经上皮准分子激光角膜切削术治疗近视的临床疗效

Clinical results of transepithelial photorefractive keratectomy for myopia

目的 评价经上皮准分子激光角膜切削术（TPRK）治疗近视和散光的临床效果.方法 回顾性病例对照研究.纳入行TPRK的近视和近视散光患者38例（72眼）作为TPRK组,选择准分子激光上皮下角膜磨镶术（LASEK）手术患者34例（64眼）作为对照组.术后1、3、10 d在裂隙灯显微镜下观察上皮修复情况,记录患者主观疼痛评分,术后10 d,1、3、6个月复查视力、屈光度、角膜上皮下混浊（haze）评分和角膜共聚焦显微镜检查.数据处理采用Mann-Whitney U检验、x2检验、独立样本t检验和重复测量方差分析.结果 所有患者角膜上皮一期愈合.LASEK组和TPRK组角膜上皮完全愈合时间为（3.3±1.9）d和（2.3±1.2）d,TPRK术后上皮修复时间明显较短（t=8.659,P＜0.01）.2种手术方式术后1、3d疼痛程度差异无统计学意义（Z=-0.683、-0.380,P＞0.05）.术后3d视力≥1.0者LASEK组和TPRK组分别占13％和35％（x2=9.105,P＜0.01）,术后3个月2组患者均达到术前预期矫正视力.术后10 dTPRK组等效球镜度（SE）小于LASEK组（t=5.691,P＜0.05）,术后1、3、6个月2种手术方式SE差异均无统计学意义.术后6个月所有角膜透明,无明显haze形成,共聚焦显微镜显示TPRK术后1个月角膜基质高反光和细胞激活程度较LASEK轻.结论TPRK可以有效治疗近视和散光,有较好的有效性和安全性.与LASEK相比,术后角膜上皮和视力恢复快,可获得同样良好的预期矫正视力.

Objective To evaluate the clinical results of transepithelial photorefractive keratectomy （TPRK） in the treatment of myopia.Methods Thirty-eight patients （72 eyes） who were diagnosed with myopia and astigmatism underwent TPRK and 34 patients （64 eyes） who underwent LASEK were enrolled in the study.Ablations were performed with the Schwind Amaris system.The time frame for epithelial healing and ocular pain score were recorded on 1, 3 and 10 d.The patients were examined at 10 d and at 1, 3 and 6 months postoperatively to measure uncorrected distance visual acuity （UDVA）, spherical equivalent （SE）, corneal haze and corneal confocal microscopy （CCM）.The data were analyzed with a Mann-Whitney U test, chi-square test, independent t test and RMANOVA.Results The mean time for epithelial healing was significantly shorter after TPRK than after LASEK （2.3±1.2 versus 3.3±1.9 days） （t=8.659, P〈0.01）.At 1 d and 3 d, the difference in the mean pain scores was not significant （Z--0.683,-0.380, P〉0.05）.At 3 d, more eyes had achieved 1.0 or better in the TPRK group than in the LASEK group （35% versus 13%）（x2=9.105, P〈0.01）.At 10 d, the mean SE was smaller in the TPRK group than in the LASEK group （F=5.691, P〈0.05）, but the difference in SE was not significant at 1, 3 and 6 months.All LASEK-and TPRK-treated eyes equaled or bettered UCVA and BCVA.There was no clinically severe haze but any haze tended to dissipate after 6 months.There was no significant difference in the grade of haze between the two surgeries.A high number of reflective pieces and keratocyte activation could be observed under CCM and were obviously more significant in LASEK-than in TPRK-treated eyes at 1 month.Alleviation was gradual.Conclusion TPRK for myopia is as safe and effective as LASEK.It appears to induce a shorter time for wound healing and UCVA improvement in the early postoperative period.