经上皮准分子激光角膜切削术中应用丝裂霉素C作用的观察

Observation on the effect of applying mitomycin C in transepithelial photorefractive keratectomy

目的观察在经上皮准分子激光光学屈光性角膜切削术（TPRK）中应用丝裂霉素c（MMC）的作用。方法回顾性非随机对照研究。分析TPRK61例（122眼）的临床资料。所有患者分为两组：A组，30例（60眼）术中将浸有0．02％MMC的海绵片覆盖于角膜切削区20～40S。B组，31例（62眼）术中未用MMC。术后定期随访观察6个月。结果术后眼部刺激症状B组较轻，两组差异有统计学意义（t=7．582，P=0．000）；术后3d、10d角膜上皮修复更快，两组角膜上皮愈合情况差异有统计学意义（P=0．002、0．007）。随访3d、10d、1及3个月达术前最佳矫正视力（BCVA）两组差异无统计学意义（χ2=0．439，P=0．508; χ2=2．367，P=0．124；X2=0．370，P=0．543；χ2=0．919，P=0．338）。术后6个月角膜haze发生率两组差异无统计学意义（χ2=0．726，P=0．190）。结论TPRK术中不用MMC可减轻术后眼部刺激症状，角膜上皮修复较快，而且对视力恢复及角膜haze发生无影响。

Objective To observe the efficacy of applying mitomycin C （MMC）in transepithelial photorefractive keratectomy（ TPRK ） surgery. Methods A retrospective nonrandomized controlled study. The data of 122 eyes of 61 cases received TPRK surgery were collected and analyzed. All cases were divided into two groups. Group A ,60 eyes of 30 patients, 0.02% MMC sponge was put on to the cornea ablation area during operation for 20-40 s;group B ,62 eyes of 31 cases received surgery without MMC. The follow-up time was 6 months. The incidence of haze formation, cornea epithelium healing and visual acuity of the two groups were observed. Results The eye irritation symptoms of group B was lighter than that of group A, the difference was statistically significant between the two groups （ t = 7. 582, P = 0.000 ）. At 3 and 10 days postoperatively corneal epithelium repair were faster, the difference was statistically significant between the two groups（ P = 0. 002,0.007 ）. The visual acuity at 3, 10 days, 1 and 3 months after surgery was same with that before surgery. The difference was not statistically significant （χ2 = 0. 439, P = 0. 508 ;χ2= 2. 367, P = 0. 124;χ2 =0. 370,P = 0. 543;χ2 = 0. 919,P = 0. 338）. The difference in incidence of haze was not statistically significant between the two groups （χ2= 0. 726,P = 0. 190）. Conclusion During TPRK surgery without MMC can reduce postoperative eye irritation, and repair corneal epithelium relatively fast, without influence on visual recovery and the incidence of haze.