角膜地形图引导LASEK联合MMC治疗RK术后屈光不正

doi:DOI:10.3760/cma.j.issn.1674-845X.2016.07.002

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摘要目的探讨角膜地形图引导的准分子激光上皮下角膜磨镶术（LASEK）治疗放射状角膜切开术（RK）后屈光不正的有效性及安全性。方法回顾性系列病例研究。RK术后视功能下降行角膜地形图引导的LASEK联合丝裂霉素C（MMC）治疗的患者13例（16眼），分为远视组（11眼）和近视组（5眼）。对术前及术后1年等效球镜度（SE）及散光值进行配对t检验，对裸眼视力（UCVA）、最佳矫正视力（BCVA）和角膜地形图指数进行Wilcoxon秩和检验，并对手术并发症进行总结分析。结果远视组手术前后UCVA中位数分别为0.22和0.09（logMAR）（Z=-1.732，P<0.05），术后9眼UCVA≤0.3，5眼UCVA≤0（logMAR）；仅1眼BCVA下降1行，其余均等于或高于术前1~2行；术前平均SE为（+2.63±1.69）D，平均散光值为（-1.45±0.90）D，术后两者均下降，差异有统计学意义（t=5.365，P<0.01；t=-2.359，P＜0.05）。远视组术后5眼SE≤±0.50 D，9眼SE≤±1.00 D；术后角膜表面变异指数（ISV）、角膜高度非对称性指数（IHA）及角膜像差系数（ABR）均较术前显著下降，差异有统计学意义（Z=-1.928、-2.135、-1.827，P＜0.05）。近视组手术前后UCVA中位数分别为0.92和0.09（logMAR）（Z=-1.863，P＜0.05），术后5眼UCVA≤0.3（logMAR），2眼UCVA≤0（logMAR）；所有眼BCVA均等于或高于术前1行；术前平均SE为（-3.63±2.26）D，平均散光值为（-1.55±0.70）D，术后两者均显著下降，差异有统计学意义（t=-3.549、-3.143，P＜0.05）。近视组术后2眼SE≤±0.50 D，5眼SE≤±1.00 D；术后ISV和IHA较术前显著下降，差异有统计学意义（Z=-1.827、-1.827，P＜0.05）。2组术后角膜地形图显示角膜光学区偏小及偏心得到一定程度的改善。术后1年2眼有环形haze，BCVA并未下降。结论角膜地形图引导LASEK联合MMC治疗RK术后屈光不正合并光学区偏小和（或）偏心安全、有效。

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	张钰
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关键词 ：角膜地形图, 角膜切开术, 放射状, 屈光不正, 丝裂霉素, 角膜切削术, 上皮下, 激光

Abstract：Objective To investigate the safety and efficacy of topography-guided laser-assisted subepithelial keratomileusis (LASEK) in eyes with refractive error that had previously undergone radial keratotomy (RK). Methods This was a retrospective,consecutive case series study. Sixteen eyes of 13 patients with poor visual quality after RK that had previously undergone topography-guided LASEK with mytomycin C (MMC) were reviewed. Patients were divided into a hyperopic group (11 eyes) and myopic group (5 eyes). Spherical equivalent and astigmatism were analyzed using a paired t test, and uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and topography indices were analyzed using the Wilcoxon test. Incidence of complications were recorded. Results In the hyperopic group, the respective median UCVAs were 0.22 and 0.09(logMAR) preoperatively and one year postoperatively (Z=-1.732, P＜0.05). UCVA was 0.3 in 9 eyes and 0 or less in 5 eyes. Only 1 eye lost 1 line of BCVA. Preoperative mean SE was +2.63±1.69 D and mean astigmatism was -1.45±0.90 D. Both SEs were significantly decreased 1 year postoperatively (t=5.365, P<0.01; t=-2.359, P＜0.05). At 1 year, 5 eyes were within ±0.50 D, and 9 eyes were within ±1.00 D of best corrected SE. A significant decrease in the index of surface variance (ISV), index of height asymmetry (IHA) and aberration coefficient (ABR) occurred (Z=-1.928, -2.135, -1.827, P＜0.05). In the myopic group, the retrospective median UCVAs were 0.92 and 0.09(logMAR) preoperatively and 1 year postoperatively (Z=-1.863, P＜0.05). UCVA was 0.3 or less in 5 eyes and 0 or less in 2 eyes. No eyes lost a line of BCVA. Preoperative mean SE was -3.63±2.26 D and mean astigmatism was -1.55±0.70 D and both had decreased significantly 1 year postoperatively (t=-3.549, -3.143, P＜0.05). At 1 year, 2 eyes were within ±0.50 D and 5 eyes were within ±1.00 D of best corrected SE. A significant decrease in ISV and IHA had occurred (Z=-1.827, -1.827, P＜0.05). In both groups, postoperative topography showed improvement in the optic zone to some degree. Two eyes showed grade 1 and grade 3 level circle haze, but neither lost any lines of BCVA. Conclusion Topography-guided LASEK with MMC is a safe and effective treatment to correct refractive error with a small or eccentric optic zone after RK.

Key words： Topography Keratotomy,radial Refractive error Mitomycin Keratectomy, subepithelial, laser-assisted

通讯作者: 陈跃国，Email：chenyueguo@263.net

引用本文:

张钰,陈跃国,夏英杰,杨红玉. 角膜地形图引导LASEK联合MMC治疗RK术后屈光不正[J]. 中华眼视光学与视觉科学杂志, 2016, 18(7): 389-393. Zhang Yu, Chen Yueguo, Xia Yingjie, Yang Hongyu. Topography-guided LASEK with mitomycin C for refractive error following radial keratotomy. Chinese Journal of Optometry Ophthalmology and Visual science, 2016, 18(7): 389-393. DOI: DOI:10.3760/cma.j.issn.1674-845X.2016.07.002

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