PTK-PRK-CXL和PTK-CXL治疗LASIK术后角膜膨隆的疗效  

Analysis of PTK-PRK-CXL and PTK-CXL for corneal ectasia after LASIK

作　　者：朱伟 赵秋良 ZHU Wei;ZHAO Qiuliang(Department of Ophthalmology,Jinan Central Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250013,Shandong Province,China;Department of Otolaryngology,Jinan Central Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250013,Shandong Province,China)

机构地区：[1]济南市中心医院眼科,山东大学齐鲁医学院,山东省济南市250013 [2]济南市中心医院耳鼻咽喉头颈外科,山东大学齐鲁医学院,山东省济南市250013

出　　处：《眼科新进展》2020年第10期972-976,共5页Recent Advances in Ophthalmology

摘　　要：目的评价准分子激光治疗性角膜切削术(phototherapeutic keratectomy,PTK)联合角膜交联(corneal cross-linking,CXL)术(PTK-CXL)和准分子激光治疗性角膜切削术、准分子激光屈光性角膜切削术(photorefractive keratectomy,PRK)联合CXL术(PTK-PRK-CXL)治疗准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)术后角膜膨隆的临床效果。方法选取LASIK术后角膜膨隆的患者28例(40眼),根据手术方式不同分为PTK-CXL组和PTK-PRK-CXL组。分别在治疗前及治疗后6个月、12个月测量患者的视敏度、屈光度、最大角膜曲率(maximum keratometry,K max)、最薄点角膜厚度(thinnest corneal thickness,TCT)、角膜内皮细胞计数(endothelial cell count,ECC)。将术后不同时间点的观察结果与术前做自身对照,并比较两组不同观察指标的变化量差异。结果两组均能有效降低患者的角膜曲率和屈光度,提高患者的视敏度,对角膜内皮细胞无影响。PTK-CXL组和PTK-PRK-CXL组裸眼视力术后6个月分别为(0.59±0.35)logMAR、(0.22±0.10)logMAR;术后12个月分别为(0.56±0.32)logMAR、(0.17±0.11)logMAR。两组K max术前分别为(55.51±8.08)D、(52.59±6.30)D,术后6个月降低为(54.07±8.07)D、(46.55±5.04)D;术后12个月为(53.96±8.01)D、(46.12±4.94)D。除PTK-CXL组柱镜度数在术后6个月、12个月与术前相比,差异均无统计学意义(均为P>0.05)外,两组其他观察指标在术后不同时间点与术前相比,差异均有统计学意义(均为P<0.05)。两组ECC均在术后12个月恢复至术前水平,与术前差异均无统计学意义(均为P>0.05)。两组术后不同时间点各观察指标相较于术前的变化量,除BCVA外,其他指标变化量差异均有统计学意义(均为P<0.05)。结论PTK-CXL和PTK-PRK-CXL均能安全有效控制角膜膨隆的进展,PTK-PRK-CXL较PTK-CXL能更好地改善患者的裸眼视力,角膜曲率的降低更显著。Objective To evaluate the clinical effect of phototherapeutic keratectomy combined with corneal cross-linking(PTK-CXL)and phototherapeutic keratectomy,photorefractive keratectomy combined with CXL(PTK-PRK-CXL)on corneal ectasia after laser in situ keratomileusis(LASIK).Methods A total of 28 patients(40 eyes)with corneal ectasia after LASIK were divided into PTK-CXL group and PTK-PRK-CXL group according to different surgery methods.Visual acuity,diopter,maximum keratometry(K max),thinnest corneal thickness(TCT),corneal endothelial cell count(ECC)were measured before treatment and 6 months,12 months after treatment.The results at different time points after surgery were compared with the results at baseline,and the changes of different observation indicators in the two groups were compared to see whether there was statistical significance.Results Both of the two treatments could effectively reduce the corneal curvature and diopter,and improve visual acuity,and had no effect on corneal endothelial cells.The uncorrected visual acuity in the PTK-CXL group and the PTK-PRK-CXL group were(0.59±0.35)logMAR and(0.22±0.10)logMAR at 6 months postoperatively.Twelve months after surgery,the results were(0.56±0.32)logMAR and(0.17±0.11)logMAR,respectively.In the PTK-CXL group and the PTK-PRK-CXL group,K max were(55.51±8.08)D and(52.59±6.30)D before the operation,and decreased to(54.07±8.07)D,(46.55±5.04)D 6 months after treatment and(53.96±8.01)D,(46.12±4.94)D 12 months after the operation.Except for 6 months and 12 months after surgery in the PTK-CXL group,there were no statistically significant differences in the cylinder refractive power(all P>0.05).There were statistically significant differences in other observation indexes between the two groups at different time points after and before surgery(P<0.05).Both ECCs of the two groups recovered to the preoperative level 12 months after surgery,with no significant difference compared with preoperative data(all P>0.05).The changes of each observation index at different

关 键 词：角膜交联 角膜膨隆 准分子激光原位角膜磨镶术 准分子激光治疗性角膜切削术 准分子激光屈光性角膜切削术 

分 类 号：R772.2[医药卫生—眼科]