Epi-LASIK术中联合MMC治疗高度近视的临床观察

Clinical observation of applying mitomycin C in Epi-LASIK surgery for treating middle or high myopia

目的:观察丝裂霉素C(MMC)在机械法准分子激光角膜上皮瓣下磨镶术(Epi-LASIK)矫治中高度近视的临床疗效和安全性。方法:将临床病例406眼随机分为MMC组(203眼)和对照组(203眼),所有手术采用自动旋转型Epi-LASIK角膜上皮刀制作角膜上皮瓣,以Visxstars4准分子激光仪进行激光切削,MMC组术中用含有0.2g/LMMC液的圆形滤纸片置于切削区基质面,根据屈光度数确定置留时间。对照组术中除不用MMC,其余操作与MMC组完全相同。术后随访两组患者的刺激症状、角膜上皮生长情况、术后视力、验光、眼压、haze情况并进行总结。结果:所有病例均按预期完成Epi-LASIK手术,随访时间6mo～2a。两组刺激症状较轻,多发生在手术后第1d,一般术后第2d就会好转,术后第3d检查,MMC组有15眼为II～III级刺激症状,对照组有13眼为II～III级刺激症状,两组差异无统计学意义(P>0.05);两组角膜上皮完全愈合时间为3～5d,其中MMC组平均为3.78±0.75d,对照组平均为3.55±0.89d,两组差异无统计学意义(t=1.522,P>0.05)。3～5d摘镜时,MMC组有191眼(94.1%)角膜上皮愈合良好,对照组有198眼(97.5%)。术后6mo检查,MMC组术后视力满意为195眼(93.6%),对照组为172眼(84.7%),两组差异有统计学意义(P<0.05)。术后6mo检查,屈光度较术后3mo时回退超过-0.50D,MMC组有11眼(5.4%),对照组有23眼(11.3%)。术后6mo检查,MMC组有167眼(82.3%)为0级haze,对照组有125眼(61.6%)为0级haze,两组差异有统计学意义(P<0.05)。结论:在Epi-LASIK矫治高度近视手术中,一次性应用0.2g/LMMC液可以减轻术后haze的反应,减少术后视力的回退,无明显的副作用。

AIM： To observe the effect and security of applying mitomycin C （MMC） in Epi-LASEK surgery of middle or high myopia. METHODS： The 406 eyes underwent Epi-LASIK surgery were randomly divided into MMC group （203 eyes） and control group （203 eyes）. Automatic rotational Epi-LASIK, which had features of a blunt oscillating blade, was used to make epithelium flap. Visx star S4 excimer laser was used for myopia. 0.2g/L MMC solution was covered on the corneal stroma bed after the laser ablation in MMC group. Refractive diopter determined keeping time. The eyes in control group received the same thing as MMC group except MMC. The other operate were identical. The postoperative symptom, epithelial flap, incorrect visual acuity, dioptersand, haze formation were recorded.RESULTS： All of surgery had been finished successfully. The period of follow-up ranged from 6 months to 2 years. Stimulate formation were light in two groups. It often happened in the first day and got better in the second day. On the third day of postoperative, 15 eyes had I-II level stimulate formation in MMC group and 13 eyes in control group. There was no statistically significant difference between two groups （P〉0.05）. The corneal epithelia healed up within 3-5 days in all patients, with no significant difference between two groups （3.78±0.75 vs 3.55±0.89, t=1.522, P〉0.05）. Epithelial flaps of 191 eyes （94.1%） in MMC group were well healed when took off the lens for 3-5 days and 198 eyes （97.5%） in control group. Six month after surgery, 195 eyes （93.6%） in MMC group acquired satisfactory visual and 172 eyes （847%） in control group. There were statistically difference in two groups （P〈0.05）. Refractive regressions quantity of 11 eyes （5.4%） in MMC group was up to -0.50D in 6 month after surgery and 23 eyes （11.3%） in control group. 167 eyes（82.3%） in MMC group suffered 0 level haze while 125 eyes （61.6%） in control group. There were statistically difference （P〈0.05）. CONCLUSION： The application of 0.2g/L MMC during Epi-LASIK is proved to be a safe and effective method for middle or high myopia. It can reduce the formation of haze and prevent UCVA falling.