改良准分子激光治疗性角膜切削术治疗角膜带状变性手术策略分析  

Surgical strategy analysis of modified excimer laser phototherapeutic keratectomy for band keratopathy

作　　者：赵可浩 陆文秀 王文萃 雷红 ZHAO Ke-hao, LU Wen-xiu, WANG Wen-cui, LEI Hong.(Beijing Xinli Eye Clinic, Beijing 100027, Chin)

机构地区：[1]北京新力眼科,100027

出　　处：《眼科》2018年第2期135-140,共6页Ophthalmology in China

摘　　要：目的探讨准分子激光治疗性角膜切削术(PTK)治疗角膜带状变性的手术策略。设计回顾性病例系列。研究对象 2012年12月至2015年6月在北京新力眼科就诊的角膜带状变性患者18例(23眼)。方法患者接受改良PTK、单纯角膜变性组织撕除术以及改良PTK联合变性组织撕除术三种手术方案治疗,分析其病因、手术策略的选择、术后上皮愈合情况、术后并发症及复发率等情况。随诊时间3~14个月,平均(7.13±3.47)个月。主要指标手术策略的选择、术后上皮愈合情况、变性组织清除程度、复发率。结果角膜带状变性继发于慢性葡萄炎12例(15眼),感染性眼内炎2例(2眼),急性视网膜坏死1例(1眼),眼外伤1例(1眼),青光眼1例(2眼),无明确因素但曾患淋巴结核者1例(2眼)。手术策略选择中,改良PTK治疗13眼,单纯角膜带状变性组织撕除术2眼,角膜带状变性撕除联合改良PTK 8眼。术后角膜上皮愈合时间4~21天,中位数5天。术后所有术眼角膜带状变性组织均完整清除,术前眼部疼痛者术后眼部刺激症状均消失,10眼视力改善。5眼(21.74%)发生1级及局部区域1级以上角膜上皮下雾状混浊,3眼(13.04%)复发。结论改良PTK是治疗角膜带状变性的一种创伤较小的方法,合理的手术策略选择是保证手术效果的关键。Objective To explore surgical strategies of excimer laser phototherapeutic keratectomy for treatment of band keratopathy. Design Retrospective case series. Participants Eighteen consecutive cases（ 23 eyes） with band keratopathy in Beijing Xinli Eye Clinic from December 2012 to June 2015.Methods All cases underwent modified PTK or combined abnormal tissue peeling surgeries for band keratopathy. The causes of disease,surgical strategies,epithelial healing,complications and recurrence rate were analyzed. The follow-up time was from 3 to 14 months,and the average was（ 7. 13 ± 3. 47） months.Main Outcome Measures Surgical strategies,epithelial healing,degeneration tissue removal and recurrence rate. Results The causes of band keratopathy included chronic uveitis in 12 cases（ 15 eyes）,infectious endophthalmitis in 2 cases（ 2 eyes）,acute retinal necrosis in 1 case（ 1 eye）,ocular trauma in 1 case（ 1 eye）,glaucoma in 1 case（ 2 eyes）,and unknown reason in 1 case（ 2 eyes）. The removal methods： 13 eyes received modified phototherapeutic keratectomy（ PTK）,2 eyes received mechanical abnormal tissue peeling only,and 8 eyes received combined mechanical abnormal tissue peeling and modified PTK. Epithelial healing time was from 4 to 21 days,and the median was 5 days. After operation band keratopathy tissue of all eyes was completely removed. Eye irritation symptom disappeared for patients who had eye pain before surgery. Visual acuity of 10 eyes improved. 5 eyes（ 21. 74%） had ≥ 1 degree haze. 3 eyes（ 13. 04%）experienced recurrence. Conclusions Modified excimer laser phototherapeutic keratectomy was minimal invasive effective approach for the treatment of band keratopathy. The reasonable surgical strategy was crucial to ensure the operation effects.

关 键 词：准分子激光治疗性角膜切削术 角膜带状变性 葡萄膜炎 眼表疾病 

分 类 号：R779.65[医药卫生—眼科]