激光法和器械法去上皮屈光性角膜切削术对比疗效观察  

Comparative study of trans-photorefractive keratectomy and conventional photorefractive keratectomy

作　　者：卫承华[1] 戴巧云[1] 晋毓信 许玉娟[1] 陆维真[1] 王玺[1] 韦超兵[1] 赵海峰[1] 

机构地区：[1]安徽皖南医学院附属弋矶山医院眼科,241000

出　　处：《中国实用眼科杂志》2015年第7期720-723,共4页Chinese Journal of Practical Ophthalmology

基　　金：皖南医学院中青年基金（WK2012F17）

摘　　要：目的 比较分析Nidek EC-5000治疗性角膜切削术（phototherapeutic keratectomy,PTK）联合屈光性角膜切削术（photorefractive keratectomy,PRK）与经典PRK手术临床治疗效果.方法 前瞻性临床研究.对2012年7月至2013年6月在弋矶山医院眼科就诊的30例近视患者,应用随机数字法随机分成2组,15例30只眼采用两步法PTK-PRK手术（组1）,15例30只眼行经典PRK手术（组2）.术后评估患者痛疼程度、角膜上皮愈合时间、屈光度、角膜上皮雾状混浊（HAZE）反应程度和视力.结果 角膜上皮愈合时间组l为（2.37±0.61）d,组2为（2.90±0.66）d,差异有统计学意义（t =-3.23,P＜0.05）;疼痛程度评分组1为（3.30±1.09）分,组2为（3.56±0.97）分,差异无统计学意义（Z =-0.96,P=0.34）;上皮愈合后早期裸眼视力组1为（0.30±0.10） logMAR,组2为（0.22±0.12） logMAR,差异有统计学意义（t=2.55,P=0.013）;术后6个月组1的裸眼视力（0.003±0.018）logMAR,组2的裸眼视力（0.007±0.025） logMAR,差异无统计学意义（t=-0.58,P=0.56）;组1和组2术后HAZE反应差异无统计学意义（Z =-0.32,P=0.75）;术后6个月等效球镜度组1（＋0.33±0.21）D,组2（＋0.13±0.19）D,差异有统计学意义（t=3.91,P＜0.05）.结论 PTK-PRK与经典PRK术式相比有相同的安全性和有效性,术后能较快修复角膜上皮,屈光度有远视偏移。Objective To evaluate clinical results after transepithelial photorefractive keratectomy （PTK-PRK） performed with the NIDEK EC5000 excimer laser machine or conventional photorefractive keratectomy （PRK）.Methods In this prospective study,60 eyes from 30 patients with myopia underwent transepithelial PRK perform PTK followed by PRK （30 eyes,group one） or conventional PRK （30 eyes,group two）.The epithelium was removed with the excimer laser in group one.Epithelial healing was evaluated every 24 hours until complete reepithelialization.Postoperative pain was evaluated according to the five scales.All outcomes were reported for 6 months postoperatively.Results Mean reepithelialization took （2.37±0.61） days in group one and （2.90±0.66） days in group two （t =-3.23,P 〈0.05）,mean pain score was （3.30±1.09） in group one and （3.56±0.97） in group two （Z =-0.96,P〉0.05）.The comea reepithelialing uncorrected distant visual acuity was （0.30±0.10） logMAR in group one and （0.22±0.12） logMAR in group two （t =2.55,P =0.013）.Six months postoperation distant uncorrected visual acuity was 1.0 for 29 eyes,0.8 for 1 eye in group one and 1.0 for 28 eyes,0.8 for 2 eyes in group two （t =-0.58,P =0.56）.Six months postoperation of manifest refraction was （＋0.33±0.21） D in group one and （＋0.13±0.19） D in group two （t=3.91,P 〈0.05）.The HAZE scale scores were tested between 2 groups （Z =-0.32,P 〉0.05）.Conclusions Preliminary study show PTK-PRK is as safe and effective as conventional PRK.The PTK-PRK performs more rapid reepithelialization and has hyperopia optic result.

关 键 词：屈光角膜切削术 治疗性角膜切屑术 近视 

分 类 号：R778.11[医药卫生—眼科]