Ahn C S, Clinch T E, Moshirfar M, Weis J R, Hutchinson C B
University of Utah Health Science Center, Salt Lake City, USA.
J Cataract Refract Surg. 1999 Aug;25(8):1048-55. doi: 10.1016/s0886-3350(99)00127-3.
To determine the safety and efficacy of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) early in a surgeon's experience.
Ophthalmology Department, John A. Moran Eye Center, Salt Lake City, Utah, USA.
Between October 1995 and April 1997, a retrospective analysis was performed of 200 eyes in 128 patients who had PRK or LASIK with a follow-up of at least 3 months. The mean age was 38.1 years +/- 10.4 (SD) in the PRK group and 42.3 +/- 10.1 years in the LASIK group. There were 36 women and 30 men in the former and 32 women and 30 men in the latter. Photorefractive keratectomy, PRK/astigmatic keratotomy (AK), LASIK, or LASIK/AK was performed with the Summit Omnimed excimer laser. Preoperative evaluation included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), cycloplegic refraction, tonometry, and computerized videokeratography. At 1, 3, and 6 months, UCVA, BSCVA, mean spherical equivalent (SE), astigmatism, corneal haze, subjective vision (day, night, glare, and halo), and complications were measured.
Mean SE was 0.16 +/- 0.82 diopter (D) in the PRK group and -0.09 +/- 0.63 D in the LASIK group at 1 month (P < .05), -0.18 +/- 0.66 D and -0.16 +/- 0.58 D, respectively, at 3 months, and -0.33 +/- 0.73 D and -0.09 +/- 0.62 D, respectively, at 6 months. Achieved correction was similar in the 2 groups. Mean BSCVA was 22.8 +/- 6.0 in the PRK group and 22.2 +/- 5.3 in the LASIK group at 1 month, 21.1 +/- 6.0 and 21.1 +/- 3.1, respectively, at 3 months, and 19.8 +/- 3.5 and 22.9 +/- 5.2, respectively, at 6 months (P < .005). Mean surface regularity index was 0.68 +/- 0.40 in the PRK group and 0.86 +/- 0.41 in the LASIK group at 1 month, 0.54 +/- 0.26 and 0.72 +/- 0.37, respectively, at 3 months (P < .05), and 0.49 +/- 0.27 and 0.84 +/- 0.42, respectively, at 6 months. Mean surface asymmetry index was 0.71 +/- 0.43 in the PRK group and 0.55 +/- 0.21 in the LASIK group at 1 month (P < .05), 0.53 +/- 0.24 and 0.51 +/- 0.23, respectively, at 3 months, and 0.46 +/- 0.19 and 0.64 +/- 0.54, respectively, at 6 months. The subjective parameters between the groups were significantly different only at 6 months; patients in the PRK group reported better day and night vision.
With careful preparation and proper training, PRK and LASIK appear to be safe and efficacious even during the surgeon's early learning phases.
在外科医生经验积累的早期阶段，确定准分子激光角膜切削术（PRK）和准分子原位角膜磨镶术（LASIK）的安全性和有效性。
美国犹他州盐湖城约翰·A·莫兰眼科中心眼科。
1995年10月至1997年4月，对128例接受PRK或LASIK手术且随访至少3个月的200只眼进行回顾性分析。PRK组平均年龄为38.1岁±10.4（标准差），LASIK组为42.3±10.1岁。PRK组有36名女性和30名男性，LASIK组有32名女性和30名男性。使用Summit Omnimed准分子激光进行PRK、PRK/散光性角膜切开术（AK）、LASIK或LASIK/AK手术。术前评估包括裸眼视力（UCVA）、最佳矫正视力（BSCVA）、睫状肌麻痹验光、眼压测量和计算机化视频角膜地形图检查。在术后1、3和6个月，测量UCVA、BSCVA、平均球镜当量（SE）、散光、角膜 haze、主观视力（白天、夜间、眩光和光晕）以及并发症。
PRK组术后1个月平均SE为0.16±0.82屈光度（D），LASIK组为 -0.09±0.63 D（P <.05）；3个月时分别为 -0.18±0.66 D和 -0.16±0.58 D；6个月时分别为 -0.33±0.73 D和 -0.09±0.62 D。两组实现的矫正效果相似。PRK组术后1个月平均BSCVA为22.8±6.0，LASIK组为22.2±5.3；3个月时分别为21.1±6.0和21.1±3.1；6个月时分别为19.8±3.5和22.9±5.2（P <.005）。PRK组术后1个月平均表面规则性指数为0.68±0.40，LASIK组为0.86±0.41；3个月时分别为0.54±0.26和0.72±0.37（P <.05）；6个月时分别为0.49±0.27和0.84±0.42。PRK组术后1个月平均表面不对称指数为0.71±0.43，LASIK组为0.55±0.21（P <.05）；3个月时分别为0.53±0.24和0.51±0.23；6个月时分别为0.46±0.19和0.64±0.54。两组之间主观参数仅在6个月时有显著差异；PRK组患者报告白天和夜间视力更好。
通过精心准备和适当培训，即使在外科医生的早期学习阶段，PRK和LASIK似乎也是安全有效的。
