准分子激光角膜切削术治疗高度、超高度近视眼术后角膜上皮下混浊的远期观察

A long-term observation of haze after excimer laser photorefractive keratectomy for high and superhigh myopia

目的:探讨准分子激光角膜切削术(PRK)治疗高度、超高度近视眼术后角膜上皮下雾状混浊(Haze)的发生情况及影响因素。方法:应用日本NIDEKEC-5000型准分子激光仪治疗高度、超高度近视眼143例(245眼),I组:-6.25～-10.00D,167眼;Ⅱ组-10.25～-24.00D,78眼。观察术后不同时期Haze的发生情况,随访7a以上。结果:术后3mo,0.5,1,4,7a,Haze的发生率,I组分别为74.8%,44.3%,24.5%,11.9%,7.8%;Ⅱ组为80.7%,52.1%,33.3%,24.3%,19.2%。7a时I组屈光度-0.57±1.84D,Ⅱ组-5.02±4.26D。有3级Haze7眼,I组2眼,为RK术后者;Ⅱ组5眼,4眼为年龄>40岁者。≥3级Haze者多出现在Ⅱ组,3～6mo达到高峰,持续时间达1a以上。结论:Haze为高度、超高度近视眼PRK术后的主要并发症。预矫屈光度越高,切削越深,则混浊程度越重;部分患者Haze逐渐减轻,角膜组织创伤修复时间长,部分重度Haze日后可能成为永久性瘢痕。

AIM: To evaluate haze of the patients in relation with risk factors after excimer laser photorefractive keratectomy for high and superhigh myopia.· METHODS: A total of 245 eyes of 143 patients with high and superhigh myopia were treated with NIDEK EC-5000 excimer laser. Group I included 167 eyes of -6.25- -10.00D; Group II included 78 eyes of -10.25- -24.00D. Haze was observed during the follow-up over 7a.· RESULTS: At 3,6mo, 1, 4, 7a after surgery, percentages of haze were 74.8%, 44.3%, 24.5%, 11.9% and 7.8% in the first group and 80.7%, 52.1%, 33.3%, 24.3% and 19.2% in Group I respectively. Refraction was -0.57±1.84D and -5.02±4.26D 7a after surgery in the two groups respectively. There were 7 eyes of haze of third class, 2 eyes after RK in Group I and 4 eyes of two patients over 40 years old in the second. Severe haze almost occurred at 3-6mo Group II and lasted over a year.· CONCLUSION: Haze is the main complication after PRK for high and superhigh myopia. The higher the correction of myopiais, the severe the occurrence of hazeis. Corneal wound healing are longer for some patients and cornea macula may last forever.