Background Compare with the lamellar laser refractive surgery,the laser slip on the surface operation is a better method in the correct of refractive error without the flap-related complications.However,whether to remain corneal epithelial flap and its influence for epithelial healing and visual restoration are still under investigation.Objective The aim of this study was to compare the short-term clinical efficacy of epipolis laser insitu keratomileusis (Epi-LASIK) and flap-free Epi-LASIK for correction of refractive error in high myopia.Methods The paired control design was adopted.Sixty eyes of consecutive 30 patients with high myopia were collected in this study.The written consent form was obtained from each patients prior to operation.Regular EpiLASIK was performed in the right eyes and the flap-free Epi-LASIK was carried out in the left eyes.Patients were followed-up for one month.The postoperative ocular irritation symptoms were scored,and the healing period of corneal epithelium and uncorrected visual acuity were examined at 1,3 and 5 days after operation.The naked visual acuity,diopter,best corrected visual acuity and the grading of haze were recorded and compared between the two groups at one month after operation.Results After surgery,the scores of corneal irritation were 3.13 ±0.43 and 3.30±0.47on the first day,showing insignificant differences between these two groups (t =- 1.54,P＞0.05 ).However,there existed statistically significant difference in the scores of corneal irritation on the third day after operation between the two groups (t =- 17.95,P＜0.01 ).The average time of corneal epithelial healing were (2.58 ±0.49 ) days in the flapfree Epi-LASIK group and ( 3.98 ±0.74) days in Epi-LASIK group with the significant difference between them (t=-11.36,P＜0.01 ).There was no statistical difference in uncorrected visual acuity in the first day (0.59±0.12 vs 0.58±0.11,t=0.39,P＞0.05),the fifth day (0.69±0.08 vs 0.67±0.09,t=0.84,P＞0.05) and 1 month (t =-1.90,P＞0.05 ).No significant difference was seen in the diopter between the two groups in 1 month after surgery (-1.03±0.45 vs -1.07 ±0.38,t =-0.31,P＞0.05 ).The eye numbers of corneal haze for 0 grade were 27 ( 90.00％ ) and over the 0.5 grade were 3 ( 10.00％ ) in flap-free Epi-LASIK group respectively,and those of corneal haze for 0 grade were 26(86.66％ ) and above the 0.5 grade were 4 (13.33％) in Epi-LASIK group respectively,showing a considerably difference between the two groups (x2 =0.0031,P＞0.05).Conclusions Both the flapfree or reserved epithelial Epi-LASIK allow the safe and effective correction of refractive error in high myopia,showing good predictability and stability in short term.Flap-free Epi-LASIK can relieve the corneal irritation symptom and accelerate the healing of corneal epithelium and recovery of visual acuity.%背景 准分子激光角膜表层屈光手术与准分子激光角膜板层切削术相比,前者无基质瓣的相关并发症,是目前矫正屈光不正较好的手术方式.角膜上皮瓣的保留与否及其对术后角膜上皮愈合时间、视力恢复等方面的影响受到关注.目的 比较去上皮瓣和留上皮瓣机械法准分子激光上皮瓣下角膜磨镶术( Epi-LASIK)治疗高度近视的疗效.方法 采用配对对照研究设计.收集高度近视患者30例60眼行EpiLASIK,术中患者右眼采用去上皮瓣Epi-LASIK,左眼采用留上皮瓣Epi-LASIK,术后随访期为1个月.对术后1、3、5d术眼的刺激症状进行评分,观察去上皮瓣组和留上皮瓣组角膜愈合时间及裸眼视力；术后1个月对两种术式的裸眼视力、屈光状态、最佳矫正视力及haze分级情况进行比较.结果 术后第1天去上皮瓣组与留上皮瓣组的角膜刺激症状评分分别为3.13±0.43和3.30±0.47,差异无统计学意义(t=-l.54,P＞0.05)；术后第3天分别为1.20±0.75和3.47±0.51,二者比较差异有统计学意义(t=-17.95,P＜0.01).术后第1天去上皮瓣组与留上皮瓣组裸眼视力分别为0.59±0.12和0.58±0.11,术后第5天分别为0.69±0.08和0.67±0.09,二者比较差异均无统计学意义(t=0.39、0.84,P＞0.05)；但术后第3天去上皮瓣组裸眼视力明显好于留上皮瓣组(0.66±0.10 vs 0.26±0.07),二者比较差异有统计学意义(t=18.21,P＜0.05)；术后1个月两组裸眼视力分别为0.89±0.23、0.95±0.22,二者比较差异无统计学意义(t=-l.90,P＞0.05)；2个组术后1个月平均等效球镜分别为(- 1.03±0.45)D和(- 1.07±0.38)D,二者比较差异无统计学意义(t=-0.31,P＞0.05).术后去上皮瓣组角膜上皮愈合时间平均为(2.58±0.49)d,留上皮瓣组为(3.98±0.74)d,二者比较差异有统计学意义(t=-11.36,P＜0.01).去上皮瓣组haze为0级和0.5级者分别为27眼(90.00％)和3眼(10.00％),留上皮瓣组分别为26眼(86.66％)和4眼(13.33％),二者比较差异无统计学意义(x2=0.003,P＞0.05).两组术眼均未出现l级以上haze.结论 留上皮瓣Epi-LASIK及去上皮瓣Epi-LASIK矫治高度近视短期疗效均好且安全,具有良好的可预测性.但去上皮瓣有利于减轻患者术后角膜刺激反应,加快上皮愈合和视力恢复.
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