Clinical Efficacy Investigation Of Flap-free Epi-LASIK And Epi-LASIK For High Myopia

Objective To compare the cilinical and the situation of tear film of epipolis laser in-situ keratomileusis (Epi-LASIK) and Flap-free epipolis laser in-situ keratomileusis( Flap-free Epi-LASIK) treatment of high myopia.To discuss the postoperative corneal stimulate symptoms,the healing of corneal epithelium,the recover of early visual acuity,haze formation and tear film about epithelial clear or left. To provide a reference for the diopter surgeon made more reasonable choice for the operation .Method Thirty high myopia patients(60 eyes)accept the Epi-LASIK in our hospital.The right eyes were reserved epithelial flap and the left eyes were reserved removed epithelial flap during the operatio.All patients were followed up at one year. To observation postoperative corneal stimulate symptoms, The healing characteristics of corneal epithelium,naked visual acuity after operation at one day,three days,five days.Observations the situations of haze were recorded and compared between the two groups on postoperation one week,one month,three months,six months,thirteen months.Patients were instructed to rate their naked visualacuity,diopter,mucus fern test ,tear film break-up time,tear secretion and conjunctival goblet cells on preoperation and postoperative month 1,3,6 and 12Result 1. There was no statistical significance on corneal irritation on the first day(t=-1.306, p>0.05) and the fifth day(t=-0.372, p>0.05) , but there existed statistical significance on the third day(t=-15.817, p<0.01) after operation between the two groups. The corneal irritation in group Flap-free Epi-LASIK is lighter than group Epi-LASIK. 2.There was no statistical difference in uncorrected visual acuity on the first day(t=0.387, p>0.05)and the fifth day(t=0.841, p>0.05), but there existed statistical significance on the third day(t=18.205, p<0.05) after operation between the two groups. The uncorrected visual acuity in group Flap-free Epi-LASIK is better than group Epi-LASIK.3. The average time of epithelial healing were(2.57±0.57)days in group Flap-free Epi-LASIK and (4.60±0.50)days in group Epi-LASIK.There existed statistical significance on time of epithelial healing between Flap-free Epi-LASIK and Epi-LASIK(t=-15.503, p<0. 01).4. There was no statistical difference in uncorrected visual acuity(p>0.05)and diopter (p>0.05) between the two groups after operation on one month,three months,six months,thirteen months.5. There was no statistical significance in haze formation(p>0.05) between the two groups after operation on one week,one month,three months,six months,thirteen months.6. There was no statistical significance in tear film break-up time,tear secretion and mucus fern test (p>0.05) between the two groups after operation on one month,three months,six months,thirteen months. There existed statistical significance in tear film break-up time,tear secretion and mucus fern test (p<0.05) after operation between the two groups on one month,three months compare to preoperation. There was no statistical significance in tear film break-up time,tear secretion and mucus fern test (p>0.05) between the two groups after operation on six months,thirteen months compare to preoperation. There was no statistical significance in conjunctival goblet cells(p>0.05) between the two groups after operation on one month,three months,six months,thirteen months. There existed statistical significance in conjunctival goblet cells (p<0.05) after operation between the two groups on one month,three months,six months compare to preoperation. There was no statistical significance in conjunctival goblet cells(p>0.05) between the two groups after operation on thirteen months compare to preoperation.Conclusions 1.Compare with Epi-LASIK, Flap-free Epi-LASIK can help to relieve the patient's corneal irritation symptom,accelerate the healing of the corneal and early uncorrected visual acuity recovery. 2. The diopter and haze have the same changing trendence in group Flap-free Epi-LASIK and in group Epi-LASIK . 3.The tear film break-up time shorter,tear secretion decreased,the stage of mucus fern test and conjunctival squamous metaplasia deterioted in the early stage in group Flap-free Epi-LASIK and in group Epi-LASIK. 4.Six months postoperatively the tear film break-up time shorter,tear secretion decreased,the stage of mucus fern test recovered to the preoperative level.Tirteen months postoperatively conjunctival squamous metaplasia recovered to the preoperative level.5. Either the removed or reserved epithelial Epi-LASIK has good effect for the treatment of high myopia, the postoperative clinical indicators is stabilized and consistent with the forecast line.