Epi-LASIK与Flap-free Epi-LASIK矫正高度近视的临床研究

发布时间：2018-03-13 04:31

本文选题：机械法准分子激光上皮瓣下角膜磨镶术　切入点：去上皮瓣下角膜磨镶术　出处：《南华大学》2011年硕士论文　论文类型：学位论文

【摘要】：目的通过对机械法准分子激光上皮瓣下角膜磨镶术(epipolis laser in-situ keratomileusis, Epi-LASIK)和去瓣准分子激光上皮下角膜磨镶术(Flap-free epipolis laser in-situ keratomileusis, Flap-free Epi-LASIK)治疗高度近视临床与泪膜情况的研究,探讨上皮瓣的去留对患者术后角膜刺激症状、角膜愈合、早期视力的恢复、Haze及泪膜的影响,为屈光手术医生更合理选择手术方式提供一定参考。方法选择在我院接受Epi-LASIK的高度近视患者30例(60眼),将患者右眼去瓣,左眼留瓣。术后随访1年,术后1、3、5d观察患者术后角膜刺激症状、角膜愈合情况及裸眼视力;术后1w、1、3、6、12m裂隙灯显微镜观察并记录各组Haze分级情况;术前及术后1、3、6、12m患者双眼分别行裸眼视力、屈光状态、泪液羊齿状试验、泪膜破裂时间检查、泪液分泌量测定和结膜印记细胞学检查。结果1.术后角膜刺激症状评分比较,术后1d,t =-1.306,p0.05;术后5d,t=-0.372,p0.05,差异无统计学意义。术后3d,去瓣组角膜刺激症状较留瓣组轻,t=-15.817,p0.01,差异有统计学意义。2.术后早期裸眼视力比较,两组术后1d、5d裸眼视力基本一致(1d,t=0.387,p0.05;5d,t=0.841,p0.05),差异无统计学意义。术后3天去瓣组裸眼视力明显好于留瓣组(t=18.205,p0.05),差异有统计学意义。3.术后角膜上皮愈合时间,去瓣组平均为(2.57±0.57)d。留瓣组平均为(4.60±0.50)d。两组间比较差异有统计学意义(t=-15.503,p0. 01)。4.术后1、3、6、12m两组裸眼视力及屈光度比较p0.05,差异无统计学意义。5.Haze形成情况,术后1w、1、3、6、12m haze两组比较差异无统计学意义,p0.05。6.术后1、3、6、12m两组泪膜破裂时间、泪液分泌量、泪液羊齿状试验比较差异无统计学意义,p0.05;术后1、3m两组泪膜破裂时间、泪液分泌量、泪液羊齿状试验分别与术前比较差异有统计学意义,p0.05;术后6、12m两组泪膜破裂时间、泪液分泌量、泪液羊齿状试验分别与术前比较差异无统计学意义,p0.05。术后1、3、6、12m两组印记细胞学检查差异无统计学意义,p0.05。术后1、3、6 m两组印记细胞学检查与术前比较差异有统计学意义,p0.05;12m两组印记细胞学检查差异无统计学意义,p0.05。结论1、Flap-free Epi-LASIK较Epi-LASIK患者术后角膜刺激反应明显减轻、上皮愈合时间缩短和早期裸眼视力恢复更快。2、Flap-free Epi-LASIK与Epi-LASIK术后屈光度及Haze变化趋势相同。3、Flap-free Epi-LASIK与Epi-LASIK术后早期泪膜稳定性下降、泪液分泌量减少、泪液羊齿状试验蕨样级别及结膜鳞状化生级别增高。4、Flap-free Epi-LASIK与Epi-LASIK术后泪膜逐渐恢复,泪膜稳定性、泪液分泌量、泪液羊齿状试验分级在术后6个月时基本达到术前指标,结膜上皮鳞状化生分级在术后12个月时基本达到术前指标。5、Epi-LASIK及去瓣Epi-LASIK治疗高度近视短期均有较好的效果、术后临床指标稳定,与术前的预测较符合。
[Abstract]:Objective to study the clinical and lacrimal film status of epipolis laser in-situ keratomileusissis (Epi-LASIKA) and flap-free epipolis laser in-situ keratomileusissis (Flap-free Epi-LASIKI) in the treatment of high myopia by mechanical excimer laser supra-flap keratomileusis (Epi-LASIKI) and excimer laser excimer laser keratomileusis (Flap-free Epi-LASIKI). To explore the effect of upper flap on corneal irritation symptoms, corneal healing, early visual acuity recovery and tear film, and to provide a reference for refractive surgery doctors to choose more reasonable operation methods. Methods Thirty patients (60 eyes) with high myopia who received Epi-LASIK in our hospital were selected. The right eye was devalved and the left eye was left. The patients were followed up for one year, and the symptoms of corneal irritation, corneal healing and naked visual acuity were observed at 1, 3 and 5 days after operation. The Haze grading of each group was observed and recorded by slit lamp microscope 1 week after operation, visual acuity, refractive state, tear goosetooth test and lacrimal film rupture time were examined in both eyes before and after operation. Measurement of tear secretion and cytological examination of conjunctival imprinting. Results 1.Compared with the score of postoperative corneal irritation symptom, the difference was not significant at 1 day after operation (P 0.05) and 5 days after operation (P 0.05). 3 days after operation, the symptoms of corneal irritation in the devalved group were lighter than those in the remaining flap group (P 0.01), the difference was statistically significant. 2. The early uncorrected visual acuity was significantly higher in the devalving group than in the remaining flap group. The uncorrected visual acuity of the two groups was almost the same on the 1st day and 5th day after operation. There was no significant difference between the two groups. The naked visual acuity of the group without flap on 3 days after operation was significantly better than that of the group with left flap, and the difference was statistically significant. 3. The time of corneal epithelial healing after operation was significantly higher in the group of removing the flap than that in the group of the left flap, and there was no significant difference in the healing time of corneal epithelium between the two groups on the 3rd day after operation. The average value was 2.57 卤0.57 d in the valvular group and 4.60 卤0.50 d in the remaining group. The difference between the two groups was statistically significant (P < 0.05). The visual acuity and diopter of the two groups were significantly higher than those of the control group (P 0.05), and the difference was not statistically significant (P < 0.05), and the difference was not significant between the two groups (P < 0.05), and there was no significant difference between the two groups in terms of visual acuity and diopter (P 0.05). There was no significant difference in tear film rupture time, tear secretion and tear tooth test between the two groups at 1 week after operation (p 0.05), but there was no significant difference in tear film rupture time (P 0.05) between the two groups (P < 0.05), tear film rupture time (P 0.05) and lacrimal secretion volume (P < 0.05) between the two groups after operation (P < 0.05), and there was no significant difference in tear film rupture time (P < 0.05) and tear secretion volume (P < 0.05) between the two groups (P < 0.05). There were significant differences between the two groups in tear tooth test (P 0.05), tear film rupture time (612m) and tear secretion (P 0.05). There was no significant difference in tear tooth test between before and after operation (p 0.05). There was no significant difference in imprint cytology between the two groups (P 0.05). There was a significant difference in imprint cytology between the two groups after operation. There was no significant difference in imprinting cytology between the two groups (P 0.05). Conclusion (1) Flap-free Epi-LASIK significantly alleviated corneal irritation, shortened epithelial healing time and improved early uncorrected visual acuity. The diopter and Haze change trend of Flap-free Epi-LASIK and Epi-LASIK were the same. 3 Flap-free Epi-LASIK and Epi-LASIK decreased the stability of lacrimal film early after operation. The amount of tear secretion decreased, the grade of ferns and conjunctival squamous metaplasia increased. The tear film recovered gradually after Epi-LASIK, the tear film was stable, and the amount of tear secretion was increased. The tear tooth test grade basically reached the preoperative index at 6 months after operation, the conjunctival epithelial squamous metaplasia grade basically reached the preoperative index. 5 Epi-LASIK and valvular Epi-LASIK in the treatment of high myopia in a short period of time, and the conjunctival epithelial squamous metaplasia grade had a good effect on the treatment of high myopia in the short term. The postoperative clinical indexes were stable and consistent with the preoperative prediction.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.63

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