PRK术中角膜上皮的去除  

Evaluation of three different methods of corneal epithelium removal in PRK

作　　者：张明昌[1] 麦才铿[1] 聂绍松[1] 

机构地区：[1]同济医科大学附属协和医院眼科

出　　处：《眼科》1998年第4期202-204,共3页Ophthalmology in China

摘　　要：目的：了解ＰＲＫ术中激光（Ｌ组）、激光加机械刮除（Ｌ＋Ｓ组）及机械刮除（Ｓ组）三种去除角膜上皮方法在操作时间、术后上皮修复、视力、角膜上皮下混浊（Ｈａｚｅ）、切削偏中心及角膜中央岛发生等方面的异同。方法：对上述三种方法去除角膜上皮的ＰＲＫ术后追踪超过半年的４９６例（９６４只眼）近视眼进行统计学分析。结果：Ｓ组刮除上皮的时间是其它组的２倍，其上皮修复也相对较慢，偏中心及过矫发生的比例及程度也较重；Ｌ组屈光欠矫及中央岛的发生较多；Ｌ＋Ｓ组视力最好。三组Ｈａｚｅ发生差异无显著性。结论：激光去除上皮快捷、中心位易确定、术后恢复较快，但有时因角膜表面水分积聚不均、患眼眼球转动、角膜厚度的个体差异等可能导致角膜上皮去除不彻底或小岛残余；机械刮除角膜上皮彻底、可减少过多激光脉冲叠加对角膜的热损伤、玻璃体的扰动及视网膜的震荡，但因耗时长，角膜干燥变薄，术后易产生过矫，同时术中如角膜变混，中心位也较难确定；激光加机械刮除兼有二者的优点，并可克服其缺点，应视为首选。但对超高度近视，尤其患眼有严重近视眼视网膜病变时。To evaluate three different methods of corneal epithelium removal in PRK,the results of PRK with three methods,Laser Transepithelium removal(Group 1),Laser+Scraping epithelium removal(Group 2),Scraping(Gorup 3),were retrospectively analyzed.496 cases (964 eyes) were followed up more than six months.There were more eyes of undercorrection and central island in Group 1.The time of scraping epithelium was longer and epithelium recovered more slowly in Group 3.Also the incidence of decentration and overcorrection in Group 3 was relatively higher.The patients of Group 2 had the best visual acui ty There was no significant difference in corneal haze among three groups.Our result showed that the best way of removing corneal epithelium was Laser+Scraping,and singal scraping corneal epithelium was much safer for patients with very high degree of myopia,especially with severe myopic retinopathy.

关 键 词：角膜上皮 激光手术 近视 

分 类 号：R778.110.5[医药卫生—眼科] R779.63[医药卫生—临床医学]