Dai Jin-hui, Chen Chong-da, Chu Ren-yuan, Zhou Xing-tao, Qu Xiao-mei, Wang Xiao-yin, Yu Zhi-qiang, Zhang Bao-hua
Department of Ophthalmology, Eye and ENT Hospital affiliated to Fudan University, Shanghai 200031, China.
Zhonghua Yan Ke Za Zhi. 2005 Mar;41(3):211-5.
To investigate the surgical characteristics and clinical results of Epi-LASIK on high myopia.
Epi-LASIK was performed with a rotational epikeratome, which features a blunt oscillating blade. Corneal epithelial separation was achieved mechanically without the use of alcohol. Laser ablation was performed with Zeiss Mel-80 excimer laser. After ablation, epithelial sheet was repositioned and a therapeutic contact lens was applied to the eye for 3 to 5 days. The postoperative symptom, epithelial flap, contrast sensitivity, wavefront aberration and haze formation were investigated. The period of follow-up ranged from 3 to 6 months.
52 eyes of 30 patients with a mean spherical equivalent (SE) of (-12.82 +/- 4.38) D were included in the clinical trial. Among which 36 eyes were pathologic myopia and 16 eyes were simple high myopia. Patient age ranged from 20 to 50 years. Integrated epithelial flap with a diameter of 8 to 9 mm was made in 49 eyes leaving an about 3 mm superior hinge. Epithelial flap contained part of stroma tissue was seen in one eye. Free epithelial flap was made in 2 eyes. 4 eyes had moderate photophobia, tearing and foreign body sensation. Other patients only had mild discomfort. No patient reported other subjective symptom after 2 days with the exception of mild foreign body sensation. In 3 months after surgery, spherical equivalent of 44 eyes (84.61) were within +/- 1.00 D of attempted refraction. No eye lost more than one line of best spectacle-corrected visual acuity (BSCVA), whereas 10 eyes (19.23%) gained one or two lines of BSCVA. Grade 0.5 haze was found in 8 eyes (15.38%) and grade 1 haze was found in 2 eyes (3.84%). In 6 months after surgery, Grade 0.5 haze was found in 3 eyes. Contrast sensitivity decreased 1 month postoperatively and recovered to preoperative lever gradually 3 months postoperatively. Higher order aberration was increased postoperatively.
Epi-LASIK is a safe and efficient method to correct high myopia with the advantages of having mild irritating symptom and haze. Larger series with adequate follow-up are needed to observe the long term clinical results and haze.
探讨准分子上皮下角膜磨镶术（Epi-LASIK）治疗高度近视的手术特点及临床效果。
使用旋转式上皮刀行Epi-LASIK手术，该上皮刀具有钝性振荡刀片。通过机械方法分离角膜上皮，无需使用酒精。用蔡司Mel-80准分子激光进行激光消融。消融后，将上皮瓣复位，并给术眼配戴治疗性隐形眼镜3至5天。观察术后症状、上皮瓣情况、对比敏感度、波前像差及 haze形成情况。随访时间为3至6个月。
30例患者的52只眼纳入临床试验，平均等效球镜度（SE）为（-12.82±4.38）D。其中病理性近视36只眼，单纯性高度近视16只眼。患者年龄20至50岁。49只眼制作了直径8至9mm的完整上皮瓣，上方保留约3mm的铰链。1只眼可见包含部分基质组织的上皮瓣。2只眼制作了游离上皮瓣。4只眼有中度畏光、流泪及异物感。其他患者仅有轻度不适。除轻度异物感外，术后2天后无患者报告其他主观症状。术后3个月，44只眼（84.61%）的等效球镜度在预期屈光度±1.00D范围内。无眼最佳矫正视力（BSCVA）下降超过一行，而10只眼（19.23%）BSCVA提高了一或两行。8只眼（15.38%）出现0.5级 haze，2只眼（3.84%）出现1级haze。术后6个月，3只眼出现0.5级haze。对比敏感度在术后1个月下降，术后3个月逐渐恢复至术前水平。高阶像差术后增加。
Epi-LASIK是一种安全有效的治疗高度近视的方法，具有刺激症状轻和haze少的优点。需要更大样本量及足够的随访来观察长期临床效果及haze情况。
