外傷性複發性角膜上皮糜爛的治療分析

Efficacy analysis of traumatic recurrent corneal epithelial erosion

目的回顧性分析外傷性複發性角膜上皮糜爛採用藥物治療或酒精輔助去角膜上皮準分子激光治療性角膜切削術(A-PTK)的療效。方法回顧性病例研究。取2019年3月~2022年10月在本院診斷外傷性複發性角膜上皮糜爛患者78眼,觀察其臨床表現、治療方法及複發率、複發間隔等。對於經A-PTK治療的患者,進行為期6個月的術後觀察,包括複發率、複發間隔及有無手併發症等。並對A-PTK手術酒精浸泡時間、切削深度與複發率有無相關性等進行分析。結果(1)本研究共入組78眼,男性32眼(41%),女性46眼(59%);整體發作間隔天數為123.04±115.93天,男性平均發作間隔天數77.88±72.65天,女性154.46±130.0天。Spearman's相關係數分析結果顯示,男性較女性複發的間隔更短(P<0.001)。(2)藥物治療組64眼,在數據收集期複發率為48.4%。A-PTK組14眼,術後6個月内複發率為28.6%。(3)A-PTK治療組患者在術後的6個月隨訪結束時視力均恢復到術前水準。有一例患者術後出現-0.50DS近視,戴鏡矯正1.0。無一例發生HAZE。(4)經A-PTK治療的患者,其治療後的發作間隔天數(144.36±66.03天),明顯比治療前(52.43±41.98天)延長,有統計學意義(P=0.004)。結論本研究外傷性複發性角膜上皮糜爛的病例,男性比女性複發更頻密;A-PTK治療外傷性複發性角膜上皮糜爛可以減少複發的頻率,是治療頻繁複發外傷性角膜上皮糜爛有效和安全的治療方法。

Objective To observe the clinical effects of traumatic recurrent corneal epithelial erosion caused by alcohol-assisted exfoliation and PTKs.Methods This was a retrospective series of case studies.A total of 78 eyes with traumatic recurrent corneal epithelial erosion diagnosed in our hospital between March 2019 and October 2022 were selected,and their clinical manifestations,treatment methods,recurrence rate,and recurrence interval were observed.Fourteen eyes were treated with alcohol-assisted epithelial PTK(A-PTK)and observed for 6 months to determine whether there were complications,especially corneal subepithelial haze(HAZE),or if the BCVA decreased postoperatively.Correlations between the duration of corneal epithelium soaking in alcohol or cutting depth and the recurrence rate during A-PTK surgery was also analyzed.Results A total of 78 participants were included in this study;32 were male(41%),and 46 were female(59%).Similarly,the average interval seizures were significantly shorter for males than for females(P<0.05).In this study,the recurrence rate was 48.4%in the medical treatment group and 28.6%in the A-PTK group.After the 6-month follow-up,all the BCVA returned to the preoperative level at the end of the 6-month follow-up.One patient had-0.50DS myopia after TPTK,which was corrected by wearing glasses to 20/20.No complications,such as HAZE,occurred during observation.In the A-PTK group,the number of days between attacks after treatment(144.36±66.03 days)was significantly greater than that before treatment(52.43±41.98 days)(P=0.004).Conclusion This group of observation objects was used.With traumatic recurrent corneal epithelial erosion,males have more frequent attacks than females.A-PTK is safe and effective in the treatment of traumatic recurrent corneal epithelial erosion and can reduce the frequency of recurrence.