高度近视行Trans-PRK术中联合MMC对术后haze的影响

Effect of intraoperative Trans-PRK combined with MMC on postoperative haze in the treatment of high myopia

目的:评价经上皮准分子激光角膜切削术(Trans-PRK)联合0.02%丝裂霉素C(MMC)治疗高度近视预防角膜上皮下雾状混浊(haze)的临床效果。方法:回顾性病例分析。收集我院2016-01/2017-12行Trans-PRK手术治疗的高度近视患者89例142眼,其中94眼联合使用0.02%MMC设为MMC组,MMC的使用时间为30~45s;48眼未使用MMC设为对照组。两组患者术后均规律使用类固醇激素滴眼液治疗4mo,随访6mo。采用树模型分析探讨不同相关因素与haze发生的相关性。结果:按照Fantes分级进行haze评估。MMC组术后haze发生率为8.5%(8/94),对照组为33.3%(16/48)(P=0.001)。树模型结果显示,切削光区直径和切削深度是haze发生的主要相关因素(P<0.01)。当切削光区直径≤5.6mm时发生haze的可能性越大,当切削光区直径>5.6mm时,最大切削深度成为haze发生的主要影响因素。结论:对于薄角膜及角膜形态异常的高度近视患者,在选择Trans-PRK治疗时应考虑切削光区直径及切削深度,同时应联合使用0.02%MMC,可以安全有效地减少haze发生。

AIM:To evaluate the mitomycin-C(MMC)0.02%efficacy in preventing haze after trans-epithelial photorefractive keratectomy(Trans-PRK)in the treatment of the high myopia.METHODS:Retrospective case series.Trans-PRK were performed on 142 eyes with a preoperative spherical equivalent.They were divided into with 0.02%MMC(MMC group)and without MMC(control)groups.In MMC group there were 94 eyes with MMC 0.02%;in control group there were 48 eyes.Patients were treated with an intraoperative application of MMC 0.02%for 30-45s depending on refractive error in MMC group.After surgery,fluorometholone 0.1%eye drops were used for 4mo in all groups.The mean follow-up time was 6mo.The regression trees were used to analyse the relationship between different related factors and haze.RESULTS:Haze was quantified with Fantes.Incidence of haze was 8.5%eyes in MMC group and 33.3%in without MMC group(P=0.001).In the regression trees,optical zone and ablation depth MAX were related to haze(P<0.01).It was possibility induce haze when optical zone is≤5.6mm.When optical zone is>5.6mm,ablation depth MAX becomes the main factor for haze.CONCLUSION:The design of optical zone and ablation depth MAX in Trans-PRK should be considered for the treatment of the high myopia with thin cornea and abnormal corneal morphology.MMC 0.02%was effective in preventing haze after Trans-PRK in the treatment of the high myopia.