The Comparison Of Clinical Efficacy After Individualized TransPRK Versus Individualized Epi-LASIK

Part Ⅰ Evaluation of the corneal epithelium thickness of patients with myopia using High-resolution Spectralis OCTObjective:To quantify corneal epithelial thickness of patients with myopia by High-resolution Spectralis OCT.To set the reference range for laser removes the thickness of the corneal epithelium in aser surgery.Methods:This was a perspective study.Thirty patients(sixty eyes) par ti-cipated in this study. Epithelial thickness before myopic TransPRK we re measured by a High-resolution Spectralis OCT. Average central and t he nasal and temporal side epithelial thickness within 0.5、1.0、1.5、2.0、2.5、3.0、3.5、4.0mm before TransPRK.Results:1 Average central epithelial thickness was(67.02±5.14)μm,The range was(52~80μm).2 The bitamporal epithelial thickness of with in 0.5、1、1.5、2、2.5、3、3.5、4mm were(67.50±5.26)μm、(68.50±5.05)μm、(68.67±4.21)μm、(70.17±4.33)μm、(71.17±6.00)μm、(54.77±5.81)μm、(69.17±4.14)μm、(71.17±4.34)μm;The range wer e(50~74μm)、(54~76μm)、(48~73μm)、(60~74μm)、(57~76μm)、(42~68μm)、(59~76μm)、(59~79μm);The nasal epithe lial thickness of within 0.5、1.0、1.5、2.0、2.5、3.0、3.5、4mm were(56.00±4.19)μm、(66.67±4.20)μm、(69.17±5.07)μm、(55.54±6.33)μm、(69.67±4.07)μm 、(67.33±3.52)μm、(68.00±3.97)μm、(70.67±3.21)μm;The range were(47~68μm)、(51~69μm)、(60~76μm)、(42~71μm)、(61~79μm)、(54~79μm)、(63~80μm)、(61~81μm).3 The correlation between the central epithelial thicknesswith ag e、diopter were not statistically significant(r=0.051、-0.06,P>0.05).Conclusion :High-resolution Spectralis OCT precisely mapped corneal epithelial thickness with myopia,provided the reliable data in laser removed the corneal epithelium intraoperative TransPRK surgery.Part Ⅱ The Comparison of clinical efficacy after individualized TransPRK versus individualized Epi-LASIKObjective: Compare the clinical efficacy for patients with refractive errors after corneal refractive surgery:individualized:transepithelial phot-orefractive keratectomy(TransPRK) VS Epipolis laser in situ keratomil eusis(Epi-LASIK) to provide more theoretical basis for corneal surface surgery.Methods: Two different corneal refractive surgeries in a prospective study from the excimer myopic treatment center in our hospital(September2014 to 2015). 41patients(82eyes, group A) received Wavefront guided TransPRK and 37patients(73 eyes, group B)received Wavefront guided Epi-LASIK, cases separated with low to moderate myopia(spherical equivalent,SE)(-1.00<SE≤-6.00D)and high myopia(SE≥-6.00D).Patients were required to take preoperative and postoperative examinations,including UCVA, BCVA, refraction, IOP, Wave Scan aberrometer test, contrast sensitivity.Patients were evaluated at 1,3and 6 months postoperatively.Using statistical software(version 13.0)to take comparative study.Results:1 VisionLow to moderate myopia:at l、3、6month postoperatively,the UCVA in TransPRK were 0.87±0.15,0.96±0.17, 1.01±0.17;the UCVA in Epi-LASIK were 0.93±0.17、1.07±0.16 、1.13±0.25;the Epi-LASIK is significantly better than TransPRK,Until six month,there is no significant difference between two groups.high myopia: the UCVA in TransPRK were 0.86±0.20 、 1.00±0.11 、1.02±0.16;the UCVA in Epi-LASIK were 0.91±0.17、1.00±0.20、1.06±0.22;The Epi-LASIK is significantly better than TransPRK,the comparison of differences between two groups at each time has no statistical significance.2 Postoperative refractionLow to moderate myopia:until six month,the postoperative refraction within±0.75 D were 90%(24 eyes) in TransPRK,100%(23 eyes) in Epi-LASIK,there is no significant difference between two groups. the postoperative refraction within±0.50 D were 69%(18 eyes)in TransPRK,73%of patients(22eyes) in Epi-LASIK,there is no significant difference between two groups.High myopia:until six month,the postoperative refraction within ±0.50 D were 64 %(29 eyes) in TransPRK, 67%(29 eyes) in Epi-LASIK, the difference between two groups was statistically significant(P < 0.05).the postoperative refraction within±0.75 D were 80%( 36 eyes) in TransPRK,97%(42 eyes) in Epi-LASIK,there is no significant difference between two groups.3 Wavefront aberration3.1 Comparison within two groupsLow to moderate myopia:until six month,the RMSh、SA、Coma、Trefoil were increased compared with preoperative in TransPRK,the SA 、Trefoil were no statistically significant difference compared with preoperative.The RMSh、Coma compared with preoperative were were statistically significant(P<0.05);The RMSh、Coma、Trefoil were increased compared with preo-perative in Epi-LASIK, the Coma、Trefoi were no statistically significant,difference compared with preoperative. The RMSh compared with preoperative were was statistically significant(P<0.05),the SA was decreased compared with preoperative,and has no statistically significant difference.High myopia:until six month,the RMSh 、 SA 、 Coma 、 Trefoil were increased compared with preoperative in TransPRK, the difference were statistically significant(P < 0.05).In Epi-LASIK, the RMSh 、 SA was increased,the SA compared with preoperative was difference were statistically significant(P < 0.05).The Coma 、 Trefoil were decreased compared with preoperative,and was no statistically significant difference.3.2 Compared TransPRK with Epi-LASIKUntil six month,the RMSh, Coma, Trefoil in TransPRK were better than Epi-LASIK both in low to moderate and high myopia,and the difference was statistically significant(P < 0.05),the SA in TransPRK was better than Epi-LASIK in low to moderate myopia,there was no statistically significant difference in two groups. The SA in Epi-LASIK was better than TransPRK in high myopia, and there was no statistically significant difference in two groups.4 Contrast sensitivityTransPRK:until six month,the CS and GS were improved after operation in low to moderate myopia,CS of 1.5c/d and GS of 1.5c/d were improved,the difference was statistically significant(P < 0.05).the CS of 1.5c/d and GS1.5c/d were decreased after operation in high myopia, the difference was statistically significant(P < 0.05), The CS of 18c/d was improved after operation,the difference was statistically significant(P<0.05).Epi-LASIK:until six month, the GS and CS after operation in low to moderate and high myopia were no statistically significant difference compared with preoperation.Compared TransPRK with Epi-LASIKuntil six month,the GS and CS in TransPRK were better than Epi-LASIK both in low to moderate and high myopia.in low to moderatethe, CS of 6c/d、18c/d in TransPRK were better than Epi-LASIK,the difference was statistically significant(P<0.05).the CS of 18c/d and GS of 12c/d、18c/d in high myopia of two groups were statistically significant(P<0.05).Conclusion:1 wavefront aberration guided Epi-LASIK is better than wavefront aberration guided TransPRK in diopter, the incidence of Haze, high-order aberration, the wavefront aberration guided TransPRK is better than wavefront aberration guided Epi-LASIK in contrast sensitivity.2 Wavefront-guided TransPRK and wavefront-guided Epi-LASIK both have Well safety, predictability, stability.