角膜板层刀制瓣和FEMTO LDV飞秒激光制瓣

角膜板层刀制瓣和femto ldv飞秒激光制瓣

lasik术后临床效果比较

徐婧  姜洋  李莹  王忠海 金玉梅  夏文薇

国家自然基金项目  批准号：81170826北京协和医院眼科李莹

教育部博士点博士导师基金  批准号： 20111106110045

中国医学科学院北京协和医学院 北京协和医院眼科，北京 100730

通讯作者：李莹  电话：[phone]，emal：[e-mail]

【摘要】  目的 比较研究角膜板层刀制瓣准分子原位角膜磨镶术（m-lasik）和femto ldv飞秒激光制瓣角膜磨镶术(f-lasik)的手术后临床效果。方法 选取2011年7月至2012年7月在北京协和医院眼科治疗的近视患300例 （600眼），其中接受m-lasik手术和f-lasik手术各150例300眼。观察手术后1个月内角膜瓣愈合、视力、干眼的三项客观指标即泪膜破裂时间（tear film break-up time，but）、泪液分泌试验（schirmer i test）和角膜荧光染色（fluorescein staining，fs）评分和地形图以及患者主观症状的问卷评估，包括干涩、疼痛、视力波动、夜间眩光、光晕、虚影、夜间驾车困难、精细操作困难、看书/阅读电脑屏幕困难及总体满意度。结果 两组术后角膜瓣一期愈合，f-lasik组一只眼术后第一天角膜瓣细皱，冲洗后好转；所有眼均达到手术前预期矫正视力。角膜地形图角膜曲率（k）值术后1个月两组k₁值、k₂值均较术前明显减小 (p<0.05)，术后1个月两组之间比较差异无统计学意义(p>0.05)。术后1个月与术前相比两组but、schirmer i 均有下降，fs评分增加，差异有统计学意义(p<0.05)。术后一个月f-lasik组but高于m-lasik组，差异有统计学意义(p<0.05)，schirmer i 试验、fs评分两组间无统计学意义(p>0.05)。f-lasik组主观症状的评分总和低于m-lasik组，差异有统计学意义（z=-0.989，p=0.043）；满意度高于m-lasik组，差异有统计学意义（z=-2.316，p=0.021）。结论 传统角膜板层刀制瓣lasik和现代femto ldv飞秒激光制瓣lasik均可以使患者获得良好的术后视力及生活视觉质量，飞秒激光制瓣术后满意度更高；femto ldv飞秒激光制瓣可以减少术后干眼的发生。

【关键词】眼

 

the result comparison of lasik flap made by microkeratome with femto ldv femotosecond laser

xu jing，jiang yang，li ying，wang zong-hai，jing yue-mei，xia wen-wei

department of ophthalmology，peking union medical college hospital，chinese academy of medical science & peking union medical college，beijing 100730，china

corresponding author：li ying  tel:[phone] ，emal：[e-mail]

【abstract】 objective  to evaluate the effect of laser in situ keratomileusis (lasik) surgery after flap creation with a femtosecond laser and a mechanical microkeratome. methods 300 eyes of 150 cases after femto ldv femtosecond laser lasik surgery( f-lasik group) and 300 eyes of 150 cases after mechanical microkeratome lasik surgery( m-lasik group)were included from july 2011 to december 2011. uncorrcted visual acuity (ucva)，dry-eye syndromes including tear film break-up time（but），schirmer i test and corneal fluorescein staining，subjective symptoms including dryness，pain，blurring，glare at night，hale of light，double image，nighttime driving difficulty，fine manipulation difficulty，reading difficulty and the whole satisfaction. results 1eye have a little fold of flap on the fist day post- sugery in f-lasik group，getting better after washing. desired result of uncorrected visual acuity has been obtained in 1 month post-operation in both groups.the values of steep keratometric power (k₁) and  the values of flat keratometric power (k₂) were significantly lower at 1 month after operation(p<0.05). there was no statistically difference between the two group(p>0.05).  but and schirmer i test were reduced after surgery，and the score of fs was increased after surgery. (p<0.05). there was statistically difference compared with before operation. at 1 month after operation the average of but of f-lasik group was significantly longer than that of m-lasik group(p<0.05). schirmer i test results and the score of fs were comparable between the two groups(p>0.05). the total score of 9 symptoms in f-lasik group was significantly lower than that in m-lasik group（z=--0.989，p=0.043）. the score of satisfaction in f-lasik group was significantly higher than that in m-lasik group（z=--2.316，p=0.021）.conclusions both traditional lasik and femto ldv lasik can achieve good visual acuity and improve quality of life. the incidence and severity of dry eye is lower in femto ldv lasik than in traditional lasik.

【key words】keratomileusis laser in situ；femtosecond laser；dry eye