应用波前像差引导的LASEK治疗近视散光和低、高度近视

摘要

目的：对比在矫正低度近视,近视散光和高度近视时应用波前像差引导的激光上皮瓣下角膜磨镶术( LASEK )的安全性,有效性,可预测性,稳定性和并发症。方法：该回顾性分析共纳入416眼,分为3组,低度近视组159眼,等值球镜-3.68±1.33D；近视散光组161眼,等值球镜-5.99±2.24D,柱镜度2.41±1.07D；高度近视组96眼,等值球镜-7.41±0.80D.制瓣后,进行波前像差为基础的准分子激光削切术。在术后10d,2,6和12mo后评估其安全性,有效性,可预测性和稳定性。结果：术后12mo,低度近视组等值球镜-0.36±0.31D,近视散光组0.15±0.41D,高度近视组0.58±0.68D。低度近视组中,裸眼视力为20/20的患者占90.60%,近视散光组78.90%,高度近视组67%。疗效指标在三组中分别为0.98,1.04和0.92.安全性指标分别为1.00,1.07和1.05。低度近视组有5眼(3.1%)最佳矫正视力提升1行,近视散光组有44眼(27.3%)提升1~3行,高度近视组18眼(19.2%)提升1~2行。低度近视组只有2例产生角膜雾状混浊。在疗效和安全性方面三组比较均无统计学差异。结论：波前像差引导的激光上皮瓣下角膜磨镶术是治疗低度近视,近视散光和高度近视的一种有效安全的方法,而在治疗近视散光时其可预测性、有效性和安全性更佳。%To compare the safety, efficacy, predictability, stability and complications of wavefront-guided laser-assisted subepithelial keratectomy ( LASEK ) in low myopia, myopic astigmatism and high myopia correction.METHODS: A retrospective analysis of 416 eyes were assigned to 3 groups:159 eyes with low myopia ( LM) and mean refractive spherical equivalent (MRSE) of-3. 68±1. 33 dioptre ( D ); 161 eyes with myopic astigmatism ( MA ) and MRSE of -5. 99 ± 2. 24D and mean cylinder of 2. 41 ± 1. 07D;and 96 eyes with high myopia (HM) and MRSE of- 7. 41 ± 0. 80D. After an epithelial flap creation, a wavefront-based excimer laser ablation was performed. Safety, efficacy, predictability and stability were evaluated at day 10, 2, 6 and 12mo postoperatively.RESULTS:At 12mo, the MRSE was -0. 36 ± 0. 31D in LM group, 0. 15 ± 0. 41D in MA group and 0. 58 ± 0. 68D in HM group. The uncorrected visual acuity ( UCVA) was 20/20 in 90. 60% of patients in LM group, 78. 90% in MA group and 67% in HM group. Efficacy indices were 0. 98, 1. 04 and 0. 92 in LM, MA and HM groups, respectively. Safety indices were 1. 00, 1. 07 and 1. 05 in LM, MA and HM respectively. Five eyes (3. 1%) in the LM group gained 1 line. Forty-four eyes (27. 3%) in MA gained 1-3 lines and eighteen eyes (19. 2%) of HM group gained 1-2 lines of BSCVA. Only 2 eyes in LM group developed corneal haze. There were not statistically significant differences in efficacy and safety indices amongst three groups.CONCLUSlON:Wavefront-guided LASEK is an effective and safe procedure for the treatment of LM, MA, and HM. although in myopic astigmatism the predictability, efficacy and safety indices had been better.