改良去瓣Epi-LASIK与LASIK治疗高度近视的临床与实验室检查的对比研究

发布时间：2018-08-05 10:10

【摘要】：目的:通过观察改良去瓣机械法准分子激光上皮瓣下角膜磨镶术(Epipolis laserin-situ keratomileusis，Epi-LASIK)与准分子激光原位角膜磨镶术(Laser in situkeratomileusis，LASIK)治疗高度近视的临床疗效与实验室检查结果，比较两组术后角膜刺激症状、裸眼视力、角膜上皮愈合、角膜上皮下雾状混浊（HAZE）、泪膜及角膜地形图等指标的变化，探讨两种手术方式的差异，为屈光手术医生根据个体情况选择手术方式提供参考。方法:选择2011年7月到2012年3月在我院行改良去瓣Epi-LASIK手术的高度近视患者42例(84眼)，LASIK手术的高度近视患者38例(76眼)，术后随访1年。观察术后1d、3d、5d、7d患者角膜刺激症状、裸眼视力及角膜上皮愈合情况，术后1m、3m、6m、12m两组出现HAZE分级情况、术前及术后1m、3m、6m、12m两组患者双眼裸眼视力、泪膜破裂时间、泪液分泌量、泪液蕨类试验及角膜地形图检查等指标。结果：1.术后角膜刺激症状评分比较，术后1d、3d两组间比较差异有统计学意义（t=-6.18，t=-4.51，P＜0.05）；术后5d、7d两组间比较差异无统计学意义（t=-1.94，t=-1.35，P＞0.05）。 2.术后角膜上皮愈合时间比较，LASIK组平均为（1.66±0.62）d，改良去瓣Epi-LASIK组平均为（4.93±0.80）d，两组间比较差异有统计学意义（t=-28.56，P＜0.05）。 3.术后早期裸眼视力（Uncorrected visual acuity UCVA）比较，两组术后1d、3d、5d比较差异均有统计学意义（t=11.34，t=13.96，t=4.04，P＜0.05）；术后7d、15d比较差异无统计学意义（t=1.63，t=1.65，P＞0.05）。 4.术后1m、3m、6m、12m两组间裸眼视力比较（t=0.87，t=0.98，t=1.40，t=-1.17，P＞0.05），差异均无统计学意义。屈光度比较差异无统计学意义（P＞0.05） 5.术后3m两组间HAZE的形成情况比较差异有统计学意义（χ~2=4.64，P＜0.05）；术后1m、6m、12m HAZE比较差异无统计学意义(χ~2=2.75，χ~2=1.82，χ~2=0.91，P＞0.05)。 6.术后15d两组间视觉质量问卷评分比较差异无统计学意义（t=1.86，P＞0.05），术后1m、3m、6m、12m两组间视觉质量问卷评分比较差异有统计学意义（t=2.03，t=3.49，t=3.98，t=3.75，P＜0.05）。 7.术前及术后1m两组间的泪液分泌试验比较差异无统计学意义(t=-0.48，t=-1.75，P＞0.05)，术后3m、6m、12m两组间比较差异均有统计学意义(t=-8.68，t=-12.79，t=-10.94，P＜0.05)；LASIK组术后1m、3m、6m、12m泪液分泌量分别与术前比较差异均有统计学意义（t=21.09，t=22.56，t=18.40，t=14.88，P＜0.05），改良去瓣Epi-LASIK组术后1m、3m泪液分泌量与其术前比较差异有统计学意义（t=29.20，，t=28.32，P＜0.05），术后6m、12m与其术前比较差异无统计学意义（t=1.93，t=0.43，P＞0.05）。 8.术前两组间泪膜破裂时间、泪液蕨类试验比较差异无统计学意义(P＞0.05)，术后1m、3m、6m、12m两组间比较差异均有统计学意义(P＜0.05)；LASIK组术后1m、3m、6m、12m泪膜破裂时间、泪液蕨类试验分别与术前比较差异均有统计学意义（P＜0.05），改良去瓣Epi-LASIK组术后1m、3m泪膜破裂时间、泪液蕨类试验与其术前比较差异有统计学意义（P＜0.05），术后6m、12m与其术前比较差异无统计学意义（P＞0.05）。 9.术前两组间的角膜表面非对称性指数（Surface Asymmetry Index SAI）、角膜表面规则性指数（Surface Regularity Index SRI）比较差异无统计学意义(t=0.57，t=-1.31，P＞0.05)；LASIK组及改良去瓣Epi-LASIK组术后12m SRI值比较差异有统计学意义(P＜0.05)，术后1m、3m、6m SRI值比较差异无统计学意义(P＞0.05)；LASIK组及改良去瓣Epi-LASIK组术后12m SAI值比较差异有统计学意义(P＜0.05)，术后1m、3m、6m SAI值比较差异无统计学意义(P＞0.05)；LASIK组术前与术后1m、3m、6m、12m SRI值比较差异有统计学意义(P＜0.05)，改良去瓣Epi-LASIK术前与术后1m、3m SRI值比较差异有统计学意义(P＜0.05)，与术后6m、12m SRI值比较差异无统计学意义(P＞0.05)，LASIK组术前与术后1m、3m、6m、12m SAI值比较差异有统计学意义(P＜0.05)，改良去瓣Epi-LASIK术前与术后1m、3m、6m SAI值比较差异有统计学意义(P＜0.05)，与术后12m SAI值比较差异无统计学意义(P＞0.05)。结论： 1.高度近视患者采用改良去瓣Epi-LASIK与LASIK相比术后早期角膜刺激症状重、视力恢复慢、上皮愈合时间长。 2.改良去瓣Epi-LASIK组HAZE发生除3m外与LASIK组无明显差异，远期视力可达到同样的效果。 3.改良去瓣Epi-LASIK组与LASIK组两组术后早期均有泪膜稳定性下降、泪液分泌量减少及泪液蕨类结晶分级级别与SRI及SAI值增高，随着时间的推移上述指标逐渐恢复，改良去瓣Epi-LASIK组泪膜损伤与角膜规则性的修复及视觉质量优于LASIK组。
[Abstract]:Objective: To observe the clinical efficacy and laboratory results of Epipolis laserin-situ keratomileusis (Epi-LASIK) and excimer laser in situ keratomileusis (Laser in situkeratomileusis, LASIK) in the treatment of high myopia, and compare the corneal irritation symptoms in two groups. The changes of naked eye vision, corneal epithelial healing, HAZE, tear film and corneal topography were discussed, and the difference between the two surgical methods was discussed, which provided a reference for the refractive surgeon to choose the operation mode according to the individual condition.
Methods: 42 cases of high myopia (84 eyes) were selected in our hospital from July 2011 to March 2012. 38 patients (76 eyes) with high myopia in LASIK operation were followed up for 1 years after operation. The corneal irritation symptoms of 1D, 3D, 5D, 7d patients after operation, naked eye vision and corneal epithelium healing were observed, HAZE scores in 1m, 3M, 6m, 12m two after operation were observed. The visual acuity of the eyes, tear film rupture time, tear secretion, tear fern test and corneal topography were observed before and after operation in 1m, 3M, 6m, 12m two groups.
Results: the scores of corneal irritation symptoms after 1. were compared, and there were significant differences in 1D and 3D two groups after operation (t=-6.18, t=-4.51, P < 0.05), and there was no statistical difference between groups of 5D and 7d two after operation (t=-1.94, t=-1.35, P > 0.05).
The time of corneal epithelial healing after 2. was compared in group LASIK (1.66 + 0.62) D and (4.93 + 0.80) d in the modified group Epi-LASIK group. The difference between the two groups was statistically significant (t=-28.56, P < 0.05).
Compared with Uncorrected visual acuity UCVA after 3. operation, the differences of 1D, 3D and 5D in the two groups were statistically significant (t=11.34, t=13.96, t=4.04, P < 0.05), and there was no significant difference in postoperative 7d.
After 4. 1m, 3M, 6m, and 12M, there was no significant difference in the visual acuity between the two groups (t=0.87, t=0.98, t=1.40, t=-1.17, P > 0.05). There was no significant difference in the diopter difference (P > 0.05).
After 5., there was a significant difference in the formation of HAZE between the 3M two groups (x ~2=4.64, P < 0.05), and there was no statistical difference between 1m, 6m, and 12m HAZE after the operation (x ~2=2.75, Chi ~2=1.82, Chi ~2=0.91, P > 0.05).
After 6., there was no significant difference in visual quality questionnaire between groups of 15d and two groups (t=1.86, P > 0.05). The scores of visual quality questionnaire among groups of 1m, 3M, 6m, 12m two after operation were statistically significant (t=2.03, t=3.49, t=3.98, t=3.75, P < 0.05).
7. before and after the operation, there was no significant difference in the tear secretion test between the 1m two groups (t=-0.48, t=-1.75, P > 0.05), and the postoperative 3M, 6m, and 12m two groups were statistically significant (t=-8.68, t=-12.79, t=-10.94, P < 0.05). T=22.56, t=18.40, t=14.88, P < 0.05). The difference in the secretion of 3M tear secretion between the modified Epi-LASIK group and the Epi-LASIK group was statistically significant (t=29.20, t=28.32, P < 0.05) and 6m after operation. There was no significant difference between 12m and before operation (0.05).
8. the tear film rupture time between the two groups was not statistically significant (P > 0.05). There were significant differences in 1m, 3M, 6m, and 12m between groups after operation (P < 0.05), and 1m, 3M, 6m, and 12m tear film rupture time after operation in group LASIK, and the difference of tear ferns were statistically significant (P < 0.05) respectively (P < 0.05). The time of tear film rupture in 1m and 3M after operation in group Epi-LASIK was statistically significant (P < 0.05). There was no statistical difference between 6m, 12m and before operation (P > 0.05).
9. the corneal surface asymmetry index (Surface Asymmetry Index SAI) between the two groups before operation, and there was no statistical difference between the corneal surface regularity index (Surface Regularity Index SRI) (t=0.57, t=-1.31, P > 0.05). There was no statistically significant difference in the value of 6m SRI (P > 0.05), and there was significant difference in 12m SAI value in group LASIK and modified Epi-LASIK group (P < 0.05), and there was no significant difference in the postoperative 1m, 3M, 6m SAI value. There was significant difference in the value of 1m and 3M SRI before and after the operation of Epi-LASIK (P < 0.05). There was no significant difference in the value of 6m, 12m SRI (P > 0.05). There was a statistically significant difference between the preoperative and postoperatively 1m, 3M, and postoperatively. The significance of study (P < 0.05) was not significantly different from that of postoperative 12m SAI (P > 0.05).
1. Compared with LASIK, modified flap-removal Epi-LASIK has more severe corneal irritation symptoms, slower visual recovery and longer epithelial healing time in patients with high myopia.
2. there was no significant difference in the occurrence of HAZE between the improved Epi-LASIK group and the LASIK group except for 3M, and the long-term visual acuity could achieve the same effect.
3. the early postoperative tear film stability decreased, tear secretion decreased and tear ferns crystallinity grade level and SRI and SAI value increased in the two groups of improved decidal Epi-LASIK group and group LASIK. With the time lapse the above indexes gradually recovered. The modified tear film injury and the regular repair of the angle membrane and the visual quality were superior to those of the LASIK group.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R778.11

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