目的:前瞻性研究游离上皮瓣Epi-LASIK手术的临床效果及其愈合机制。方法:近视患者27例54眼,随机将1眼做游离上皮瓣的Epi-LASIK作为实验组(A组)。另1眼为标准的Epi-LASIK作为对照组（B组）。观察角膜刺激症状、疼痛分级、角膜上皮愈合时间、裸眼视力、屈光度、眼压、haze分级等,随访6mo以上。结果:疼痛分级A组1~3（平均2.2）级,B组1~3（平均2.3）级。眼异物感持续时间：A组1~3（平均2.2）d；B组1~3（平均2.9）d。上皮愈合时间A组3~6（平均4.4）d；B组5~7（平均5.8）d。术后6mo裸眼视力（UCVA）较术前最佳矫正视力（BCVA）下降1行者两组各有1眼（4.0%）,其余52眼（96.0%）均达到或高于术前BCVA。无BCVA下降者。术后屈光度（等效球镜度数）A组 -0.50~+0.75（平均0.28±0.27）D；B组-0.25~+0.68（平均0.23±0.26）D。haze分级A组≤0.5级者19眼（70.4%）,1级者8眼（29.6%）；B组≤0.5级18眼（66.7%）,1级9眼（33.3%）。两组均无haze≥2级者。结论:游离上皮瓣的Epi-LASIK与普通Epi-LASIK都具有良好的安全性、预测性和屈光稳定性,但游离上皮瓣的Epi-LASIK明显缩短了术后刺激症状的持续时间,加快了视力恢复,舒适性更好。

AIM: To analyze the therapeutic effects and clinical characteristics of free-flap epipolis laser in situkeratomileusis (Epi-LASIK). METHODS: In this prospective case-series study, 27 eyes of 27 myopic and myopic astigmatism patients underwent Epi-LASIK with free-flap as group A and the other 27 eyes underwent standard Epi-LASIK as group B. Symptoms, slit-lamp examination, uncorrected visual acuity(UCVA), spherical equivalent refractive error, intraocular pressure, haze were observed in these patients in 6-month follow-up period. RESULTS: Pain grade: Group A 1 to 3, with an average of 2.2; Group B 1 to 3, with an average of 2.3. Eye sensation duration: 1 to 3 days in group A, an average of 2.2 days; Group B 1 to 3 days, an average of 2.9 days. Epithelial healing time: group A was 3 to 6 days, an average of 4.4 days; 5 to 7 days in Group B, with an average of 5.8 days. Compared with the preoperative best- corrected visual acuity (BCVA), after six months, 1 (4.0%) eye in each group was with UCVA lower than one line, and the remaining 52 (96.0%) were at or higher than the preoperative BCVA. No BCVA declined. Diopter (spherical degree) group A -0.5D- +0.75D equivalent, an average of 0.28±0.27D; group B -0.25D - +0.68D, with an average 0.23±0.26D. Haze grading less than or equal to 05 in 19 (70.4%) eyes in group A, grade 1 in eight (29.6%); group B was with less than or equal to grade 0.5 in 18(66.7%), grade 1 in nine (33.3%) . There were no haze grade higher than or equal to 2.CONCLUSION: Both the free-flap Epi-LASIK and the ordinary Epi-LASIK have safety, predictive and refractive stability, but the free-flap Epi-LASIK surgery significantly shortened the time of stimulating symptoms and improve the recovery of visual acuity.