-eye syndromes including tear film break-up time(BUT), Schirmer Ⅰ test, and corneal fluorescein staining, corneal topography data, and subjective symptoms evaluated with questionnaire wererecorded and compared between these two groups. Results:Primary healing was achieved in both groups. In F-LASIK group, 1 eye had a little fold of flap on the fist postoperative day, which was improved after washing. The expected uncorrected visual acuity was achieved within 1 month after surgery in both groups. The values of steep keratometric power (K1) and flat keratometric power (K2) were significantly decreased 1 month after operation in both groups (P<0.05), whereas no significant difference was found between these two groups(P>0.05). BUT and Schirmer Ⅰ test results were significantly declined 1 month after surgery,and the FS score significantly increased (P<0.05). One month after the operation, the average BUT was significantly longer in F-LASIK group than in M-LASIK group (P=0.045). Schirmer Ⅰ test results and the FS score were not significantly different between these two groups (P>0.05). The total score of 9 symptoms in F-LASIK group was significantly lower than that in M-LASIK group (Z=-0.989,P=0.043). The score of satisfaction in F-LASIK group was significantly higher than that in M-LASIK group(Z=-2.316,P=0.021). Conclusions:Both traditional LASIK and FEMTO LDV LASIK can achieve good visual acuity and improve quality of life. However, the incidence and severity of dry eye is lower in FEMTO LDV LASIK than in traditional LASIK.

关键词(KeyWords): |准分子激光原位角膜磨镶术|飞秒激光|干眼|
|laser in situ keratomileusis|femtosecond laser|dry eye|

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作者(Author): 姜洋;金玉梅;李莹;王忠海;夏文薇;徐婧

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