PRK+MMC与LASEK治疗高度近视效果比较

Curative effect comparison between PRK with the prophylactic use of mitomycin-C and LASEK for high myopia.

目的比较PRK术中预防性使用丝裂霉素C(MMC)治疗高度近视和LASEK治疗高度近视的疗效。方法将高度近视(-6.0^-10.0D)随机分为PRK+MMC组40例(80眼)和LASEK组38例(76眼)。另以早年PRK手术屈光状态与之相似的40例(80眼)作为对照。PRK+MMC组在PRK术中使用0.02%MMC,LASEK组采用常规LASEK,评价术后角膜上皮下雾状浑浊(haze),屈光回退、视力及角膜内皮细胞改变等情况。结果PRK+MMC组未出现2级或2级以上haze,无术后矫正视力下降者,术后欠矫小于-0.5D者70眼;LASEK组有6眼出现2级及2级以上haze,有6眼出现术后矫正视力下降,术后欠矫小于-0.5D者56眼。两组的差异有显著性。使用MMC未见明显毒副作用。结论PRK术中预防性使用MMC,在术后减少haze、防止屈光回退、改善视力方面较LASEK为优。

Objective To compare the curative effect of the PRK procedure with prophylactic use of mitomycin-C and LASEK procedure for high myopia. Methods 78 cases of myopia with a spherical equivalent correction between -6.00 and - 10.00 diopters （D） were divided into 2 groups randomly： first group （PRK ＋ MMC group） and second group （LASEK group）. The first group contained 40 patients （80 eyes） were treated by PRK with a intraoperative use of mitomycin （0.2 mg/ mL）, which was applied topically with a soaked microsponge placed over the ablated area and maintained for 2 minutes. The second group contained 38 patients （76 eyes） were treated by laser- assisted subepithelial keratectomy （LASEK） procedure. Refraction, uncorrected visual acuity （UCVA）, best - corrected visual acuity （BCVA）, corneal endothelial cell counts, and slitlamp evidence of corneal opacity （haze） or other visible complications were evaluated. Results No toxic or side effects were encountered postoperatively. In first group, no eye had a haze rate higher than stage 1 during the first year follow-up;6 eyes （7.9%）in the second group had haze severe than stage 1 （P 〈 0.05）. At I Year,refractlve outcome was statistically significant,70 eyes （87.5%） in first group and 56 eyes（73.6 % ） in second group within - 0.50 D. Conclusion The prophylactic use of 0.02% mitomycin-C solution intraoperatively in PRK ean produce lower haze rates, better UCVA and BCVA results, and more accurate refractive outcomes.