【摘要】  目的 对比机械法准分子激光上皮瓣下磨镶术（epipolis laser in situ keratomileusis，Epi-LASIK）与准分子激光原位角膜磨镶术（laser in situ keratomileusis，LASIK）手术后的基本视功能。方法 回顾性分析对比400眼术前角膜厚度相同、屈光度及矫正视力相同而分别行Epi-LASIK（A组,198眼）和LASIK（B组,202眼）手术患者3个月后的视力、残余屈光度、眩光对比敏感度及泪膜破裂时间。结果 术后第3个月视力情况：A组93.94%≥0.6,89.90%≥0.8，62.12%≥1.0；超过术前最佳矫正视力者比例为45.96%，达到术前最佳矫正视力者比例为42.93%；B组：95.54%≥0.6，94.06%≥0.8，67.82%≥1.0；超过和达到术前矫正视力者比例分别为35.15%和53.96%。残余屈光度：A组（-0.12±0.51）D，B组 （-0.06±0.37）D，两组差异无显著性（P >0.05）。对比敏感度：B组术后第3个月时较A组下降更明显（P<0.05）。泪膜破裂时间：A组为（8.28±7.68）s，B组为(7.38±4.30)s，两组差异有显著性（P =0.043）。结论 Epi-LASIK手术容易掌握，术后成像质量更高，是一项非常有前景的手术，其远期的稳定性和疗效需要更长时间的随访观察。

    【关键词】  角膜磨镶术，激光原位/方法；屈光手术；视功能；对比研究

    ［Abstract］  Objective  To compare basic image quality between Epi-LASIK patients and LASIK patients after surgery. Methods  To retrospectively compare vision, residual refractive error, contrast sensitivity, and tear break-up time (BUT) 3 months after surgery. Four hundred eyes with equivalent preoperative corneal thickness and refractive error were recruited to undergo either Epi-LASIK (group A, 198 eyes) or LASIK(group B, 202 eyes). Results  At 3 months postoperatively, the vision in group A was：93.94%≥0.6，89.90%≥0.8，62.12%≥1.0 and in group B was：95.54%≥0.6，94.06%≥0.8，67.82%≥1.0. The percent exceeding or reaching preoperative BCVA in group A was 45.96%, or 42.93%, and in group B was 35.15%, or 53.96%. Residual refractive error for group A was    (-0.12±0.51)D and for group B was (-0.06±0.37)D, P>0.05. Contrast sensitivity for group B was more obvious than for group A (P<0.05). BUT for group A was (8.28±7.68)s and for group B was (7.38± 4.30)s， P=0.043. Conclusion  Epi-LASIK is easier to master and image quality after surgery is better than that for LASIK. This is a promising operation. Long-term stability and the curative effect need to be followed up and observed.

    [Key words]  keratomileusis，laser in situ/methods; refractive surgery; visual function； comparative study

    早期的近视经准分子激光角膜表面切削术（photorefractive keratectomy，PRK）后，有很多视力达到1.5的报道[1，2]，尤其是低、中度近视患者术后；但由于PRK术后存在有haze、视力恢复慢、刺激症状重、近视回退比例高[3]等诸多缺点而逐渐被准分子激光原位角膜磨镶术（laser in situ keratomileusis，LASIK）所取代。随着LASIK的大量开展，关于瓣源性像差[4，5]和继发性圆锥角膜[6~8]以及最大限度保留角膜厚度的重要性又逐渐被人类所认识。为取得两种手术兼有的优点，意大利医生Pallikaris在2002年最早将机械法准分子激光上皮瓣下磨镶术(epipolis laser in situ keratomileusis，Epi-LASIK)应用于临床[9]。我们于2005年6月开始开展Epi-LASIK手术，总体情况令人满意，现将随访时间达到3个月、术前近视情况基本相同而分别行Epi-LASIK（A组）和LASIK（B组）手术的400眼近视患者进行总结与分析，报告如下。

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