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目的探讨经角膜上皮准分子激光表层切削术(Trans PRK)与准分子激光上皮下角膜磨镶术(LASEK)对薄角膜近视眼术后视力、屈光度及角膜生物力学性能的影响。方法选择118例近视和散光患者为研究对象,纳入右眼数据(118眼)进行分析。61例(61眼)行Trans PRK治疗者设为Trans PRK组,57例(57眼)行LASEK治疗者设为LASEK组。比较两组患者术后1周、1个月、3个月和6个月裸眼视力(UCVA)、屈光度、中央角膜厚度(CCT)、角膜后表面高度、非球面参数Q值、角膜滞后量(CH)和角膜阻力因子(CRF)以及角膜像差。结果术后1周、1个月、3个月和6个月时,两组患者术后UCVA达到或超过术前最佳矫正视力(BCVA)的比例无统计学差异(P>0.05);术后1周、1个月时,Trans PPK组患者屈光度矫正量达到术前期望矫正量的比例高于LASEK组(P<0.05)。术后,两组后表面高度较术前显著降低(P<0.05),后表面Q值无显著性变化(P>0.05)。两组术后1周、1个月和6个月的CH值和CRF值均显著低于术前(P<0.05),组间比较,彗差、球差和高阶像差显著高于术前(P<0.01),两组术后各个时间点CH值、CRF值,彗差、球差和高阶像差无统计学差异(P>0.05)。结论Trans PRK作为新兴表层手术方式,治疗薄角膜近视患者疗效确切,屈光度稳定,整个手术过程无需在眼球上操作,对角膜表面形态及生物性能影响小,手术安全性好。
Objective To investigate the effects of corneal epithelial excimer laser surface excision (Trans PRK) and excimer laser subepithelial keratomileusis (LASEK) on visual acuity, refraction and corneal biomechanical properties after thin myopia. Methods A total of 118 patients with myopia and astigmatism were selected as the study object, and the data of right eye (118 eyes) were included in the analysis. 61 patients (61 eyes) were treated with Trans PRK as Trans PRK and 57 eyes (57 eyes) with LASEK as LASEK. UCVA, diopter, central corneal thickness (CCT), posterior corneal height, asphericity Q, corneal hysteresis at 1 week, 1 month, 3 months and 6 months after surgery were compared between the two groups CH) and corneal resistance factor (CRF) as well as corneal aberrations. Results There was no significant difference in UCVA between preoperative and postoperative UCVA at 1 week, 1 month, 3 months and 6 months postoperatively (P> 0.05). At 1 week and 1 month after operation, the proportion of patients receiving trans PPK was significantly higher than that of LASEK group (P <0.05). After operation, the posterior surface height of the two groups was significantly lower than that before operation (P <0.05), while the posterior surface Q value had no significant change (P> 0.05). The CH values and CRF values at 1 week, 1 month and 6 months after operation in both groups were significantly lower than those before operation (P <0.05). Coma, spherical aberration and higher-order aberrations were significantly higher in the two groups (P <0.01). There were no significant differences in CH value, CRF value, coma, spherical aberration and higher order aberration between the two groups at all time points (P> 0.05). Conclusion Trans PRK as a new surgical method of surface surgery, the treatment of thin myopia patients with exact effect, stable refraction, the entire operation without eye surgery, the corneal surface morphology and biological properties of small, good surgical safety.