目的 探讨前弹力层下切削(SBK)与薄瓣准分子激光原位角膜磨镶术(LASIK)治疗近视及散光的安全性、预测性和有效性. 方法 收集接受SBK手术46例(91眼)为SBK组,球镜(-5.16 ± 1.37)D(-1.5~ -9 D),柱镜(-0.72 ± 0.45)D(0~ -2.5 D);接受薄瓣LASIK手术46例(92眼)为薄瓣LASIK组,球镜(-5.60 ± 1.59)D (-1.5~ -10 D),柱镜(-1.38 ± 0.68)D(0~ -4.5 D).采用OU P-ONE角膜板层刀和M2110刀头,比较2组角膜瓣厚度、术后裸眼视力、屈光度及并发症. 结果 2组患者左眼角膜瓣厚度均明显小于右眼;薄瓣组患者的左、右眼和双眼角膜瓣厚度均明显大于SBK组(P<0.01),且变异较大.SBK组、薄瓣组术后3月内裸眼视力均明显优于术前裸眼视力,2组术后不同时期祼眼视力达到或超过术前最佳矫正视力的比例均无显著差异.SBK组、薄瓣组术后干眼症状发生率分别为21.7% 及23.9%. 结论 SBK及薄瓣LASIK矫正近视及散光安全有效,Q值引导下依据患者角膜形态、厚度及散光方向个性化选择术式可以提高手术的预测性.%Objective To evaluate the safety,predictability and efficacy of sub-bowman keratom-ileusis(SBK)and thin-flap laser in situ keratomileusis(LASIK)in the treatment of myopia and astigma-tism. Methods 46 patients(91 eyes)underwent sub-bowman keratomileusis(SBK group),with the concave-sphere(-5.16 ± 1.37)D(-1.5 ~ -9 D)and cylinder(-0.72 ± 0.45)D(0 ~ -2.5 D);46 patients(92 eyes)underwent thin-flap LASIK(thin-flap group),with the concave-sphere(-5.60 ± 1.59) D(-1.5~ -10 D)and cylinder(-1.38 ± 0.68)D(0 ~ -4.5 D)simultaneously. Allegretto Wave EX-500,M2and OUP-ONE microkeratome were used. The corneal flap thickness,postoperative visual acuity,diopter and complications were compared between two groups. Results The corneal flap thick-ness of the left eye was significantly smaller than that in the right eye in both groups. The thickness of left,right eye and double corneal flap in the thin- flap group was significantly larger than that in SBK group(P<0.01),and the variation was greater. The post-operative visual acuity were better than the baseline in both groups within 3 months postoperation. The naked visual acuity,the ratio of uncorrected visual acuity reaching or exceeding the preoperative best corrected visual acuity had no significant differ-ence between the two groups at all follow-up visits,respectively. The incidence rates of dry eye symp-toms were 21.7% in the SBK group and 23.9% in the thin-flap group,respectively. Conclusions SBK and thin slice LASIK are safe and effective for correction of myopia and astigmatism. Under the guidance of Q value,individualized surgery based on the corneal morphology,thickness and direction of astigmatism can improve the predictability of surgery.
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