角膜瓣掀起式与角膜瓣不掀起式上皮下准分子原位角膜磨镶术矫正薄角膜中低度近视的临床效果比较

Comparison of clinical results between flap-on and flap-off techniques of epithelial-laser in situ keratomileusis in correction of low to moderate myopia in eyes with thin corneas.

作者信息

Shaher Aziz, Al-Gassaly Yahia, Alansy Horia, Alkhatib Tawfik

机构信息

Ophthalmology Center, Al-Thawra Modern General Teaching Hospital, Faculty of Medicine, Sana'a University, PO Box 12272, Sana'a, Yemen.

出版信息

Saudi J Ophthalmol. 2013 Jan;27(1):31-5. doi: 10.1016/j.sjopt.2012.06.001. Epub 2012 Jun 18.

DOI:10.1016/j.sjopt.2012.06.001

PMID:23964184

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3729376/

Abstract

PURPOSE

To prospectively compare flap-on and flap-off techniques of epithelial-laser in situ keratomileusis (epi-LASIK) for the correction of low to moderate myopia in patients with thin corneas.

METHODS

In this randomized, interventional study, the cohort was comprised of 88 eyes (44 patients) with myopia which underwent epi-LASIK. The epithelium was separated as a 9 mm flap with 2-4 mm nasal hinge with epikeratome (Lasatom, Gebauer Medizintechnik GmbH, Neuhausen, Germany) and the ablation was performed with the MEL 80 excimer laser (Carl Zeiss, Meditec, Jena, Germany). Thirty-eight eyes underwent flap-on Epi-LASIK where the flap was repositioned after ablation (flap-on group) and 50 eyes underwent flap-off Epi-LASIK where the epithelial flap was discarded (flap-off group). Pre- and post-operative uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), and spherical equivalent (SE) were collected for each group. Post-operative pain, time to epithelialization, and corneal haze were also collected postoperatively. Variables were compared with the paired t-test, chi-squared test and one-way analysis of variance. Statistically significance was indicated by p < 0.05.

RESULTS

The mean preoperative SE was -3.89 ± 1.9 diopters (D) for the flap-on group and -3.92 ± 2.17 D for the flap-off group (p = 0.96). The mean follow-up was 12 months. The mean pain score was comparable on all postoperative days except the 2nd postoperative day where the flap-on had significantly lower mean pain scores (p = 00). Time for epithelial healing was 4.39 ± 0.49 days in flap-on group and 4.64 ± 0.69 days in flap-off group (p = 0.07). There was no significant difference in the postoperative UCVA between groups (p = 0.77). Corneal haze at the end of postoperative follow-up was not different between groups (p = 0.217).

CONCLUSION

There is no significant difference in the clinical outcomes between flap-on and flap-off techniques of Epi-LASIK for the correction of low to moderate myopia.

摘要

目的

前瞻性比较上皮瓣原位角膜磨镶术（epi-LASIK）中瓣上和瓣下技术矫正薄角膜患者低度至中度近视的效果。

方法

在这项随机干预研究中，队列包括88只眼（44例患者）接受epi-LASIK治疗的近视患者。使用角膜上皮刀（Lasatom，德国纽豪森的格鲍尔医疗技术有限公司）制作一个9毫米的瓣，鼻侧铰链为2 - 4毫米，然后用MEL 80准分子激光（德国耶拿的卡尔蔡司医疗技术公司）进行消融。38只眼接受瓣上epi-LASIK，即消融后将瓣复位（瓣上组）；50只眼接受瓣下epi-LASIK，即丢弃上皮瓣（瓣下组）。收集每组术前和术后的裸眼视力（UCVA）、最佳矫正视力（BSCVA）和等效球镜度（SE）。术后还收集疼痛情况、上皮化时间和角膜 haze。变量采用配对t检验、卡方检验和单因素方差分析进行比较。p < 0.05表示具有统计学意义。

结果

瓣上组术前平均SE为-3.89 ± 1.9屈光度（D），瓣下组为-3.92 ± 2.17 D（p = 0.96）。平均随访时间为12个月。除术后第2天外，所有术后天数的平均疼痛评分相当，术后第2天瓣上组的平均疼痛评分显著较低（p = 0.00）。瓣上组上皮愈合时间为4.39 ± 0.49天，瓣下组为4.64 ± 0.69天（p = 0.07）。两组术后UCVA无显著差异（p = 0.77）。术后随访结束时两组角膜 haze无差异（p = 0.217）。