| Purpose: To explore the clinical efficacy and feasibility of femtosecond laser assisted LASIK in correcting myopia and astigmatism by comparing the postoperative clinical efficacy and visual quality in the treatment of myopic and astigmatic patients whose corneal is relatively thick(the thickness of the corneal is usually greater than or equal to 500um)between femtosecond laser assisted excimer laser in situ keratinectomy(FS-LASIK,the following is called FORK)and individualized excimer laser corneal cutting(ORK),and by comparing the postoperative clinical efficacy and visual quality between femtosecond laser assisted excimer laser in situ keratinectomy(FORK)which treat the myopic and astigmatic patients whose corneal is relatively thick(the thickness of the corneal is usually greater than or equal to 500um)and individualized excimer laser subepithelial keratoplasty(LASEK)which treat the myopic and astigmatic patients whose corneal is relatively thin(the thickness of the corneal is usually less than 500um),and provide a more objective basis for the selection of surgical methods.Method: The design of prospective non-randomized controlled study was adopted.A total of 306 patients(612 eyes)were included in the excimer laser corneal refractive surgery in our hospital from January to June 2016,there are FORK 144cases(288 eyes),ORK 102 cases(204 eyes)and LASEK 60 cases(120 eyes).FORK group adopts the American Intralasa FS laser system to make corneal flap,ORK group adopts the French Moria M2 laser system to make corneal flap,and LASEK group used a volume fraction of 20% alcohol to soak for 15 s and then removed the flap from the cornea with a corneal epithelium.After the completion of flaps,the three groups were guided by the wavefront aberration which was used to scan the corneal matrix with the German ESIRIS eighth flying-spot scanning laser.Research One:Comparing the preoperative age,degree of equivalent spherical mirrors,naked eye vision,best corrected visual acuity,darkroom pupil diameter,intraocular pressure,corneal thickness,Sim K difference,corneal surface high-order aberration,coma aberration,spherical aberration between the FORK group and the ORK group.Postoperative follow-up visit for half a year,comparing the difference of the postoperative naked eye vision,degree of equivalent spherical mirrors,naked eye vision,Sim K difference,corneal surface high-order aberration,coma aberration,spherical aberration after 1 day,after 10 days,after 1 month,after 3 months,after 6 months and the complications.Research Two: Comparing the preoperative age,degree of equivalent spherical mirrors,naked eye vision,best corrected visual acuity,darkroom pupil diameter,intraocular pressure,corneal thickness,Sim K difference,corneal surface high-order aberration,coma aberration,spherical aberration between the FORK group and the LASEK group.Postoperative follow-up visit for half a year,comparing the difference of the postoperative naked eye vision,degree of equivalent spherical mirrors,naked eye vision,Sim K difference,corneal surface high-order aberration,coma aberration,spherical aberration after 10 days,after 1 month,after 3 months,after 6 months and the complications.SPSS 18.0 software was applied to analyze the data,P<0.05 indicates that the difference is statistically significant.ResultsResearch One:1.There were no statistically significant differences in the preoperative age,degree of equivalent spherical mirrors,column mirror,naked eye vision,best corrected visual acuity,darkroom pupil diameter,intraocular pressure,corneal thickness,Sim K difference,corneal surface high-order aberration,coma,spherical aberration between the FORK group and the ORK group.2.Postoperative naked eye vision: There was no statistically significant difference in the naked eye vision at each time point between the FORK group and the ORK group.There was a significant difference in the naked eye vision at each time point between the postoperative time and preoperative time for both groups.Both group of naked eye vision were improved significantly,but the effectiveness of FORK group was higher than that of ORK group.3.Postoperative degree of equivalent spherical mirrors: there was no statistically significant difference in degree of equivalent spherical mirrors at each time point between the FORK group and the ORK group,but the stability of FORK group is better than that of ORK group.There was a significant difference in the degree of equivalent spherical mirrors at each time point between the postoperative time and preoperative time for both groups.4.Postoperative Sim K difference: there was no statistically significant difference in Sim K difference at each time point between the FORK group and the ORK group.There was a significant difference in the Sim K difference at 1 day,10 days,1 month between the postoperative time and preoperative time for FORK group,there was no significant difference in the Sim K difference at 3 months,6 months between the postoperative time and preoperative time for FORK group.There was a significant difference in the Sim K difference at 1 day between the postoperative time and preoperative time for ORK group,there was no significant difference in the Sim K difference at 10 days,1 month,3 months,6 months between the postoperative time and preoperative time for ORK group.5.Postoperative wavefront aberration: there was statistically significant difference in corneal surface high-order aberration,coma,spherical aberration between the FORK group and the ORK group,the FORK group was lower than the ORK group.There was a significant difference in the coma at 1 day,10 days,1 month between the postoperative time and preoperative time for both groups,there was no significant difference in the coma at 3 months,6 months between the postoperative time and preoperative time for both groups.There were significant differences in the corneal surface high-order aberration and spherical aberration at each time point between the postoperative time and preoperative time for both groups.Research Two:1.There were no statistically significant differences in the preoperative age,degree of equivalent spherical mirrors,column mirror,naked eye vision,best corrected visual acuity,darkroom pupil diameter,Sim K difference,corneal surface high-order aberration,coma,spherical aberration between the FORK group and the LASEK group,and there were significant differences in the intraocular pressure and corneal thickness between the two groups.2.Postoperative naked eye vision: There was statistically significant difference in the postoperative naked eye vision at 10 days and 1 month between the FORK group and the LASEK group.There was no statistically significant difference in the postoperative naked eye vision at 3 months and 6 months between the two groups.There was a significant difference in the naked eye vision at each time point between the postoperative time and preoperative time for both groups.Both group of naked eye vision were improved significantly,but the effectiveness of FORK group was higher than that of LASEK group.3.Postoperative degree of equivalent spherical mirrors: there was no statistically significant difference in degree of equivalent spherical mirrors at each time point between the FORK group and the LASEK group,but the stability of FORK group is better than that of LASEK group.There was a significant difference in the degree of equivalent spherical mirrors at each time point between the postoperative time and preoperative time for both groups.4.Postoperative Sim K difference: there was no statistically significant difference in Sim K difference at each time point between the FORK group and the LASEK group.There was no significant difference in the Sim K difference at each time point between the postoperative time and preoperative time for the LASEK group.5.Postoperative wavefront aberration: there were no statistically significant differences at each time point in coma and spherical aberration between the FORK group and the LASEK group,but there was statistically significant difference at each time point in corneal surface high-order aberration between the two groups,the FORK group was lower than the LASEK group.There was no significant difference in the coma at each time point between the postoperative time and preoperative time.There were significant differences in the corneal surface high-order aberration and spherical aberration at each time point between the postoperative time and preoperative time for the LASEK group.Complications:Operative negative pressure loss: FORK 0 case,ORK 1 case;corneal flap bleeding: FORK 0 case,ORK 2 cases,LASEK 0 case;subconjunctival hemorrhage:FORK 2 cases,ORK 1 case,LASEK 0 case;Postoperative interlayer foreign matter:FORK 2 cases,ORK 3 cases,LASEK 3 cases;intraocular pain: FORK 0 case,ORK 0 case,LASEK 16 cases;dry eye: FORK 1 case,ORK 3 cases,LASEK 6 cases;Haze: FORK 1 cases,ORK 2 cases,LASEK 5 cases;dazzle light at night: FORK 1 case,ORK 2 cases,LASEK3 cases;high intraocular pressure: FORK 0 case,ORK 0 case,LASEK 2 cases.There was no free flap,broken flap,incomplete flap and other operative complications.No flap transposition was found,no flap healed badly,no infection and so on in the follow-up period.ConclusionResearch One:1.Both FORK and ORK groups had good naked eye vision,but the FORK group is more effective.2.The degree of equivalent spherical mirrors of FORK and ORK group can be improved effectively,but the stability and the predictability of the FORK group are better.3.There was no statistically significant difference in Sim K difference between the FORK group and the ORK group.4.The front aberrations of both the FORK group and the ORK group are higher than before,but the FORK group increase smaller relatively,so reduce the patient's dry eye,bad night glare,halo and other occurrence probability,and improve the visual quality of patients after surgery effectively.Reserach Two:1.Both FORK and LASEK groups had good naked eye vision,but the FORK group is more effective,and the FORK group's visual recovery was faster.2.The degree of equivalent spherical mirrors of FORK and LASEK group can be improved effectively,but the stability and the predictability of the FORK group are better.3.There was no statistically significant difference in Sim K difference between the FORK group and the LASEK group.4.The front aberrations of both the FORK group and the LASEK group are higher than before,but the FORK group increase smaller relatively,so reduce the patient's dry eye,bad night glare,halo and other occurrence probability,and improve the visual quality of patients after surgery effectively.In terms of complications,the FORK group,the ORK group and the LASEK group had the risk of operative and postoperative complications,but the incidence of complications of FORK was lower than the ORK group and the LASEK group,so that the surgical safety was improved effectively.On the whole,the clinical effect of the femtosecond laser assisted excimer laser in situ keratinectomy is good.It is a kind of safe,efficacy,predictability and good visual quality to treat myopia and astigmatism. |
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