中低度近视眼Trans-PRK术中使用丝裂霉素C对术后haze影响的研究  

Efficacy of mitomycin C 0.02% for prevention of haze after transepithelial photorefractive keratectomy for mild and moderate myopia

作　　者：靳琳 张铎龄 于春晶[1] 梁巍[1] 张蕊[1] 张巧思 刘小钰 张立军[1] Jin Lin;Zhang Duoling;Yu Chunjing;Liang Wei;Zhang Rui;Zhang Qiaosi;Liu Xiaoyu;Zhang Lijun(Department of Ophthalmology,the Third People′s Hospital of Dalian,Dalian 116033,China;The Second Affiliated Hospital of Dalian Medical University,Dalian 116023,China)

机构地区：[1]大连市第三人民医院眼科,大连116033 [2]大连医科大学附属第二医院,大连116023

出　　处：《中华眼科杂志》2022年第2期130-136,共7页Chinese Journal of Ophthalmology

基　　金：辽宁省自然科学基金(20180550976);辽宁省自然基金(2020-MS-339);大连市科技创新基金(2019J13SN105)。

摘　　要：目的探讨中低度近视眼行经上皮准分子激光角膜切削术(Trans-PRK)中使用0.02%丝裂霉素C(MMC)预防术后角膜上皮下雾状混浊(haze)的临床效果。方法回顾性队列研究。纳入行Trans-PRK的近视眼患者295例(588只眼),其中低度近视眼(近视度数<3.00 D)45例(90只眼),年龄(20.53±4.95)岁(18~41岁);男性37例,女性8例;32只眼术中使用MMC浸润角膜基质床。中度近视眼(近视度数≥3.00 D)患者250例(498只眼),年龄(23.66±6.12)岁(18~46岁);男性168例,女性82例;261只眼术中使用MMC。低度和中度近视眼患者术中MMC的作用时间分别为15和30 s。所有患者随访6个月,观察指标包括最佳矫正视力、等效球镜度数及haze情况。正态分布资料的比较用两独立样本t检验,非正态分布资料的比较采用Mann-WhitneyU检验,术后haze的发生情况比较采用χ^(2)检验。结果按照Fantes分级,将0.5~4级均纳入标准进行haze评估。术中使用MMC的低度近视眼患者术后haze发生率为6.25%(2/32),未使用MMC者为8.62%(5/58),且均为0.5级haze,差异无统计学意义(χ^(2)=0.00,P>0.999)。术中使用MMC的中度近视眼患者术后haze发生率为9.19%(24/261),均为3个月内发生,其中91.67%(22/24)haze为0.5级,8.33%(2/24)haze为1级,未使用MMC者术后haze发生率为29.53%(70/237),其中84.29%(59/70)haze为3个月内发生,60.00%(42/70)haze为0.5级,18.57%(13/70)haze为1级,5.71%(4/70)haze为2级,未发生2级以上haze;15.71%(11/70)haze在3个月之后发生且均为0.5级,差异有统计学意义(χ^(2)=12.36,P=0.002)。术后6个月,术中使用和未使用MMC的低度近视眼患者最佳矫正视力分别为5.0(5.0,5.1)和5.0(5.0,5.1)(Z=-0.34,P=0.733),等效球镜度数分别为(0.33±1.07)和(0.32±0.57)D(t=0.25,P=0.805),差异均无统计学意义;术中使用和未使用MMC的中度近视眼患者最佳矫正视力分别为5.0(5.0,5.1)和5.0(5.0,5.1)(Z=-2.05,P=0.040),等效球镜度数分别为(0.66±0.85)和(0.53±0.67)D(t=2.97,P=0.003),差异均有统计Objective To investigate the efficacy of mitomycin C(MMC)0.02%for prevention of haze after transepithelial photorefractive keratectomy(Trans-PRK)for mild and moderate myopia.Methods Retrospective cohort study.We reviewed medical records of 295 patients(588 eyes)who underwent Trans-PRK with or without use of MMC.There were 45 patients(90 eyes)in the mild myopia group(aged between 18 and 41 years;37 males and 8 females;myopia diopter<3.00 D)and 250 patients(498 eyes)in the moderate myopia group(aged between 18 and 46 years;168 males and 82 females;myopia diopter:3.00 to 6.00 D).The two groups were divided into subgroups with MMC 0.02%and without MMC,respectively.The time of intraoperative application of MMC,if there was,was 15 s and 30 s in the mild myopia group and the moderate myopia group,respectively.The mean follow-up time was 6 months.Postoperative best corrected visual acuity(BCVA),spherical equivalent(SE)and haze were analyzed and compared using an independent Student t-test or Mann-Whitney U test between subgroups.Haze variables were compared using chi-square statistics.Results Haze was quantified with Fantes from grade 0.5 to 4.In the mild myopia group,all haze grades were 0.5 within 3 months.The incidence of haze was 6.25%(2/32)in eyes treated with MMC and 8.62%(5/58)in eyes treated without MMC;there was no statistical significance(χ²=0.00,P>0.999).In the moderate myopia group,the incidence of haze was 9.19%(24/261)in eyes treated with MMC within 3 months;the grade was 0.5 in 91.67%(22/24)of eyes with haze and 1 in 8.33%(2/24).The incidence of haze was 29.53%(70/237)in eyes treated without MMC;the grade was 0.5 in 60.00%(42/70)of eyes with haze,1 in 18.57%(13/70),and 2 in 5.71%(4/70)within 3 months,and 0.5 in 15.71%(11/70)after 3 months(χ²=12.36,P=0.002).In the mild myopia group,BCVA was 5.0(5.0,5.1)versus 5.0(5.0,5.1)in the subgroups with MMC and without MMC(Z=-0.34,P=0.733).In the moderate myopia group,BCVA was 5.0(5.0,5.1)versus 5.0(5.0,5.1)in the subgroups with and without MMC(Z=-2.05,P=0.040).In

关 键 词：近视 角膜混浊 上皮 角膜 激光 准分子 屈光性角膜切削术 丝裂霉素 治疗结果 

分 类 号：R779.63[医药卫生—眼科]