经上皮准分子激光角膜切削术治疗高度近视1年随访研究

1 Year Follow-up of Transepithelial Photorefractive Keratectomy for the Correction of High Myopia

目的:通过1年随访,探讨经上皮准分子激光角膜切削术(TransPRK)矫正高度近视的有效性及安全性。方法:选取2017年2月-2018年7月于本院接受TransPRK进行屈光治疗的高度近视(等效球镜≥-6 D)患者共31例62只眼作为高度近视组。另选取同时期进行相同术式治疗的中低度近视(等效球镜<-6 D)患者共31例62只眼作为对照组。术后随访1年,比较两组术后疼痛情况及上皮愈合时间。比较两组术后1个月、3个月、1年的裸眼视力(UDVA)及屈光度。比较两组术后角膜上皮下混浊(haze)发生情况并比较有无haze发生者的手术切削厚度与光学区切削直径。比较两组术后3个月与1年的角膜曲率。结果:两组明显疼痛异物感发生率比较,差异无统计学意义(P>0.05)。除对照组1例术后5 d角膜上皮愈合外,其余患者角膜上皮均于术后3 d内愈合。术后1个月,高度近视组UDVA低于对照组(P<0.05)。高度近视组术后1个月、3个月、1年UDVA比较,差异均有统计学意义(P<0.05),其中术后3个月UDVA最佳。术后1个月、3个月、1年,两组等效球镜比较,差异均无统计学意义(P>0.05)。高度近视组术后1个月,3个月,1年等效球镜比较,差异均有统计学意义(P<0.05),其中术后1年等效球镜低于术后3个月(P<0.05)。高度近视组1级haze发生率为14.5%(9/62),高于对照组的0(P<0.05)。发生haze者切削厚度与光学区切削直径均高于未发生haze者(P<0.05)。两组术后3个月和1年角膜曲率比较,差异均无统计学意义(P>0.05)。结论:相比于低中度近视,高度近视患者TransPRK术后早期裸眼视力恢复较慢,但随访1年,视力维持较稳定,具有较好的安全性和有效性。对于术后角膜基质厚度在安全范围内,能够定期随访的患者,临床工作中可以适当扩大TransPRK适应证。

Objective:To investigate the safty and efficacy of the transepithelial photorefractive keratectomy(TransPRK)for the correction of high myopia through 1 year follow-up.Method:A total of 31 patients including 62 eyes with high myopia(equivalent spherical lens≥-6 D)treated with TransPRK in our hospital from February 2017 to July 2018 were selected as the high myopia group.In addition,a total of 31 patients including 62 eyes with low and medium myopia(equivalent spherical lens<-6 D)treated with the same surgical treatment in the same period were selected as the control group.Postoperative follow-up was conducted for 1 year to compare the postoperative pain and epithelial healing time of the two groups.The uncorrected distance visual acuity(UDVA)and diopter of the two groups were compared at 1 month,3 months and 1 year after surgery.The incidence of postoperative haze was compared between the two groups and the surgical cutting thickness and optical cutting diameter of patients with or without haze were compared.The corneal curvature at 3 months and 1 year after surgery was compared between the two groups.Result:There was no significant difference in the incidence of obvious pain and foreign body sensation between the two groups(P>0.05).Except for 1 case in the control group,the corneal epithelium healed within 3 d after surgery.1 month after surgery,UDVA of the high myopia group was lower than that of the control group(P<0.05).In the high myopia group,there were significant differences in UDVA at 1 month,3 months and 1 year after surgery(P<0.05),and the best UDVA was 3 months after surgery.After 1 month,3 months,1 year,there were no significant differences in equivalent spherical lens between the two groups(P>0.05).In the high myopia group,there were statistically significant differences in the equivalent spherical lens at 1 month,3 months and 1 year after surgery(P<0.05),and the equivalent spherical lens at 1 year after surgery was lower than that at 3 months after surgery(P<0.05).The incidence of grade 1 haze in the high myopia group was 14.5%(9/62),higher than 0 in the control group(P<0.05).Both the cutting thickness and the cutting diameter of patients with haze were higher than those patients without haze(P<0.05).There were no significant difference in corneal curvature between the two groups at 3 months and 1 year after surgery(P>0.05).Conclusion:Compared with low and moderate myopia,high myopia patients with TransPRK had a slower recovery of visual acuity in the early stage after surgery.However,follow-up for 1 year,the visual acuity is maintained stably,with good safety and efficacy.For patients with postoperative corneal stromal thickness within a safe range and can be followed up regularly,the indications of TransPRK can be appropriately expanded in clinical work.