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目的比较常规准分子激光上皮下角膜磨镶术(lasersubepithelialkeratomileusis,LASEK)与改良的“Y”型上皮瓣的LASEK在近视矫正中的临床结果。方法50例近视患者(100眼)均匀分为两组。组1常规使用20%乙醇20s后制成一个完整的上皮瓣,并分离至上方角膜缘,激光切削后将上皮瓣复位至切削区。组2角膜上皮也使用20%乙醇相同时间后制成三个角膜瓣,其中心点即“Y”字的中心,位于瞳孔缘的上方,三个上皮瓣的切缝向角膜周边延伸,直径约达8mm,然后分别将三个角膜瓣分离至角膜周边,完整地暴露约8mm直径的角膜床,激光切削后将上皮瓣复位,接缝呈“Y”型。两组术毕均使用绷带型角膜接触镜(Acuvue2,美国强生公司),并滴眼药水3d。评估两种LASEK的瓣完整性、制瓣所需时间、眼部刺激反应(角膜缘充血和角膜水肿反应)、舒适度的主观评分(从差到很好记为0至5分)及术后3个月时的裸眼视力(LogMAR记录法)。结果制瓣所需时间,组1平均为(5.36±1.18)min,组2为(2.89±0.46)min。组1有88%获得完整的角膜瓣,而组2有94%为完整瓣。两组术后角膜反应轻微,均在5周内完全消失。舒适度的主观评分两组差异无显著性(1周时组1为3.1±0.69,组2为3.2±0.64;3个月时组1为4.3±0.66,而组2为4.3±0.63)。裸眼视力两组差异也无显著性(1周时组1为0.21±0.13,组2为0.22±0.12;3个月时组1为0.01±0.08,而组2为0.01±0.06)。两组术后裸眼视力均在术后3个月时达到术前最佳矫正视力。结论“Y”型LASEK与常规LASEK比较,更易制瓣,成功率更高,并且不影响手术的视觉效果。
Objective To compare the clinical results of LASEK with laseredubial hemialkeratomileusis (LASEK) and modified “Y” epithelial flap in myopia correction. Methods 50 patients with myopia (100 eyes) were evenly divided into two groups. Group 1 routine use of 20% ethanol after 20s made a complete epithelial flap, and separated to the top of the limbus, the laser cutting will be reset to the cutting area of the skin flap. Group 2 corneal epithelium also made use of 20% ethanol at the same time after the three corneal flap, the center of which is the center of the word “Y”, located above the edge of the pupil, the three epithelial flap incision to the perimeter of the cornea extends, diameter About 8mm, and then the three corneal flap were separated to the corneal periphery, complete exposure of about 8mm diameter corneal bed, the laser flap will be reset after the flap, the seam was “Y” type. Bandage-type contact lenses (Acuvue2, Johnson & Johnson, USA) were used in both groups and eye drops were administered 3d. Assess the valve integrity of the two LASEKs, the time required to make the valve, the ocular irritation response (limbal hyperemia and corneal edema response), the subjective assessment of comfort (from poor to well recorded as 0 to 5), and postoperative Uncorded visual acuity at 3 months (LogMAR recording). Results The time required to make the flap was (5.36 ± 1.18) min for group 1 and (2.89 ± 0.46) min for group 2, respectively. Group 1 had 88% complete corneal flap, while group 2 had 94% complete flap. Corneal responses were mild in both groups and disappeared completely within 5 weeks. Subjective scores for comfort did not differ significantly between groups (3.1 ± 0.69 for group 1 at week 1 and 3.2 ± 0.64 for group 2 at 1 week and 4.3 ± 0.66 for group 1 at 3 months and 4.3 ± 0.63 for group 2). There was also no significant difference in visual acuity between the two groups (group 1, 0.21 ± 0.13 at week 1, group 0.22 ± 0.12 at group 2, group 0.01 at 0.01 ± 0.08 at group 3, and group 0.01 at 0.01 ± 0.06 at group 2). Uncorrected visual acuity in both groups reached the best corrected visual acuity at 3 months after operation. Conclusion “Y” type LASEK compared with conventional LASEK, more flap-making, higher success rate, and does not affect the visual effects of surgery.