准分子激光治疗性角膜切削术在初发性翼状胬肉治疗中的应用

Excimer Laser Phototherapeutic Keratectomy for the Treatment of Primary Pterygium

目的评价准分子激光治疗性角膜切削术(phototherapeutic keratectomy,PTK)联合丝裂霉素C(mitomycin C,MMC)治疗初发性翼状胬肉的临床疗效。方法回顾分析2005-06/2011-02月行PTK治疗的初发性翼状胬肉患者126例140眼,在手术显微镜下分离及切除胬肉及变性球筋膜组织,结膜下置0.4 mg/ml MMC棉球2 min,彻底冲洗后使用193 nm准分子激光行PTK切削残余病变组织。术后均使用相应的局部抗菌及激素滴眼液巩固治疗。术后随访观察至少1年以上。观察术后上皮愈合情况,记录视力恢复、角膜散光度数及胬肉复发情况。结果 PTK平均切削直径(3.86±0.89)mm,平均切削深度(94.21±23.29)μm。术后患眼反应轻,平均上皮愈合时间(2.88±0.83)天。平均随访(17.9±5.4)月,3例患者(4眼)胬肉复发,复发率为2.5%。随访结果:术后裸眼视力较术前均有显著提高,差异具有统计学意义(P<0.01);术后角膜散光度数较术前均有显著降低,差异有统计学意义(P<0.01)。结论PTK作为一种微创的手术方法,可以安全、有效的清除角膜上残留的胬肉及变性组织,重建角膜表面的光滑平整性,有利于创面角膜上皮修复,减少角膜散光,从而改善视功能。其与MMC的联合应用,能有效地降低翼状胬肉的术后复发率。

Objective To evaluate the treatment efficacy of excimer laser phototherapeutic keratectomy（PTK） combined with mitomycin C（MMC） for primary pterygium.Methods A total of 140 eyes of 126 patients with primary pterygium that had undergone PTK between June 2005 and February 2011 were evaluated retrospectively.The conjunctiva and pathological tissues were separated under the microscope.The pterygia as well as the extensive section of the denatured bulbar conjunctiva were excised.After thorough cleansing,a 0.4 mg/ml MMC cotton patch was placed under the bulbar conjunctiva sac for 2 minutes.The residual pathological tissues were excised by PTK using 193nm excimer laser by Technolas 217z.Topical antimicrobal drops and dexamethasone eye drops were postoperatively administered to the patients.At least 12 months of follow-up was performed.Preoperative and postoperative slit lamp biomicroscopy,reepithelialization,recurrence rate,corneal astigmatism,visual acuity,and corneal haze were recorded and analyzed.Results The mean ablation diameter of PTK was（3.86±0.89） mm.The mean ablation depth was（94.21±23.29） μm.The mean reepithelialization time was（2.88±0.83） days.The mean follow-up time was（17.9±5.4） months.Three cases（4 eyes） presented recurrent pterygium and the recurrence rate was 2.5%.At the end of the last follow-up,the mean postoperative uncorrected visual acuity was significantly better than preoperative（P0.01）.The mean postoperative corneal astigmatism was significantly less than preoperative（P0.01）.Conclusion PTK as a minimally invasive surgery,can safely and effectively eradicate pterygia and pathological tissue,hasten reepithelialization,reduce corneal astigmatism and improve visual function.The combination of PTK with MMC can effectively decrease the postoperative recurrence rate of pterygium.