目的: 观察不同制瓣方式准分子激光原位角膜磨镶术(LASIK)对患者术后视觉质量的影响。方法: 收集2017-06/12于我院行屈光手术患者332例664眼。根据手术方式不同分为机械板层刀制瓣准分子激光原位角膜磨镶术组(M-LASIK)患者104例208眼, 飞秒激光制瓣准分子激光原位角膜磨镶术(FS-LASIK)患者228例456眼。观察两组患者术前, 术后1、2 w, 1、3、6 M裸眼视力(Uncorrected visual acuity, UCVA)、泪液分泌试验(Shirmer I test, SIt) 、平均非侵犯性泪膜破裂时间(Average non-invasive break-up time, aNIBUT) 、泪河高度(Tear meniscus height, TMH) 、角膜瓣厚度和角膜知觉的变化情况, 并进行对比分析。结果: UCVA: 不同手术方式患者UCVA比较, 差异无统计学意义(P＞0.05)。SIt: 两组患者SIt组间比较, 差异有统计学意义(P＜0.05)。FS-LASIK组术后1 M恢复正常(P＞0.05), 而M-LASIK组在术后3 M时恢复至术前。aNIBUT: 不同手术方式患者aNIBUT比较差异有统计学意义(P＜0.05)。FS-LASIK组在术后2 w时恢复至术前(P＞0.05), 而M-LASIK组在术后1 M时逐渐恢复(P＞0.05)。TMH: FS-LASIK组术后TMH恢复较M-LASIK组更快(P＜0.05)。角膜瓣厚度: 两组实际角膜瓣中央厚度为与预计角膜瓣厚度差值平均值比较差异有统计学意义(P＜0.05)。角膜知觉: 不同手术方式及不同观察时间角膜知觉比较, 差异均有统计学意义(均P＜0.05)。M-LASIK组角膜知觉恢复较FS-LASIK组慢。结论: 飞秒激光制瓣较板层刀制瓣术后可预测性好、恢复快、视觉质量高。

Objective: To observe the effect of laser in situ keratomileusis(LASIK)on the visual quality of patients after different flap creation methods. Methods : A total of 332 patients(664 eyes)accepted the LASIK surgery in our hospital from June to December 2017. According to the different surgical methods, 104 patients(208 eyes)with microkeratome-assisted LASIK(M-LASIK)surgery, and 228 patients(456 eyes)with femtosecond laser LASIK(FS-LASIK)surgery . The uncorrected visual acuity(UCVA), schirmer I test(SIt), average non-invasive break-up time(aNIBUT), tear meniscus height(TMH), flap thickness, and central corneal sensation were compared and analyzed in two groups before and 1, 2 w, 1, 3 and 6 M after operation. Results: UCVA: There was not statistically significant between patients with different surgical methods(P＞0.05). Sit: There was a statistically significant difference between the two groups(P＜0.05). The FS-LASIK group recovered to normal level at 1 month(P＞0.05)after surgery, while the M-LASIK group returned to preoperative 3 months after surgery. aNIBUT: There was a statistically significant difference in aNIBUT between different surgical procedures(P＜0.05). The FS-LASIK group returned to preoperative 2 weeks postoperatively(P＞0.05), while the M-LASIK group gradually recovered after 1 month(P＞0.05). TMH: The recovery of TMH after FS-LASIK was faster than that of M-LASIK(P＜0.05). Flap thickness: The difference average between the actual thickness of the corneal flap and the predicted corneal flap thickness in the two groups was statistically significant(P＜0.05). Central corneal sensation: There was statistically significant difference in central corneal sensation between different surgical procedures and different observation times(all P＜0.05). Central corneal sensation recovery was slower in the M-LASIK group than in the FS-LASIK group. Conclusion: FS-LASIK has better predictability compared to M-LASIK, faster recovery, and higher visual quality.