SPT-TPRK联合0.02%MMC治疗中度近视术后角膜神经纤维再生的随机对照研究  

Corneal nerve fiber regeneration after SPT-TPRK combined with 0.02%MMC for moderate myopia:a random control study

作　　者：闫春晓 靳琳 方石峰 韦玉山[3] 王丽晶 崔林[1] 赵丹[1] 牟亚男[1] 张立军[1,2] YAN Chunxiao;JIN Lin;FANG Shifeng;WEI Yushan;WANG Lijing;CUI Lin;ZHAO Dan;MU Yanan;ZHANG Lijun(Department of Ophthalmology,The Third People's Hospital of Dalian/Dalian Eye Hospital,Dalian 116033,Liaoning,China;Dalian Medical University,Dalian 116044,Liaoning,China;The First Affiliated Hospital of Dalian Medical University,Dalian 116011,Liaoning,China)

机构地区：[1]大连市第三人民医院/大连市眼科医院眼科,辽宁大连116033 [2]大连医科大学,辽宁大连116044 [3]大连医科大学附属第一医院,辽宁大连116011

出　　处：《山东大学耳鼻喉眼学报》2021年第6期25-32,共8页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：辽宁省自然科学基金指导计划(20180550976);辽宁省自然基金资助计划(2020-MS-339);大连市科技创新基金项目(2019J13SN105);大连市医学科学研究计划项目(1911032)。

摘　　要：目的观察智能脉冲技术辅助的经上皮准分子激光角膜切削术(SPT-TPRK)联合使用0.02%丝裂霉素C(MMC),术后角膜消融区神经纤维的再生情况。方法随机对照研究。入组患者25例(50只眼),等效球镜度数(SE)-3.00 D~-6.00 D,随机一眼使用0.02%MMC,为SPT-TPRK+MMC组(25只眼),另一眼不使用0.02%MMC,为SPT-TPRK组(25只眼),利用HRTⅢ共聚焦显微镜观察术后14 d、1个月、3个月角膜上皮下激光消融区边缘、中央、周边的神经纤维密度(CNFD)、神经纤维长度(CNFL)较术前的变化。结果术前角膜中央区CNFD(52.40±12.61)根/mm^(2),CNFL(73.00±12.61)mm/mm^(2)。角膜消融区中央神经纤维变化如下:术后14 d SPT-TPRK+MMC组CNFD(13.41±4.99)根/mm^(2),CNFL(17.44±7.30)mm/mm^(2)。SPT-TPRK组CNFD(5.73±3.27)根/mm^(2),CNFL(5.03±3.52)mm/mm^(2),两组间差异具有统计学意义(P<0.0001)。术后1个月SPT-TPRK+MMC组CNFD(20.57±5.43)根/mm^(2),CNFL(27.57±8.97)mm/mm^(2)。SPT-TPRK组CNFD(8.46±5.07)根/mm^(2),CNFL(9.46±4.81)mm/mm^(2),两组间差异具有统计学意义(P<0.0001)。术后3个月SPT-TPRK+MMC组CNFD(23.47±7.28)根/mm^(2),CNFL(33.87±9.49)mm/mm^(2)。SPT-TPRK组CNFD(13.75±5.78)根/mm^(2),CNFL(17.00±5.90)mm/mm^(2),两组间差异具有统计学意义(P<0.0001)。结论通过HRTⅢ共聚焦显微镜观察到SPT-TPRK联合0.02%MMC在术后早期(14 d、1个月、3个月)可以促进神经纤维再生,术后3个月时角膜消融区中央神经纤维状态仍然未恢复至术前状态。Objective To observe the regeneration of nerve fibers in the corneal ablation area after transepithelial photorefractive keratectomy with smart pulse technology(SPT-TPRK)combination of 0.02%mitomycin C(MMC).Methods This random control study included 25 patients(50 eyes)with spherical equivalent(SE)from-3.00D to-6.00D.After SPT-TPRK,MMC was applied for 20 s in a concentration of 0.02%on one random eye(SPT-TPRK+MMC group)and no MMC on the other eye(SPT-TPRK group)for the contrl.All patients were observed by HRTⅢconfocal microscopy in order to compare CNFD and CNFL in peripheral and centeral corneal ablation area at preoperatively and 14 days,1month,and 3months postoperatively.Results Preoperatively,the CNFD in the central corneal zone was(52.40±12.61)nerves/mm^(2),and the CNFL was(73.00±12.61)mm/mm^(2).The neural changes in the central cornea ablation area are described below.Fourteen days after surgery,the CNFD and CNFL in the SPT-TPRK+MMC and SPT-TPRK groups were(13.41±4.99)nerves/mm^(2) and(5.73±3.27)nerves/mm^(2),and(17.44±7.30)mm/mm^(2) and(5.03±3.52)mm/mm^(2),respectively.The difference between the two groups was statistically significant(P<0.0001).One month postoperatively,the CNFD and CNFL in the SPT-TPRK+MMC and SPT-TPRK groups were(20.57±5.43)nerves/mm^(2) and(8.46±5.07)nerves/mm^(2),and(27.57±8.97)mm/mm^(2) and(9.46±4.81)mm/mm^(2),respectively,with statistically significant differences between the two groups(P<0.0001).Three months postoperatively,the CNFD in the SPT-TPRK+MMC and SPT-TPRK groups were(23.47±7.28)nerves/mm^(2) and(13.75±5.78)nerves/mm^(2),and(33.87±9.49)mm/mm^(2) and(17.00±5.90)mm/mm^(2),respectively,with statistically significant differences between the two groups(P<0.0001).Conclusion SPT-TPRK combined with 0.02%MMC may promote nerve fiber regeneration in the early postoperative period(14 days,1 month,3 months).The nerve fibers have not returned to the preoperative situation at three months postoperatively.

关 键 词：智能脉冲技术辅助的经上皮准分子激光角膜切削术 丝裂霉素C 上皮下雾状混浊 共聚焦显微镜 神经纤维 

分 类 号：R779.63[医药卫生—眼科]