Ophthalmology Service, Walter Reed Army Medical Center, Washington, DC, USA.
J Refract Surg. 2012 Jan;28(1):65-71. doi: 10.3928/1081597X-20111004-01. Epub 2011 Oct 10.
To evaluate visual outcomes following epi-LASIK compared to photorefractive keratectomy (PRK).
Of a total 294 patients aged ≥21 years, 145 (290 eyes) underwent epi-LASIK and 149 (298 eyes) underwent PRK for low to moderate myopia or myopic astigmatism. Epi-LASIK was performed with the Amadeus II epikeratome (Abbott Medical Optics) and PRK with the Amoils rotary epithelial brush (Innovative Excimer Solutions). All ablations were performed using the same excimer laser system. Outcome measures included intraoperative complications, corneal reepithelialization, postoperative pain, uncorrected distance visual acuity (UDVA), manifest refraction spherical equivalent (MRSE), corrected distance visual acuity (CDVA), corneal haze, and quality of vision.
Mean preoperative MRSE was -2.97±1.19 diopters (D) for epi-LASIK versus -2.95±1.06 D for PRK. Complete reepithelialization was achieved by postoperative day 4 in 46.9% of epi-LASIK eyes versus 92.4% of PRK eyes, with superior UDVA at postoperative day 1 in the PRK group (P=.002). Using Fisher exact test, a significantly higher percentage of epi-LASIK eyes compared to PRK eyes achieved 20/15 or better at 1 month (25.8% vs 17.8%, P=.031), 3 months (62.3% vs 49.3%, P=.004), 6 months (77.1% vs 57.9%, P<.001), and 12 months (75.9% vs 61.9%, P=.002). A change in MRSE >0.50 D occurred in 8.4% of epi-LASIK eyes within the 3- and 12-month interval versus 17.7% of PRK eyes (P=.04). No differences were noted between the two procedures in CDVA or clinically significant haze.
Epi-LASIK showed superior refractive efficacy and stability but required more time for wound healing, resulting in inferior early visual outcomes and a tendency to overcorrect higher refractive errors compared to PRK. Both treatments were safe and comparable in terms of pain and haze formation.
评估相对于光折射性角膜切削术（PRK）的表层角膜磨镶术（LASIK）后的视力结果。
在 294 名年龄≥21 岁的患者中，有 145 名（290 只眼）接受了表层角膜磨镶术（LASIK），149 名（298 只眼）接受了光折射性角膜切削术（PRK），用于治疗低度至中度近视或近视散光。表层角膜磨镶术采用 Amadeus II 角膜上皮刀（Abbott Medical Optics）进行，PRK 采用 Amoils 旋转上皮刷（Innovative Excimer Solutions）进行。所有消融均使用相同的准分子激光系统进行。观察指标包括术中并发症、角膜再上皮化、术后疼痛、未矫正距离视力（UDVA）、明显折射等效球镜（MRSE）、矫正距离视力（CDVA）、角膜混浊和视觉质量。
LASIK 术前平均 MRSE 为-2.97±1.19 屈光度（D），PRK 术前平均 MRSE 为-2.95±1.06 D。LASIK 术后 4 天有 46.9%的眼完全再上皮化，而 PRK 术后有 92.4%的眼完全再上皮化，PRK 组术后第 1 天 UDVA 更好（P=.002）。采用 Fisher 确切概率法，PRK 组术后 1 个月（25.8%对 17.8%，P=.031）、3 个月（62.3%对 49.3%，P=.004）、6 个月（77.1%对 57.9%，P<.001）和 12 个月（75.9%对 61.9%，P=.002）时，LASIK 组有更高比例的眼达到 20/15 或更好。LASIK 组术后 3 个月和 12 个月时，MRSE 变化超过 0.50 D 的发生率分别为 8.4%和 17.7%，PRK 组分别为 8.4%和 17.7%（P=.04）。两种手术在 CDVA 或临床显著混浊方面无差异。
LASIK 显示出更好的屈光效果和稳定性，但需要更多的时间来愈合伤口，导致早期视觉效果较差，并且与 PRK 相比，更容易过度矫正较高的屈光误差。两种治疗方法在疼痛和混浊形成方面均安全且相当。
