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目的比较应用飞秒激光(IntraLase)和微型角膜刀(Moria M2,90μm刀头)进行薄瓣准分子激光角膜原位磨镶术(LASIK)矫正高度近视的安全性、有效性和可预测性。设计前瞻性临床研究。研究对象高度近视患者148例(274眼),其中飞秒激光组76例(134眼),微型角膜刀组72例(140眼)。方法飞秒激光组应用IntraLase飞秒激光仪制作角膜瓣,微型角膜刀组应用Moria 90微型角膜刀制作角膜瓣。两组均应用VISX Star S4准分子激光设备行LASIK手术。术后第1天、1周、1个月和3个月行视力、屈光、波前像差等检查。主要指标视力、屈光状态、波前像差、泪液分泌试验(Schirmer试验)、泪膜破裂时间(BUT)。结果飞秒激光组术后3个月检查,达到或超过术前最佳矫正视力者(BSCVA)108眼(80.6%),与微型角膜刀组(116眼,82.9%)无显著性差异(P=0.642);等效球镜为(-0.49±0.70)D,与微型角膜刀组(-0.56±0.83)D无显著性差异(P=0.448);Schirmer试验结果为(9.5±4.0)mm,与微型角膜刀组(9.5±7.2)mm无显著性差异(P=0.950);BUT结果(7.9±4-3)秒,与微型角膜刀组(8.1±5.5)秒无显著性差异(P=0.867);高阶像差RMS值为(0.480±0.133)μm,低于微型角膜刀组(0.578±0.169)μm,差异有统计学意义(P=0.034)。结论应用飞秒激光或微型角膜刀进行薄瓣LASIK手术是矫正高度近视安全有效的方法,具有良好的可预测性和稳定性。飞秒激光制瓣的临床效果略优于微型角膜刀。(眼科,2007,16:201-205)
Objective To compare the safety, efficacy and predictability of laser in situ keratomileusis (LASIK) for the correction of high myopia with intraluminal femtosecond laser (IntraLase) and microkeratome (Moria M2, 90 μm head). Design prospective clinical studies. A total of 148 patients (274 eyes) with a high degree of myopia were included, including 76 femtocells (134 eyes) and 72 eyes (140 eyes) with microkeratome. Methods The femtosecond laser was used to make the corneal flap with IntraLase femtosecond laser instrument. The corneal flap was made using the Moria 90 microkeratome. Both groups were treated with VISX Star S4 excimer laser device LASIK surgery. After 1 day, 1 week, 1 month and 3 months visual acuity, refractive, wavefront aberrations and other tests. Key indicators of visual acuity, refractive status, wavefront aberration, tear secretion test (Schirmer test), tear film break-up time (BUT). Results In the femtosecond laser group, 108 eyes (80.6%) who had reached or surpassed the preoperative best corrected visual acuity (BSCVA) and 3 months postoperatively did not show any significant difference with the microkeratome (116 eyes, 82.9%) = 0.642). The equivalent sphere was (-0.49 ± 0.70) D, which was not significantly different from that of the microkeratome (-0.56 ± 0.83) D (P = 0.448). The Schirmer test was (9.5 ± 4.0) (9.5 ± 7.2) mm in the microkeratome group (P = 0.950). The BUT results (7.9 ± 4-3) s were not significantly different from those in the microkeratome group (8.1 ± 5.5) s (P = 0.867). The RMS value of high-order aberrations was (0.480 ± 0.133) μm, which was lower than that of the microkeratome (0.578 ± 0.169) μm. The difference was statistically significant (P = 0.034). Conclusion The application of femtosecond laser or microkeratome for thin-flap LASIK is a safe and effective method to correct high myopia, with good predictability and stability. The clinical effect of femtosecond laser valve flap slightly better than the microkeratome. (Ophthalmology, 2007,16: 201-205)