【摘要】  目的：探讨微型角膜刀准分子激光角膜上皮瓣下磨镶术（Epi-LASIK）矫治薄角膜近视的疗效、安全性、稳定性。方法：对10例（20眼）无法行准分子激光原位角膜磨镶术（LASIK）的相对薄角膜近视患者行Epi-LASIK手术。术前近视球镜为-4.00~-10.25D，平均（-7.32±1.66）D，柱镜0~-2.50D，平均（-0.71±0.72）D。术前角膜厚度463~519μm，平均（491±20）μm。观察术中术后并发症，并对术后1~6mo裸眼视力、屈光度及上皮下雾状浑浊（Haze）进行随访。结果：术中无严重并发症，术后最佳矫正视力与术前相比无1例下降，术后6mo球镜平均（-0.04±0.18）D，柱镜平均（-0.20±0.44）D。20眼等效球镜均在-0.75~+0.75D之间，其中17眼（85%）等效球镜在-0.50~+0.50D之间。角膜厚度平均（412±14）μm。I级Haze者为1眼。 结论：Epi-LASIK对于薄角膜近视治疗安全有效，可作为薄角膜中高度近视的首选术式。

【关键词】  薄角膜；近视；上皮下角膜磨镶术

    Results after epipolis laser in situ keratomileusis for miopia with thin cornea

    Jing Chen, Su-Ning Han, Xin Wu, Xiao-Xue Gong, Jun-Li Wu, Mou-Yu Tang

    Department of Ophthalmology, Guangzhou General Hospital of Guangzhou Command, Guangzhou 510010, Guangdong Province, China

     AbstractAIM: To study the efficacy, safety and stability of epipolis laser in situ keratomileusis (Epi-LASIK) for myopia with thin cornea. METHODS: Epi-LASIK was performed on 20 eyes of 10 myopia patients with thin cornea which could not be performed with laser in situ keratomileusis (LASIK). The mean preoperative sphere and cylinder were -7.325±1.655 D (range -4.00- -10.25D) and -0.713±0.718D (range 0--2.50D). The range of preoperative central corneal thickness was 463-519μm, averaged (491±20)μm. All the cases were followed up for 6 months. Postoperative uncorrected visual acuity (UCVA), refraction, and corneal haze were examined. RESULTS: There was no serious complication during and after the operation. The best corrected vision acuity (BCVA) remained the same to or more than pre-operation in all the operative eyes. The postoperative sphere averaged (-0.038±0.179)D, cylinder averaged (-0.199±0.442)D. The postoperative mean spherical equivalents (MES) were all at -0.75- +0.75D, 17 eyes (85%) MES reached -0.50- +0.50D. the mean central corneal thickness was (412±14)μm. The I grade haze was found in one eye. CONCLUSION: Epi-LASIK is a safe, effective and stable surgery for myopia.

    · KEYWORDS: thin cornea; myopia; epipolis laser in situ keratomileusis

     0引言

    准分子激光屈光性角膜手术发展20a来，随着屈光手术者的不断努力探索，先后出现了准分子激光屈光性角膜切削术（photorefractive keratectomy, PRK）、准分子激光原位角膜磨镶术（laser in situ keratomileusis, LASIK）、准分子激光角膜上皮瓣下磨镶术（laser epithelial keratomileusis, LASEK）、微型角膜刀准分子激光角膜上皮瓣下磨镶术（epipolis laser in situ keratomileusis，Epi- LASIK）。在国际主流手术LASIK的背景下， Epi-LASIK鉴于在适应症上的特点和术后视觉质量的潜在优势，引起广泛的关注和期待。

    Epi-LASIK是2003-08由希腊医生Ioannis Pallikaris[1]最先报道。Epi-LASIK实际上是一种机械制瓣法的LASEK手术。术中应用一种高速震荡的塑性“钝刀”分离角膜上皮层，制作一个完整的、带蒂的角膜上皮瓣，然后完成激光切削并将上皮瓣复位。本文皆在探讨在无法行LASIK的相对薄角膜近视患者行Epi-LASIK手术的安全性、有效性、稳定性。

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