准分子激光角膜表层屈光手术进展

The advance in excimer laser corneal surface refractive surgery

准分子激光角膜屈光手术方式主要分为全激光、全飞秒激光和全准分子激光三大类。由于角膜瓣带来的并发症,或者是对于二次手术、波差引导及Q值引导的个性化手术的需求,让人们的目光再次转向全准分子激光,即角膜表层切削手术。从最初的准分子激光角膜表面切削术(photorefractive keratectomy,PRK),到乙醇法准分子激光上皮瓣下角膜磨镶术(laser assisted subepithelial keratomileusis,LASEK)和机械法准分子激光上皮瓣下角膜磨镶术(epipolis laser in situkeratomileusis,Epi-LASIK),直至经角膜上皮的激光角膜切削术(transepithelial PRK,Trans PRK),表层切削手术经历了20余年的发展逐渐成熟。传统PRK、LASEK、Epi-LASIK术后疼痛、愈合慢、HAZE等并发症出现,一直是困扰我们的难题。为了解决这些问题,衍生出了经角膜上皮的激光角膜切削术(transepithelial PRK,t PRK)和Trans PRK。Trans PRK于2009年进入临床,标志着准分子激光表层手术进入了崭新的时代,它能有效简化手术步骤,缩短手术时间,特异性切削角膜中央和周边上皮厚度,矫正波前像差等,作为一种新的手术方式,为屈光不正患者提供了一个新选择。

Currently, the procedure of excimer laser corneal refractive surgery is mainly divided into three categories ： full laser,femtosecond laser and excimer laser. Because of the corneal flap complications or the second surgery or needs for individualized surgeries guided by the wave-front aberration and the Q wave,the at- tention of people turns to the whole excimer laser again, i. e. the cor-neal surface ablation surgery. From the initial photorefractive keratectomy （PRK） to ethanol excimer laser epithelial keratomileusis （LASEK） and mechanical methods of excimer laser epithelial in situ keratomileusis （Epi-LASIK）, up to corneal epithelial keratectomy （transepithelial PRK, TransPRK）, the surface cutting surgery has experienced 20 years of development and gradually become maturity. The postoperative pain, slow healing, HAZE and other complications after traditional PRK, LASEK and Epi-LASIK were confusing prob- lems for us. To solve these problems, the corneal epithelial keratectomy （ transepithelial PRK, tPRK） and TransPRK were further devel- oped. Since it entered into clinic in 2009,TransPRK marked that the excimer laser surface surgery has entered a new era of develop- ment. It has advantages of effectively simplifying operation procedure, shortening operative time, specifically cutting central and periph- eral corneal epithelial thickness and correcting wave-front aberration. As a new surgical approach,it also provides an alternative choice for natients with refractive errors.