Objective To explore the long-term safety, efficacy and stability of laser epithelial keratomileusis (LASEK) and epipolis laser in situ keratomileusis (Epi-LASIK) for the correction of myopia and astigmatism in suspected keratoconus. Methods This was a retrospective clinical study.Thirty-eight patients with 55 eyes suspected to have keratoconus were enrolled in the study. All eyes were myopic, ranging from -3.25 to -7.75 D [(-5.54±2.18) D], cylinder 0 to 3 D[(0.80±0.75)D],with a central corneal thickness of 479 to 605 μm, and stage one keratoconus (KC1) detected by keratography. Refraction and keratograph were stable for at least 2 years in all eyes. Fifty-five eyes successfully underwent either LASEK (38 eyes) or Epi-LASIK (17 eyes). Visual acuity, refraction,and keratograph were checked postoperatively from 6 months to more than 2 years (2 to 5 years).A paired samples t test (normal distribution) and a Wilcoxon Signed Ranks test (non-normal distribution)were used to compare the data before and after surgery. Results More than 2 years postoperatively,uncorrected visual acuity was 1.0 or better in 48 eyes (87.3%), the efficacy index was 1.002; best spectacle-corrected visual acuity remained unchanged or improved in 51 eyes (92.7%), and one line was lost in 4 eyes (7.3%), the safety index was 1.053. Mean spherical equivalent refraction was (-0.11±0.45) D; spherical equivalent refraction was within ±0.50 D in 49 eyes (89.1%) and within ±1.00 D in 53 eyes (96.4%). Myopic refraction and astigmatism more than 2 years postoperatively were not significantly different from 6 months postoperatively (P＞0.05). Mean keratoconus index was 1.08±0.01 preoperatively and 1.02±0.04 more than 2 years postoperatively (Z=-6.098, P＜0.01). There was no obvious haze or keratoeonus progression during the follow-up period. Conclusion Patient's age, myopic refraction, corneal thickness and stability of refraction and keratograph are the key points to determine whether suspected cases of keratoconus can undergo LASEK or Epi-LASIK.LASEK and Epi-LASIK seem to be safe and effective procedures for reducing or eliminating myopia and astigmatism in suspected keratoconus with stable refraction and keratograph. More monitoring is needed to prove long-term safety.%目的 探讨准分子激光上皮瓣下角膜磨镶术(LASEK)及机械法准分子激光上皮瓣下角膜磨镶术(Epi-LASIK)矫治疑似圆锥角膜引起的近视及散光的长期安全性、有效性和稳定性.方法 回顾性病例系列研究.疑似圆锥角膜患者38例(55眼),年龄19～44岁,男7例,女31例.近视度-3.25～-7.75 D,平均(-5.54±2.18)D;散光度0～3 D,平均(0.80±0.75)D;中央角膜厚度479～605μm,平均(541.8±30.0)μm.角膜地形图均提示1期圆锥角膜,近视及散光度、角膜地形图形态稳定至少2年.55眼均成功接受了LASEK(38眼)或Epi-LASIK(17眼).术后6个月及2年以上(2～5年)随访,检查患者的视力、屈光度及角膜地形图.对手术前后的数据进行配对t检验(正态分布)或Wilcoxon Signed Ranks检验(非正态分布).结果 术后2年以上,48眼(87.3%)的裸眼视力≥1.0,有效指数为1.002;51眼(92.7%)的最佳矫正视力较术前不变或提高,仅4眼(7.3%)下降1行,安全指数为1.053;等效球镜度为(-0.11±0.45)D,在±0.50 D范围内为49眼(89.1%),在±1.00 D范围内为53眼(96.4%);近视度和散光度分别为(-0.01±0.45)D和(0.25±0.33)D.术后2年以上的近视及散光度与术后6个月比较,差异均无统计学意义(P＞0.05).术后2年以上的角膜地形图圆锥角膜指数KI值为1.02±0.04,较术前(1.08±0.01)降低,差异有统计学意义(Z=-6.098,P＜0.01).随访期间未见明显haze及圆锥角膜进展.结论 疑似圆锥角膜患者的年龄、近视屈光度、角膜厚度及屈光度和角膜地形图的稳定性是其能否接受LASEK或Epi-LASIK治疗的关键.LASEK和Epi-LASIK对于矫治屈光及角膜地形图形态稳定的疑似圆锥角膜的近视及散光,可能是一种安全、有效的方法,但更长期的安全性有待于进一步的观察.
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