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目的定量分析我国LASIK矫正近视的远期效果、预测性和安全性等。方法检索1988～2008年在中、英文数据库发表的关于LASIK矫正近视的远期效果文献,进行Meta分析。结果共有8篇中、英文文献1338例近视患者(2465眼)被纳入本研究,术后随访时间2～7年不等。Meta分析结果显示,LASIK矫正低中度近视(≤-6.0D)的效果优于矫正高度近视(>-6.0D),差异有统计学意义(OR=8.36,95%CI:6.31～11.08)。比较术后裸眼视力达到0.5(20/40)和1.0(20/20)的比例发现,在低中度近视组随访2年时分别为99.7%和92.2%,随访5～7年则分别为100%和88.8%;在高度近视组分别达84.9%和54.4%(随访2年)以及87.7%和51.0%(随访5～7年)。虽然术后裸眼视力达0.5的比例随时间变化略有增加,达1.0的比例有所降低,但差异均未显示有统计学意义。手术预测性或准确性方面,无论是低中度近视还是高度近视组,随访5年及以上的术后屈光度在±1.0D的比例较术后2年有明显降低,差异具有统计学意义(χ2=58.74,P<0.01;χ2=226.1,P<0.01);术后5～7年,屈光度在±1.0D以内的比例分别是78.5%和38.3%。术后5年以上最佳矫正视力较术前下降2行的比例为1.0%～3.4%。眩光、屈光度数回退或欠矫及术后干眼是LASIK的主要术后长期并发症。结论LASIK矫正近视的长期效果是满意的,但对高度近视者的预测性较低,尚缺乏视功能方面的远期效果研究。
Objective To quantitatively analyze the long-term effect, predictability and safety of LASIK correction myopia in China. Methods The long-term effect literature about LASIK correction myopia published in Chinese and English databases from 1988 to 2008 was retrieved and analyzed by Meta-analysis. Results A total of 8 articles of 1338 cases of myopia (2465 eyes) from Chinese and English literature were included in this study. The follow-up time ranged from 2 to 7 years. The results of Meta analysis showed that the effect of LASIK in correcting low and moderate myopia (≤-6.0D) was better than that of correcting high myopia (> -6.0D) (OR = 8.36,95% CI: 6.31-11.08). Comparing the postoperative visual acuity of 0.5 (20/40) and 1.0 (20/20), the rate of 99.7% and 92.2% in the low and medium myopia group at 2 years of follow-up were respectively 100 and 100% at the follow-up of 5-7 years % And 88.8%, respectively; 84.9% and 54.4% (2 years follow-up) and 87.7% and 51.0% (5-7 years follow-up) respectively in the high myopia group. Although postoperative uncorrected visual acuity of 0.5 increased slightly over time, the proportion of 1.0 decreased, but the differences were not statistically significant. In terms of predictive or accuracy of surgery, the rate of postoperative refraction within ± 1.0D at 5 years and over was significantly lower than that at 2 years after surgery (both χ2 = 58.74, P <0.01; χ2 = 226.1, P <0.01). The percentage of refraction within ± 1.0D was 78.5% and 38.3% respectively after 5-7 years. The best corrected visual acuity of more than 5 years after surgery was 1.0% ~ 3.4% lower than that of preoperative 2 lines. Glare, refraction or undercorrection and postoperative dry eye is the main long-term complications of LASIK. Conclusions The long-term effect of LASIK in the correction of myopia is satisfactory, but the predictive value of LASIK in myopia is low, and the long-term effect of visual function is still lacking.