准分子激光角膜切削术治疗圆锥角膜行角膜表层镜片术后的屈光不正  

A preliminary report of epikeratophakia combined with two-stage photorefractive keratectomy in the treatment of keratoconus

作　　者：谢立信[1] 高华[1] 

机构地区：[1]山东省眼科研究所 青岛眼科医院, 266071

出　　处：《中华眼科杂志》2007年第3期228-232,共5页Chinese Journal of Ophthalmology

基　　金：山东省青岛市科技局院士基金资助（02KGYSH-01）

摘　　要：目的探讨角膜表层镜片术（EP）联合Ⅱ期准分子激光角膜切削术（PRK）治疗圆锥角膜完成期的临床疗效。方法（1）病例入选标准：①EP入选标准：圆锥角膜完成期患者，角膜中央区无瘢痕，最佳矫正视力（BCVA）≤0．3，角膜曲率≤60．0D；②Ⅱ期行PRK入选标准：角膜拆线后3个月内散光变化〈0．5D，年龄〉18岁，无其他眼部疾病。（2）手术治疗：对进入手术入选标准的患者常规Ⅰ期行EP，Ⅱ期行PRK。（3）术后随访：观察术后植片情况，记录视力、散光变化及并发症发生情况。结果8例（10只眼）患者接受了Ⅰ期EP联合Ⅱ期PRK，术后平均随访时间为40．6（30～94）个月。（1）视力：EP术后12～18个月（角膜全拆线行PRK术前），10只眼BCVA均〉0．3，其中0．3～0．5者1只眼，≥0．5者9只眼；行PRK术后〉12个月，10只眼BCVA均≥0．5，其中5只眼BCVA达到1．0。（2）角膜散光：EP术前平均角膜散光为（7．3±1．8）D，EP术后12～18个月平均角膜散光为（3．8±1．6）D，PRK术后24个月以上，平均角膜散光为（1．6±0．9）D。（3）植片情况：EP术后所有植片透明，无免疫排斥反应发生。PRK术后1只眼发生0．5级的角膜上皮下雾状混浊，未见圆锥角膜复发。（4）术后并发症与处理：1例（1只眼）患者EP术后当天继发青光眼，前房消失，急诊行前房重建后缓解；1例（1只眼）患者EP术后植床出现较大皱褶，1例（1只眼）患者EP术后3个月内缝线松动，行植片重缝后缓解。结论Ⅰ期EP联合Ⅱ期PRK可能是治疗圆锥角膜完成期的有效方法，行PRK术后视力长期稳定。Objective To study the clinical results of epikeratophakia （EP） combied two-stage photorefractive keratectomy （PRK） in the treatment of keratoconus. Methods （ 1 ） Admission criteria for EP included： Best corrected visual acuity （BCVA） was no more than 0. 3, keratoconus patients without scar in the central cornea could not tolerance the rigid gas permeable contact lens and corneal curvature was no more than 60. 0 D. Criteria for the PRK included cornea astigmatism stable within 0. 5 D for at least 3 months after EP, patient＇s age was 18 years or older, and absence of ocular disease, such as glaucoma or dry eye. （2） Surgical treatment： EP surgery was performed and then followed by PRK at the second stage. （ 3 ） Postoperative follow up： Postoperative follow up included the examination of vision, corneal curvature, complications and immune rejection. Results Eight patients （10 eyes） received PRIg： after EP. BCVA was 0. 3 - 0. 5 in 1 eye and 〉≥0. 5 in 9 eyes in 12-18 months after EP. BCVA was≥0. 5 in all eyes 12 months after PRIg： and 5 eyes obtained a BCVA of 1.0. The mean corneal astigmatism was （7.3 ± 1.8） D before EP surgery, （3. 8 ± 1.6） D 12-18 months after EP, and （ 1.6 ±0. 9） D after PRIC All grafts remained clear and no immune rejection was found after EP. 0. 5 degree haze was observed in 1 eye, and no recurrence of keratoconus was found after PRK during the follow up period. Complications ： secondary glaucoma （ with disappearance of the anterior chamber ） occurred in one eye 6 hours after EP surgery, and symptoms disappeared after reconstruction of the anterior chamber. The sutures were loosened in one cornea during the first 3 months after EP, it was corrected by resuture. Conclusion EP combined with two-stage PRK is an effective method in treatment of keratoconus.

关 键 词：圆锥角膜 表面角膜镜片术 角膜切除术 光折射 准分子激光 散光 视觉 

分 类 号：R686[医药卫生—骨科学]