LASIK vs LASEK vs PRK: advantages and indications.
LASIK vs LASEK vs PRK: advantages and indications.
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DOI：
10.1080/08820530390897738
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发表时间：
2003-03-01
影响因子：
1.7
通讯作者：
Wilson, Steven
中科院分区：
文献类型：
--
作者：
Ambrosio, Renato Jr;Wilson, Steven
准分子激光作为一种用于角膜基质重塑的仪器的出现是屈光手术的一大进步。激光能量可以在屈光性角膜切削术（PRK）过程中传递到基质表面上，或者通过板层手术传递到角膜基质上更深处，其中在激光原位角膜磨镶术（LASIK）过程中使用微型角膜刀创建瓣。LASIK是目前屈光手术中的主要手术。LASIK与LASIK相比的主要优点是与维持中央角膜上皮有关。这增加了术后早期的舒适度，允许快速视力恢复，并减少伤口愈合反应。伤口愈合减少与高度矫正的较少回归和较低的并发症发生率（如显著的基质混浊（混浊））相关。然而，角膜塑形术仍然是轻度至中度矫正的最佳选择，特别是对于与薄角膜、复发性糜烂或易受创伤（武术、军事等）相关的病例。最近，介绍了一种改良的角膜磨镶术，即激光上皮瓣下角膜磨镶术（LASEK）。在LASEK手术中，上皮瓣被创建并在消融后被替换。与传统的皮瓣相比，创建上皮瓣的益处（如果有的话）没有得到充分的认识。LASEK的支持者认为，与标准屈光不正矫正术相比，LASEK在术后早期的不适感更少，视力恢复更快，混浊更少。进一步的长期临床研究，沿着实验室研究，将是验证LASEK手术这些潜在优势的关键。
The advent of the excimer laser as an instrument for use in reshaping the corneal stroma was a great step forward in refractive surgery. Laser energy can be delivered on the stromal surface in the photorefractive keratectomy (PRK) procedure or deeper on the corneal stroma by the means of a lamellar surgery in which a flap is created with the microkeratome in the laser in situ keratomileusis (LASIK) procedure. LASIK is currently the dominant procedure in refractive surgery. The main advantage of LASIK over PRK is related to maintaining the central corneal epithelium. This increases comfort during the early post-operative period, allows for rapid visual recovery, and reduces the wound healing response. Reduced wound healing correlates with less regression for high corrections and a lower rate of complications such as significant stromal opacity (haze). PRK, however, remains as an excellent option for mild to moderate corrections, particularly for cases associated with thin corneas, recurrent erosions, or a predisposition for trauma (Martial arts, military, etc.). Recently, a modification of PRK, laser subepithelial keratomileusis (LASEK), was introduced. In the LASEK procedure, an epithelial flap is created and replaced after the ablation. The benefits, if any, of the creation of an epithelial flap compared to traditional PRK are not fully appreciated. Advocates of LASEK suggest that there is less discomfort in the early postoperative period, faster visual recovery, and less haze compared to standard PRK for correction of similar levels of refractive error. Additional long-term clinical studies, along with laboratory research, will be crucial to validate these potential advantages of LASEK procedure.