| Objective: Contrast observation of new surface cutting operation--transepithelial photorefractive keratectomy and laser-assisted subepithelial keratomileusis clinical curative effect for the treatment of myopia and myopic astigmatism.Methods:A total of 50 patients(100 eyes)were collected between October 2016 and October 2017 and the refractive status stabilized in our hospital,age 20-35,the difference between the binocular spherical equivalent is less than 0.5D,and the difference value of the astigmatism degree is less than 0.75 D.The use of random numbers to determine the operation of the eyes.One eye made Trans PRK with 50 eyes and the other made LASEK with 50 eyes.The thinnest point of the remaining corneal stroma is greater than 320μm.The stromal layer cutting was performed using the Amaris excimer laser 750 s.The elimination of cutting according to ORK-CAM software aberration free model.After surgery,it was performed in 3d,1wk,1mo,3mo,6mo,and 1y with uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),obviously optometry,intraocular pressure,and slit lamp examination.Confocal microscopy was performed at 1mo,3mo,6mo and 1y.Postoperative 1-3d,scoring method was used to score the pain of eyes.6mo and 1y,visual quality questionnaires were evaluated.After surgery 1y investigated the patient’s satisfaction and asked if the operation method would be performed again.Conclusion: After the operation,one patient of one eye showed a self-falling bandagecontact lense with LASEK,and the follow-up rate of 1y was 84%,and the final studied group of the patients with 42 eyes in the Trans PRK group,and the LASEK group has 41 eyes.Baseline data of the two groups before treatment included age,BCVA,SE,Central Corneal Thickness(CCT),and intraocular pressure for statistical comparison.The data of the Trans PRK group are(26.32±4.60)year,1.15±0.20,(-4.05±1.31)D,(509.89±15.89)μm,(14.31±5.12)mm Hg,and the LASEK group are(26.64±4.50)year,1.17±0.19,(-4.36±1.29)D,(507.72±14.53)μm,(15.11±4.92)mm Hg.There is no statistically significant difference between the two groups of baseline data(p>0.05).Postoperative 1-3d reexamination recorded the patient’s pain perception(subjective)to evaluate the postoperative symptoms of the two surgical procedures.The pain scores of the Trans PRK group were 4.5,2.9 and 0.9,and the LASEK group was 4.1,3.7 and 2.6.In the 1d after surgery,most patients were aware that Trans PRK was slightly more painful than that of LASEK,but the pain degree of the Trans PRK group was significantly lower than that of the LASEK group at 2-3d.Especially in the 3d,the pain degree of the two groups decreased significantly,and the two groups showed no symptoms in the 5d after surgery.Trans PRK group to remove the lenses of the time was(3.89±0.85)d,corneal contact lenses in postoperative 3-5d were get off,LASEK group removed the lenses of time(5.36±1.20)d,corneal contact lenses in postoperative 3-6d were get off,taking off glasses time were compared between the two groups have statistical significance(p < 0.05).The UCVA of the Trans PRK group were respectively 0.64±0.18、0.82±0.12 in 3d and 1wk after surgery,and the UCVA of LASEK group were 0.49±0.21、0.58±0.18,and the difference between the two groups was statistically significant(p < 0.05).The UCVA of the Trans PRK group were respectively 1.02±0.13、1.04±0.16、1.07±0.13、1.12±0.15,in 1mo,3mo,6mo and 1y.The UCVA of LASEK group were 0.95±0.39 、 1.01±0.10 、 1.03±0.28 、 1.08±0.28,respectively,and the differences between the two groups were not statistically significant(p > 0.05).After surgery,the postoperative SE of 1mo,3mo,6mo and 1y Trans PRK group were respectively(0.68±0.21)D、(0.58±0.16)D、(0.61±0.19)D、(0.56±0.17)D.Postoperative SE of LASEK group were respectively(0.62±0.29)D、(0.54±0.20)D、(0.64±0.13)D、(0.52±0.27)D,two groups of postoperative diopter SE at the same time in different groups has no obvious difference(p > 0.05),no statistical significance.After surgery,the proportion of postoperative BCVA of 1wk,1mo,3mo,6mo and 1y,Trans PRK group were 60.8%,92.0%,97.6%,100%,and 100%.The proportion of LASEK group were 25.3%,90.1%,95.1%,100%,100%,and the proportion of recovery of Trans PRK group was significantly higher than that of LASEK group at 1wk after surgery,and the difference was statistically significant(p < 0.05).There was no statistically significant difference between the two groups in 1mo and 3mo after surgery(p > 0.05),and all patients in the two groups reached or exceeded the preoperative BCVA after the operation of 6mo.The Haze scores of 1mo,3mo and 6mo Trans PRK group were significantly lower than that in LASEK group after surgery,and the difference was statistically significant(p < 0.05).The Haze scores of all patients were 0 in 1 year after operation,and the difference was not statistically significant(p > 0.05).In postoperative 1 mon,3 mont,6 mon and 1 y with confocal microscopy examine,the results show two groups of patients were compared with different time points,corneal epithelium in the process of repairing high Trans PRK group reaction mass less than LASEK group,and group Trans PRK regenerative nerve fibers arranged in the LASEK group more neatly,in earlier time,different time points within the same set of comparison,Trans PRK group in various aspects repair speed will be faster than LASEK group.Conclusion:Trans PRK and LASEK surgery treatment for myopia and myopic astigmatism after refractive effect has no obvious difference,but the visual acuity of early postoperative Trans PRK faster than LASEK group,postoperative symptoms were milder,shorter to pick off contact lense,a lower incidence of Haze,cytology displayed on the inflammatory response is lighter.The long-term visual quality of the Trans PRK group and the LASEK group were all high,no significant difference,but the postoperative satisfaction of the Trans PRK group was higher. |
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