眼前节OCT辅助PTK治疗角膜浅层病变的临床分析  

Analysis on Clinical Efficacy of PTK Assisted with Anterior Segment OCT in Treatment of Superficial Corneal Diseases

作　　者：王晶[1] 赵峰[1] 王林农[1] 刘蓉[1] 

机构地区：[1]南京医科大学附属南京医院眼科,南京市210000

出　　处：《中国激光医学杂志》2017年第5期240-245,共6页Chinese Journal of Laser Medicine & Surgery

基　　金：南京市医学科技发展项目(YKK15091);南京市科技发展项目(201605028)

摘　　要：目的依据前节光学相干断层扫描技术(optical cohrence tomography,OCT)扫描判断病变的范围和深度,设计治疗性准分子激光角膜切削手术(excimer laser phototherapeutic keratectomy,PTK)参数治疗角膜浅层病变,分析和评价其疗效。方法回顾性分析2013年3月至2016年3月,角膜浅层病变31只眼的临床资料。术前行眼前节OCT检查,辅助判断病变的形态和深度,指导PTK术中切削深度、直径设定。术后随访6个月以上,对手术前后视力变化、角膜形态学评估、并发症、术后原发病的复发等进行观察。结果所有患者术后角膜浅层病灶有效切削,疾病发作受到控制;术后最佳矫正视力(best corrected visual acuity,BCVA)较术前明显提高(P<0.05);角膜表面变异指数(index of surface variance,ISV)、角膜表面不规则指数(surface regularity index,SRI)等形态学指标有显著下降(P<0.05),角膜散光更趋规则。术后随访期内未出现原发灶复发或严重角膜上皮下浑浊(haze)情况;2例术后远视漂移。结论眼前节OCT可分析角膜浅层病变的分布形态,判断病灶的深度,指导PTK参数设定,确保手术效果与安全性;有效的瘢痕切除使角膜形态更趋规则,BCVA提高。通过有限的病例研究、应用,眼前节OCT辅助PTK手术对于治疗角膜浅层病变具有良好的可控性、安全性和有效性,值得临床推广。Objective To determine the extent and depth of lesion according to the resuh of anterior-segment OCT scan, design the parameters of the excimer laser phototherapeutic keratectomy （PTK） for superficial corneal diseases, and make analysis and evaluation on its efficacy.Methods A retrospective case analysis and study was conducted. Totally 31 cases of patients diagnosed with superficial corneal disea- ses from Mar. 2013 to Mar. 2016 were selected. The anterior segments were examined With OCT to determine the shapes and depths of the lesions and the cutting depths and diameter settings for the PTK. All the patients were followed up for more than 6 months, and in- eluding the visual changes before and after the operation, corneal morphology evaluations, complications, and recurrences of postopera- tive primary diseases. Results The postoperative superficial corneal lesions of all the patients were effectively cut off, and the morbidity was under control. The best corrected visual acuity （BCVA） significantly improved after the operation （P 〈 0. 05 ）. The morphological indexes for index of surface variance （ISV） and Surface regularity index （SRI） decreased significantly （ P 〈 0. 05 ） , and the irregular astigmatism tend to be regular. Neither primary recurrence nor severe haze occurred during the follow-up period while postoperative hyperopia drift being found in 2 cases. Conclusions Anterior segment OCT can be used to analyze distribution patterns of corneal superficial lesions, determine depths of the lesions, guide settings of PTK parameters, and ensure the safety and efficacy of the operations. The effective scar excision will make corneal shapes more regular and increase BCVA. It can be concluded from the limited case study that anterior segment OCT assisted with PTK operation is highly controllable and safe and effective for the treatment of superficial corneal diseases and is hence worthy of clinical promotion.

关 键 词：前节OCT 治疗性准分子激光角膜切削 角膜形态学 角膜浅层病变 

分 类 号：R779.63[医药卫生—眼科]