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目的探讨准分子激光原位角膜磨镶术(Lasik术)后二次手术方式及其临床效果。方法对31例(62眼)Lasik术后欠矫或屈光回退行二次手术的病例进行回顾性对照研究。其中A组15例(30眼)行Lasik手术,B组16例(32眼)行准分子激光上皮下角膜磨镶术(Lasek术),随访观察1年。其主要观察指标有:视力、屈光度、角膜曲率、总高阶像差值。结果二次手术采用Lasek与Lasik术后1周视力比较具有显著性差异(t=5.2140,P<0.01),B组视力明显低于A组;术后1个月、1年两组视力比较均无显著性差异(分别为t=0.5854、t=-0.5954,P>0.05);术后1年两组间裸眼视力、平均等效球镜屈光度、平均角膜曲率、总高阶像差值比较均无显著性差异(分别为t=0.6014、t=-0.0691、t=-1.1485、t=-0.9776,P>0.05)。A组发生角膜上皮内生1例,B组发生2+级角膜上皮下雾状浑浊(Haze)1例。结论 Lasik术后二次手术采用Lasek和Lasik术均可获得满意的临床效果。但从术后愈合时间、早期反应及最终结果来看,Lasik术后二次手术采用Lasik术式应该是比较恰当的选择,对于角膜基质床比较薄的患者采用Lasek手术作为候补方式也能取得较满意的临床效果。Lasek手术方式是否可以补矫更高的屈光度仍有待观察。
Objective To investigate the second surgical method and its clinical effect after laser in situ keratomileusis (Lasik’s surgery). Methods Retrospective study was performed on 31 cases (62 eyes) underwent second surgery after undergone refractive surgery or Lasik retrospectively. In group A, 15 patients (30 eyes) underwent Lasik procedure and 16 patients (32 eyes) underwent Lasek operation in group B, who were followed up for 1 year. The main observation indicators are: visual acuity, refraction, corneal curvature, total high order aberrations. Results The visual acuity of Lasek group and Lasik group was significantly different at 1 week (t = 5.2140, P <0.01). The visual acuity of group B was significantly lower than that of group A at 1 week. The visual acuity There was no significant difference (t = 0.5854, t = -0.5954, P> 0.05). One year postoperatively, the uncorrected visual acuity, average equivalent spherical refraction, average corneal curvature, There was no significant difference (t = 0.6014, t = -0.0691, t = -1.1485, t = -0.9776, P> 0.05). One case of corneal endothelium occurred in group A, and one case of grade 2+ corneal submucosal haze in group B. Conclusions Satisfactory results can be achieved by using Lasek and Lasik in the second surgery of Lasik. However, from the postoperative healing time, early response and final results, Lasik surgery after surgery should be more appropriate choice of Lasik surgery, for patients with relatively thin corneal stroma Lasek surgery as a candidate can also get more Satisfactory clinical results. It remains to be seen whether Lasek surgery can compensate for higher refraction.