The Impact Of Long-term Wearing Soft Contact Lens On The Epithelial Flap Producing And Postoperative Recovery In Lasek

Part I The impact of long-term wearing soft contact lens on the epithelial flap producing and postoperative recoveryObjective:To investigate the impact of long-term wearing soft contact lens on the epithelial flap making in LASEK and postoperative clinical recovery.Subjects and Methods:It was a foword-looking study.Patiends who were treate d with LASEK during janury2011and march2012were included.Total365p atiends(580eyes) were divided into4groups according to the time of they we aring soft contact lens:group1(G1):the time of wearing soft contact lens≥1yea r and<3years,49people (80eyes),the mean age is24.49±3.15, the mean re fractive spherical equivalent(MRSE) is (-5.99±1.99)D,the mean time of wearing soft contact lens is (1.60±0.52) years; group2(G2):the time of wearing soft c ontact lens>3years and<6years,40people (66eyes),the mean age is26.92±4.40, the MRSE is (-5.78±1.28)D,the mean time of wearing soft contact lens is (4.05±0.80) years; group3(G3):the time of wearing soft contact lens>6years,41people (67eyes),the mean age is32.46±4.28, the MRSE is (-6.28±1.65)D, the mean time of wearing soft contact lens is (10.25±2.91) years; group4(G4c ontrol group):never had worn soft contact lens,235people (367eyes),the me an age is25.26±5.93, MRSE is (-5.90±2.28)D. All the surgery is completed by the same doctor, ethanol infiltrating14seconds,0.2g/L MMC infiltrating30s econds after the laser cutting cornea,comparing the situation of the epithelial fl ap production in LASEK, take off the contact lens after1week.The total238patients (376eyes) finished the1month follow-up:group1(G1):35people (57eyes), the MRSE is (-6.57±2.01)D; group2(G2):24people (39eyes), the MRSE is (-5.85±1.74)D; group3(G3):31people (50eyes),the MRSE is (-6.45±1.69)D; group4(G4):148people (230eyes),the MRSE is (-6±2.05)D. The t otal107patients (157eyes) finished the3months follow-up:group1(G1):20people (29eyes), the MRSE is (-6.27±1.84)D; group2(G2):15people (19ey es), the MRSE is (-6.85±1.82)D; group3(G3):15people (23eyes), the MR SE is (-5.89±1.04)D; group4(G4):57people (86eyes), the MRSE is (-5.98±2 .35)D.Recorded the symptoms,uncorrected visual acuity(UCVA),the edema degr ee of the corneal epithelium;spherical equivalent(SE),Haze degree in the postop erative three months.Results:1.The epithelial flaps are divided into three types:type Ⅰ (the epitheli al flap is integrity and easy to produce), type Ⅱ (the epithelial flap is integrity but difficult to produce), type Ⅲ(the epithelial flap is not integrity and difficu It to produce).G1:12.5%,50%,37.5%;G2:9.09%,60.61%,30.3%;G3:4.48%,7.76%,47.76%;G4:22.62%,63.49%,13.89%.There are no difference between G1,G2and G3, but they are all different with G4.After long-term wearing soft contact lens,the epithelial flap is more difficult to produce and easier to break down when pe ople have LASEK.2.The symptoms postoperation are divited into four types:None,mild,moderate a nd severe.The first postoperative day:G1:33.33%,35.08%,31.59%,0%;G2:28.21%,46.15%,20.51%,5.13%;G3:38%,36%,20%,6%;G4:36.52,47.83%,15.22%,0.43%. Ther e are no difference between G1,G2and G3,but they are all different with G4. After long-term wearing soft contact lens.people have heavier postoperative sym toms.3. The edema degree of the central corneal epithelium are divited into four typ es:None,mild,moderate and severe.The first postoperative day:G1:38.6%,49.12%,10.53%,1.75%;G2:30.77%,51.28%,17.95%,0%;G3:38%,34%,20%,8%;G4:56.52%,29.57%,13.04%,0.87%.The first postoperative week:G1:36.84%,45.61%,17.54%,0%;G2:35.90%%,33.33%,30.77%,0%;G3:36%,34%,20%,10%;G4:61.74%,33.04%,4.78%,0.43%.Comparing these two sets of data:There are no difference between G1,G2and G3,but they are all different with G4on the first day and the first week postoperation. People who have worn soft contact lens for a long-term, the ed ema degree of the central corneal epithelium are heavier in the first postoperati ve week.4. The postoperative UCVA are divided into three types:≤0.5,0.6-0.8,≥1. The fi rst postoperative day:G1:8.77%,66.67%,24.56%;G2:20.51%,23.08%,51.28%;G3:18%,64%,18%;G4:10.87%,46.09%,43.04%. The first postoperative month:G1:1.75%,21.05%,77.19%;G2:0%,28.21%,71.79%;G3:2%,22%,76%;G4:6.09%,8.70%,85.22%. The third postoperative month:G1:0%,17.24%,82.76%;G2:0%,15.79%,84.21%;G3:8.70%,4.35%,86.96%;G4:3.49%,9.30%,87.21%. There are no difference between G1,G2and G3,but they are all different with G4on the first day and the first month postoperation. There are no difference between the four groups on the third postoperative month. In people who have worn soft contact lens for a lo ng-term, the visual acuity recover more slowly.5.The postoperative SE are divided into three types:≤±1D、>±1and≤±2D、>±2D. The first postoperative month:Gl:80.70%,15.79%,3.51%;G2:74.36%,25.64%,0%;G3:80%,18%,2%;G4:78.70%,16.09%,5.22%.The third postoperative month:G1:100%,0%,0%;G2:73.68%,26.32%,0%;G3:82.61%,17.39%,0%;G4:93.02%,0%,6.98%. There are no difference between the four groups on the first month and the th ird month. Long-term wearing soft contact lens caused no influence on postope rative SE in LASEK.6.There are no patient have heavier postoperative haze than level1,so there are three types:level0, level0.5, level1.The first postoperative month:G1:66.67%,31.58%,1.75%;G2:76.92%,20.51%,2.56%;G3:70%,22%,8%;G4:77.83%,19.57%,2.61%. The third postoperative month:G1:68.97%,31.03%,0%;G2:78.95%,21.05%,0%;G3:73.91%,21.74%,4.35%;G4:90.70%,9.30%,0%. There are no difference betw een the four groups on the first month the third month. Long-term wearing sof t contact lens caused no influence on postoperative haze in LASEK when used MMC in operation.Conclusions:Long-term wearing soft contact lens affect LASEK and postoperat ion:the epithelial flap is more difficult to produce and easier to break down, p eople have heavier postoperative symtoms, the edema degree of the central cor neal epithelium are heavier within first week postoperation, the visual acuity re cover more slowly. Long-term wearing soft contact lens caused no influence o n postoperative SE and postoperative haze after using MMC in operation in L ASEK.PART Ⅱ The best ethanol infiltration time when produce epithelial flap in LA SEK after long-term wearing soft contact lensObjective:To explore the best ethanol infiltration time when producing epithelia1flap in LASEK after long-term wearing soft contact lensSubjects and Methods:It was a foword-looking study.Long time soft contact lens wearers who came for LASEK are included.They are divided into two gro ups. A:12patients(24eyes) self-contrast, the mean time of wearing contact lens is6.5±4.08years,use ethanol infiltrate one eye for14S randomly(class14S),th e other eye16S(class16S),the MRSE are-6.22±1.77D(class14S),-6.32±1.70D(c lass16S),there no statisically significant difference.B:15patients(30eyes) self-c ontrast, the mean time of wearing contact lens is7.4±4.36years, use ethanol i nfiltrate one eye for16S randomly(class16S),the other eye18S(class18S),the MRSE are-6.28±1.44D(class16S),-6.01±1.43D(class16S), there no statisically significant difference.Results:The situation of producing epithelial flaps are divided into three types: Ⅰ,Ⅱ,Ⅲ.A:14S:0%,16.67%,83.88%;16S:0%;66.67%;33.33%.There are statistically significant difference between the two classes(%2=6.1714, Pr=0.013<0.05.B:16S:0%,46.67%,53.33%;18S:13.33%,73.34%,13.33%. There are statistically signific ant difference between the two classes(χ2=6.4889, Pr=0.039<0.05).In14S,16S、18S,it is easier to produce corneal epithelial flap when the ethanol infiltrati ng time extended.Conclusions:After along-term wearing soft contact lens,The epithelial flap is easier to produce and less to break when ethanol infiltrate18S compared to14S and16S. In order to raising the success rate of epithelial flap producing,the ethanol infiltration time should be extended appropriately after along-term weari ng soft contact lens.