目的：对比研究经准分子激光上皮瓣下角膜磨镶术(LASEK)治疗正常角膜厚度近视和薄角膜厚度近视的临床疗效。

方法：本研究为前瞻性对照研究。选取2023-06/2024-02在中国人民解放军联勤保障部队第983医院眼科行LASEK手术的患者55例103眼。根据中央角膜厚度不同分为薄角膜厚度(460-499 μm)近视组27例50眼，正常角膜厚度(500-550 μm)近视组28例53眼。分别于术前及术后1 wk，1、2、3、4 mo进行随访，记录两组术后裸眼视力(UCVA)、最佳矫正视力(BCVA)、等效球镜度(SE)、剩余角膜厚度、眼压(IOP)、角膜刺激症状及角膜上皮下雾状混浊(haze)情况，计算安全性指数和有效性指数。对两组所测得的指标进行比较分析。

结果：两组患者术前性别构成比、年龄、SE、裸眼视力、BCVA相比均无差异(均P>0.05)。两组患者手术前后UCVA组间和交互作用相比均无差异(均P>0.05)，时间比较有差异(P<0.001)，术后UCVA均较术前改善。两组患者术后4 mo安全性指数和有效性指数比较均无差异(均P>0.05)。两组患者手术前后SE交互作用相比无差异(P>0.05)，组间和时间比较均有差异(均P<0.05)，术后SE均较术前明显降低，薄角膜厚度近视组术后早期有轻度近视漂移。两组患者手术前后ΔIOP组间、时间和交互作用相比均无差异(均P>0.05)。两组患者术后角膜刺激症状和角膜发生haze情况比较均无差异(均P>0.05)。术后剩余角膜厚度与术前角膜厚度、术前SE、术后4 mo SE、术后4 mo IOP均呈正相关(均P<0.05)。

结论：LASEK治疗薄角膜厚度近视与治疗正常角膜厚度近视一样的安全有效。

METHODS: This study was a prospective controlled study. Totally 55 patients(103 eyes)with myopia who underwent LASEK surgery in the 983rd Hospital of Joint Logistics Support Force of Chinese People's Liberation Army between June 2023 and February 2024 were selected. According to the central corneal thickness, there were 27 patients(50 eyes)of myopia with thin corneal thickness(460-499 μm)and 28 patients(53 eyes)of myopia with normal corneal thickness(500-550 μm). The patients were followed up before operation, and at 1 wk, 1, 2, 3 and 4 mo postoperatively. The uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), spherical equivalent(SE), residual corneal thickness, intraocular pressure(IOP), corneal irritation, and corneal haze were recorded, and the safety index and efficacy index were calculated. The measured indexes were analyzed statistically.

RESULTS: There were no significant differences in preoperative gender composition, age, SE, UCVA or BCVA between the two groups(all P>0.05). There were no significant differences in UCVA between the two groups of patients and the interaction(all P>0.05); the UCVA of the two groups were improved at every time after surgery(P<0.001). There were no significant differences in the safety index and efficacy index between the two groups after 4 mo(all P>0.05). There were no differences in SE interaction between the two groups of patients before and after surgery(P>0.05), as well as in the comparison of time(all P<0.05), the SE of the two groups were decreased significantly at every time after surgery, and there was a slight myopic drift at early postoperative stage in the thin corneal thickness myopia group. There were no differences in ΔIOP between the two groups of patients before and after surgery, as well as in the comparison of time and interaction(all P>0.05). There were no significant differences in corneal irritation and corneal haze between the two groups(all P>0.05). There was a positive correlation between the remaining postoperative corneal thickness and preoperative corneal thickness, preoperative SE, SE and IOP at 4 mo postoperatively(all P<0.05).

CONCLUSION: LASEK in the treatment of thin corneal myopia is as safe and effective as normal corneal thickness myopia.