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    LASIK与LASEK对全眼高阶像差影响的Meta分析

    The Influence of Laser in-Situ Keratomileusis Versus Laser Epithelial Keratomileusis on Ocular Higher Order Aberrations: A Meta-Analysis

      摘要
    • 摘要: 目的 系统评价准分子激光原位角膜磨镶术（LASIK）与准分子激光上皮下磨镶术（LASEK）对近视患者全眼高阶像差的影响。 方法 计算机检索中国知网、万方数据库、维普中文科技期刊数据库、中国生物医学文献数据库、PubMed、Cochrane 图书馆、EMBASE等数据库中有关LASIK与LASEK对全眼高阶像差影响的临床对照研究。由2名研究员独立依据纳入及排除标准进行文献筛选、数据提取和质量评价,质量评价采用MINORS条目完成。运用RevMan 5.3软件进行Meta分析。 结果 共纳入10个非随机临床对照试验,总计患者593例,其中LASIK组286例,LASEK组307例。Meta分析结果显示: ①LASIK与LASEK对总高阶像差、彗差、水平彗差、三叶草的影响在术后1个月、3个月、6个月差异无统计学意义,对术后1个月、3个月球差的影响差异无统计学意义,对术后3个月、6个月垂直彗差的影响差异无统计学意义,对术后3个月5阶像差的影响差异无统计学意义。②LASEK术后6个月对球差的影响大于LASIK标准均数差=0.17,95%可信区间（0.00,0.33）,P=0.04。③LASEK术后1个月对垂直彗差的影响小于LASIK标准均数差=-0.35,95%可信区间（-0.57,-0.13）,P=0.002。④LASEK对术后1个月5阶像差的影响大于LASIK标准均数差=0.43,95%可信区间（0.17,0.69）,P=0.001,对术后1个月、3个月6阶像差的影响大于LASIK1个月标准均数差=0.52,95%可信区间（0.26,0.78）,P<0.001;3个月标准均数差=0.52,95%可信区间（0.26,0.78）,P<0.000 1。 结论 从整体上看,术后6个月内LASIK和LASEK对全眼高阶像差无显著影响,但存在LASEK对高阶像差影响随时间延长增大的趋势,术后6个月时LASEK对球差的影响已大于LASIK。

       

      Abstract: Purpose To systematically evaluate the influence of higher order aberrations between laser in-situ keratomileusis （LASIK） and laser epithelial keratomileusis （LASEK）. Methods Searches were conducted in databases such as PubMed, Cochrane library, EMBASE, CBM, CNKI, Wanfang Data and VIP to collect relevant clinical controlled researches about the influence of LASIK versus LASEK on higher order aberrations. The literature screening, data extraction and literature quality assessment were conducted by two researchers independently according to the inclusion and exclusion criteria and the MINORS was used for literature quality assessment. Final meta-analysis was performed by RevMan 5.3 software. Results The meta-analysis included 10 non-randomized controlled trials （non-RCT） involving 593 patients in all, among which the LASIK group had 286 cases and the LASEK group had 307 cases. The influences of total higher order aberration, coma, horizontal coma, trefoilin postoperative 1 month, 3 months and 6 months and sphere aberrationin postoperative 1 month and 3 months and vertical comain postoperative3 months and 6 months and the fifth order aberrationin postoperative 3 months between LASIK and LASEK were not found statistical difference（P>0.05）. LASEK showed greater influence on sphere aberration than LASIK in postoperative 6 monthsSMD=0.17,95%CI（0.00,0.33）, P=0.04. LASEK had less influence than LASIK on the vertical coma in postoperative 1 monthSMD=-0.35,95%CI（-0.57,-0.13）,P=0.002. LASEK displayed greater influence than LASIK on the fifth order aberration in postoperative 1 monthSMD=0.43,95%CI（0.17,0.69）,P=0.001 and on the sixth order aberration in postoperative 1 month and 3 months1 month SMD=0.52,95%CI（0.26,0.78）,P<0.001; 3 months SMD=0.52, 95%CI（0.26,0.78）, P<0.000 1. Conclusions On the whole, the influence on higher order aberrations between LASIK and LASEK, within postoperative 6 months, has no significant difference. However, LASEK has an increasing influence on higher order aberrations with the follow-up time extended, and in postoperative 6 month,LASEK shows a greater influence on sphere aberration than LASIK.

       

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