CLINICAL ANALYSIS OF EXCIMER LASER PHOTOREFRACTIVE KERATECTOMY FOR TREATMENT OF MYOPIA AND MYOPIC ASTIGMATISM

To evaluate the efficacy and accuracy of photorefractive keratectomy (PRK) for myopia and myopic astigmatism .SVS APEX excimer laser with a wave length of 193 nm(Sumit Technology Inc. Waltham, Mass, USA) was applied. 316 myopic eyes of 168 patients were treated with PRK between September, 1996 and October, 1997, and 260 eyes (84%) of 150 patients were followed for more than three months, including male 68(116 eyes, 401%) and female 82(144 eyes, 599%). The preoperative spherical equivalent refractive errors ranged from -125D to -1000 (mean -467163D), and astigmatism ranged from 0 to -200D (means -033045D). We divided the patients into two groups according to the referaction: group A (from -125D to -590D) and group B(from -600 to -1000D). The number of eyes in the two groups were 220 and 40 respectively. In group A, on the 10th day, 689% has the uncorrected visual acuity (UCVA) equal to or one line better or lower than the preoperative best corrected visual acuity (BCVA). In 1,3,6 and 12 months, 90 %, 96%, 95% and 94% had the UCVA equal to or one line better or lower than the preoperative BCVA respectively. In group B, on the 10 th day, in 1,3,6 and 12 months, UCVA equal to or one line better or lower than the preoperative BCVA occurred in 359%, 83%, 87%, 86%, and 84% of the cases respectively. Most of the haze showed 051 grades except 3 eyes with the haze of 2 grade in 3 or 6 months and it changed to 1 and 05 grade respectively within one year. In 10 days and 1,3,6,12 months postoperatively, the corneal haze was noted in 329%, 848%, 628%,90% and 28% of the treated eyes respectively. We found that 193 nm excimer laser PRK was a predictable, safe, stable, and effective refractive surgery for correcting myopia up to -1000D in Chinese patients, and the effect was better in myopia lower than -600D.

A HISTOPATHOLOGIC IMMUNOHISTOCHEMICAL AND ULTRASTRUCTURAL STUDY OF RABBIT CORNEA AFTER EXCIMER LASER PHOTOREFRACTIVE KERATECTOMY

Objective To evaluate the corneal healing of non-epuality diopter response histopathologically, immunohistochemically and ultrastructurally after excimer laser photorefractive keratectomy(PRK) with SVS APEX PLUS(Summit Technology Inc. USA) excimer laser, and the effects of corticosteroid on the healing. Methods PRK on 6 white rabbits(12 eyes) was performed on right eye or the rabbit for an attampted correction or -4.00 diopter and on left eye for an attempted correction of -8.00 diopter. The rabbits were divided into 2 groups randomly and each group included 6 eyes: Group FLM (3 rabbits, 6 eyes) and group CM (3 rabbits, 6 eyes). Fluoromethalone was given to group FLM,and chloromycetin to group CM. On 10d, 30d and 100d,the eyes of one rabbit in each group were enucleated randomly. Half of each cornea was prepared for electron microscope observation (SEM and TEM) and the rest embedded in OCT compound for immunohistochemical study to examine Ⅲ-C and FN. Results All eyes were reepithelialized within 3d after PRK. Subepithelial corneal haze was observed on 15d,which was dominant on 30 or 60d. On 100d postoperatively,corneal hazes of 11 eyes were grades 0 or 0.5,only 1 eye(the left eye or group CM) was denser haze (grade 1). On 3d postoperatively, one or two layers of corneal epithelial cell covered the ablation zone. On 30d after PRK,the epithelial cells showed hyperplastic changes. The cells were larger and increased from normal 5 or 6 layers to 7 or 8 layers of cells on l00d after PRK,epithelium was clear with more bright epithelium. Mi- croplicae and microvilli were less than before. The expression of Ⅲ-C and FN in group CM was significantly more evi- dent than that in group FLM. Conclusion The study show that despite recovery of a continuous and smooth epithelial layer and nearly normal corneal tissues on 100d after PRK,abnormalities of both epithelium and superficial stroma can be detected in the area of ablation. The ablation depth of stroma can influence the appearance of corneal haze af- ter PRK. The microplicae and microvilli of rabbit cornea epithelium become less after PRK,which can be one of cause leading to ocular dry sensation in some patients.

EXCIMER LASER PHOTOREFRACTIVE KERATECTOMY FOR MYOPIA IN CHINA A REPORT OF 750 EYES WITH A 6-MONTH FOLLOW-UP

A total of 750 six-month follow-up records of myopia treated with excimer laser photorefractive keratectomy (PRK) were analyzed. By 6 months, in group 1 (up to-6.00D, 587 eyes), uncorrected visual acuity was improved to 20 / 20 or better in 86.7% of treated eyes and 95.4% fell into the range of refraction of±1.00D. In group 2 (-6.25D to -11.00D, 163 eyes), 74.5% of treated eyes had uncorrected visual acuity of 20 / 20 or better and 89.4% of the eyes were within ±1.00D. The designed predictability of the two groups was the same (P>0.1). The refractive stability from 3 to 6 months between the two groups was not statistically different, and no severe complications were observed in these two groups. The excimer laser PRK for correcting myopia up to -11.00D appears to be effective, predictable, stable and safe in this study. The ideal outcome may result from the precise ablation quality of excimer laser, its computerized surgical manipulation and an appropriate postoperative management including detection of refractive indices by conical topography and modulation by steroid.