准分子激光上皮瓣下角膜磨镶术(LASEK)患者应用5-氟尿嘧啶和丝裂霉素C对术后haze及视力的影响

Effects of 5-fluorouracil and mitomycin C on postoperative haze and visual acuity in patients treated with laser-assisted subepithelial keratomileusis

目的探讨准分子激光上皮瓣下角膜磨镶术(laser-assisted subepithelial keratomileusis,LASEK)患者应用5-氟尿嘧啶(5-fluorouracil,5-Fu)和丝裂霉素C(mitomycin C,MMC)对术后haze及视力的影响。方法回顾性分析我院诊治的72例(144眼)屈光度在-6.50^-9.00 D均接受LASEK治疗的近视患者临床资料。按照患者术中用药情况分为5-Fu组(浓度为25 g·L^-1)和MMC组(浓度为0.2 g·L^-1)。5-Fu组32例,MMC组40例,两组患者的年龄、性别、术前等效球镜度数及最佳矫正视力比较差异均无统计学意义(均为P>0.05)。分别于术后1周、1个月、3个月、6个月检查两组患者角膜上皮愈合时间、haze出现和消退时间及haze的分级、最佳矫正视力等。结果 5-Fu组患者上皮愈合时间为(5.26±1.12)d,MMC组为(4.66±1.28)d,两组比较差异无统计学意义(P>0.05),两组患者均未见上皮延迟愈合。术后haze出现时间,5-Fu组与MMC组差异无统计学意义(P>0.05);术后MMC组haze消退时间为(62.46±12.83)d,5-Fu组为(88.45±15.36)d,两组差异有统计学意义(P<0.05)。术后1周和术后3个月两组患者haze分级差异均无统计学意义(均为P>0.05);术后2周和术后1个月两组haze分级比较,MMC组均优于5-Fu组,差异均有统计学意义(均为P<0.05)。术后1周和术后1个月MMC组最佳矫正视力均优于5-Fu组,差异均有统计学意义(均为P<0.05);术后3个月两组最佳矫正视力均恢复至术前水平,与术前比较差异均无统计学意义(均为P>0.05),但两组之间比较差异有统计学意义(P<0.05);术后6个月两组最佳矫正视力均优于术前水平,术前术后比较差异均有统计学意义(均为P<0.05),但两组之间比较差异无统计学意义(P>0.05)。结论 LASEK术中局部应用抗代谢药物5-Fu和MMC均能提高手术疗效,术后3个月haze基本消退,视力恢复到最佳矫正视力,在目前MMC缺乏的情况下可考虑替代使用5-Fu。

Objective To explore the effects of 5-fluorouracil(5-Fu) and mitomycin C(MMC) on the postoperative haze and the best corrected visual acuity in patients with laser-assisted subepithelial keratomileusis(LASEK).Methods The clinical data of 72 patients(144 eyes) of myopia treated with LASEK between-6.50 D and-9.00 D were analyzed retrospectively.The patients were divided into 5-Fu group(25 g·L^-1) and MMC group(0.2 g·L^-1) according to the intraoperative medication.There were 32 patients in 5-Fu group and 40 patients in MMC group.There was no significant difference in age,sex,preoperative equivalent spherical degree and best corrected visual acuity(all P>0.05).At 1 week,1 month,3 months and 6 months after operation,respectively,the healing time of corneal epithelium,the time of appearance and regression of haze,the grading of haze,and the best corrected visual acuity observed.Results The time of epithelium healing in 5-Fu group was(5.26±1.12)days,MMC group was(4.66±1.28) days.There was no significant differences between the two groups(P>0.05).There were no significant differences between 5-Fu group and MMC group in the time of appearance of haze after operation(P>0.05).The time of haze regression was(62.46±12.83)days in MMC group and(88.45±15.36)days in 5-Fu group.There was significant difference between the two groups(P<0.05).One week and 3 months after operation,there was no significantly difference in haze grade between the two groups(all P>0.05),and the difference between MMC group and 5-Fu group was statistically significant 2 weeks after operation and 1 month after operation(all P<0.05).The best corrected visual acuity of MMC group was better than that of 5-Fu group at 1 week and 1 month postoperatively(P<0.05).Three months after operation,the best corrected visual acuity of the two groups recovered to the best corrected visual acuity before operation(P>0.05),but there was a significant difference between the two groups(P<0.05).At 6 months after operation,the best corrected visual acuity of the two groups was better than that of the best corrected visual acuity before operation(P<0.05),but there was no significant difference between the two groups(P>0.05).Conclusion Local application of 5-Fu and MMC in LASEK increase the curative effect of the operation.After 3 months,the haze disappeared basically and the visual acuity recover to the best corrected visual acuity.In the absence of MMC at present,the alternative use of 5-Fu can be considered.