经上皮个性化表面切削术与器械法去上皮准分子激光角膜表面切削术在患者术后早期恢复情况的比较

Custom transepithelial ablation versus photorefractive keratectomy with mechanical epithelialremoval and comparision of postoperative pain, reepithelialization rate of recovery and early visual outcomes

目的比较经上皮个性化表面切削术与器械法去上皮准分子激光角膜表面切削术（PRK）的术后疼痛感、上皮愈合时间和早期视力恢复情况。方法非随机前瞻性临床对照研究。连续收集2009年3月18日至2009年10月28期间接受iVIS-Suite 100 Hz激光机切削的经上皮个性化表面切削手术患者15例（30眼，组1），接受Amoils刷器械法去上皮并由Wavelight Allegretto 400 Hz激光机切削的器械法去上皮PRK手术患者15例（30眼，组2）。术后每24小时评估患者上皮愈合情况及主观疼痛感直至上皮愈合。术后1、2、3、4周测量患者术后屈光度，裸眼视力以及最佳眼镜矫正视力。采用独立样本Wilcoxon秩和检验来比较两组患者主观疼痛程度的差别，其他数据比较使用独立样本t检验。结果组1和组2患者的平均上皮愈合时间分别为（2．6±0．5）d和（2．9±0．6）d，差异具有统计学意义（t=2．039，P=0．046）。术后第2天，组1患者疼痛感评分小于组2（Z=-3．535，P〈0．01），且组1患者在术后3d内的最强烈疼痛感评分和平均疼痛感评分均低于组2，差异均有统计学意义（Z=-2．261，P=0．024；Z=-2．982，P=0．003）。术后3周，组1患者平均裸眼视力为-0．068±0．088（10gMAR），组2为-0．024±0．069（10gMAR），差异有统计学意义（t=2．236，P=-0．030）。两组患者术后1至4周的最佳矫正视力和平均等效球镜度经分析差异均无统计学意义。结论单一步骤的经上皮个性化表面切削术与器械法去上皮PRK相比，上皮愈合时间更短，裸眼视力恢复更快，术后疼痛感更轻。两种手术的术后最佳眼镜矫正视力和屈光值无明显差异。

Objective To compare patients＇ subjective postoperative pain, rate of reepithelialization as well as visual and refractive recovery between custom transepithelial ablation and photorefraetive keratectomy （PRK） with mechanical epithelial removal. Methods This prospective non-randomized consecutive ease control study was comprised of 30 eyes （group 1） treated with custom transepithelial ablation with a iVIS-Suite 100 Hz laser, with deepithelialization integrated within the excimer laser ablation and 30 eyes （group 2） treated with PRK with a Wavelight Allegretto 400 Hz laser with Amoils brush deepithelialization between March 18, 2009 to October 28, 2009. Postoperative pain and reepithelialization were ＇measured every 24 hours postoperatively until full recovery. Patients＇ refraction, uncorrected visual acuity （UCVA） and best spectacle-corrected visual acuity （BSCVA） were measured weekly during the first month postoperatively. An independent samples Wilcoxon rank sum test was used to assess the difference of patients＇ subjective postoperative pain between the 2 groups, and an independent samples t test was used to assess the difference ofthe other parameters. Results The mean reepithelialization time was （2.63＋0.49）days and （2.93＋0.64） days for group 1 and group 2, respectively （t=2.039, P=0.046）. Pain score in group 1 was lower than group 2 （Z=-3.535, P〈0.01） 2 days postoperative. Both maximum and average subjective pain scores were lower in group 1 （Z=-2.261, P=0.024; Z=-2.982, P=0.003） 3 days postoperative. The mean UCVA on the third postoperative week was -0.068±0.088 （logMAR） for group 1 and -0.024±0.069 （IogMAR） for group 2 （t=2.236, P=0.030）. There were no significant differences in postoperative spherical equivalent or BSCVA between the 2 groups. Conclusion Integrated custom transepithelial ablation seems to result in faster reepithelialization and UCVA recovery as well as lower postoperative pain than PRK with mechanical epithelial removal, while the BSCVA and refractive outcomes are comparable.