准分子激光上皮下角膜磨镶术弃瓣中乙醇残留含量检测分析

目的　检测分析化学浸润法准分子激光上皮下角膜磨镶术弃瓣中乙醇残留含量。方法　20例40眼行准分子激光上皮下角膜磨镶术中采用体积分数20%乙醇浸润、平衡液冲洗后分离制作角膜上皮游离瓣，取出弃瓣及时密封备检，继续完成手术。观察上皮瓣制作、术后刺激症状、上皮愈合、视力恢复和术后Haze情况，检测上皮瓣中乙醇残留量。结果　制作中未发生不全角膜上皮瓣。术后刺激疼痛感觉分值为（2.52±1.46）分。术后5 d新生上皮1级32眼，2级8眼。术后12周检查Haze:0.5级3眼，1级2眼。角膜上皮弃瓣中均有乙醇残留，每只弃瓣乙醇残留量（0.205 2±0.041 0）μL。结论　使用乙醇浸润法经平衡液冲洗制作的上皮瓣仍含有一定量的乙醇残留，可能是术眼术后刺激症状及并发Haze的原因之一。     

冷敷疗法缓解经上皮准分子激光角膜切削术后疼痛的效果

目的：观察经上皮准分子激光角膜切削术（TPRK）后眼罩冷敷缓解患者术后不适的临床疗效。方法： 前瞻性随机对照研究。选取2018年10月至2019年4月在温州医科大学附属眼视光医院之江院区行 TPRK的患者87例（174眼）,根据随机数字表随机分成冷敷组和对照组,2组均选取右眼进行观察。 冷敷组在术后留观期间给予4 ℃冷藏硅胶眼罩冰敷袋,冷敷20 min,其余处理同对照组。对照组常 规用药不冷敷。分别于术后2 h、1 d、2 d、3 d、5 d每天相对固定时间填写眼部不适感评分量表,包 括视物模糊、畏光、异物感、流泪、眼痛、眼痒、眼部分泌物等术后不适情况。并于术后5 d、12 d、 1个月、3个月分别评估角膜上皮愈合情况、裸眼视力（UCVA）、等效球镜度（SE）、角膜上皮下雾状 混浊（haze）、调制传递函数截止频率（MTF cutoff）、客观散射指数（OSI）等指标。采用重复测量方差 分析、独立样本t检验对数据进行分析。结果：术后2 h时,畏光、异物感、眼痛评分等指标在2组间 差异均有统计学意义（F=15.93,P<0.001;F=9.52,P=0.003;F=13.57,P<0.001）。2组间视物模糊、流泪、 眼痒、眼部分泌物差异均无统计学意义。术后1 d视物模糊指标在2组间差异有统计学意义（F=9.69, P=0.003）,畏光、异物感、流泪、眼痛、眼痒、眼部分泌物等指标差异无统计学意义。术后2、3、5 d 所有不适症状组间差异均无统计学意义。术后5 d、12 d、1个月、3个月,2组间角膜上皮愈合情况、 UCVA、SE、Haze等差异均无统计学意义。术后3个月2组间客观光学质量评估差异均无统计学意义。 结论：TPRK术后冷敷疗法能够改善术后早期疼痛、畏光、异物感等刺激症状,但对术后远期视力恢 复没有明显作用,且对术后角膜上皮修复、视觉质量恢复等无负面影响。     

LASEK、PRK和LASIK治疗中低度近视的比较

目的对比分析准分子激光上皮下角膜磨镶术(LASEK)、碰光性角膜切削术(PRK)、激光原位角膜磨镶术(LASIK)治疗中低度近视临床疗效。方法LASEK组58例(112眼)随访3-9月,PRK、LASIK组各120眼随访1a以上,观察分析术后疼痛症状,裸眼视力及角膜混浊情况。结果术后1d出现疼痛症状:LASEK组:81眼(72.3％),PRK组120 眼(100.0％),LASIK组13眼(10.8％);术后3d裸眼视力≥0.8:LASEK组24眼(21.4％),PRK组27眼(22.5％),LASIK组113 眼(94.2％);术后3月存在角膜Haze:LASEK组31眼(27.6％)、PRK组94眼(78.3％),LASIK组0眼。结论LASEK后疼痛症状、角膜Haze明显减轻,疗效优于PRK;LASEK与LASIK相比没有角膜瓣相关并发症,早期视力恢复较慢。     

中高度近视患者LASEK术中使用0.01%丝裂霉素预防术后角膜上皮下混浊的临床研究

目的探讨根据激光切削深度选择0.01%丝裂霉素C（MMC）作用时间预防准分子激光上皮下角膜磨镶术（LASEK）术后角膜上皮下混浊（Haze）形成的效果。方法对120例（240只眼）行LASEK,术中用0.01%MMC滤纸片覆盖于激光切削后的基质床上,切削深度75～100μm浸润10 s,101～130μm浸润15 s1,31～160μm浸润20 s1,61μm以上者浸润25 s。观察术后1、3、6个月时视力、屈光状态、Haze形成情况及并发症。结果术后1个月20只眼出现0.5级Haze6,只眼出现Ⅰ级Haze,术后3个月16只眼出现0.5级Haze,4只眼出现Ⅰ级Haze,至术后6个月6只眼0.5级Haze,未见Ⅱ级以上Haze出现。不同的切削深度经MMC处理后Haze的出现在各组间差别差别无统计学意义。结论 LASEK术中应用0.01%MMC并根据切削深度选择作用时间能有效地抑制Haze的形成。     

丝裂霉素C和角膜水化对准分子激光上皮下原位磨镶术后角膜上皮下混浊的不同影响

目的比较分析准分子激光上皮下原位磨镶术（LASEK）中使用0．02％裂霉素C（MMC）和角膜水化两种不同方法对术后角膜上皮下混浊（Haze）形成的影响。方法将接受LASEK手术的高度47例近视眼患者,术中对一眼在激光消融结束后角膜瓣下使用0．02％MMC,另一眼在切削1／2脉冲总量时,用低于20℃生理盐水冲洗（角膜水化）,比较术后双眼角膜Haze发生情况。结果MMC组和角膜水化组比较：发生角膜Haze的差异程度有统计学意义（P〈0．01）。结论LASEK术中使用0．02％丝裂霉素c在抑制术后Haze形成中优于角膜水化。     

准分子激光上皮下角膜磨镶术治疗近视

目的 :研究保留角膜上皮的准分子激光上皮下角膜磨镶术治疗近视早期临床疗效。方法 :2 0例 3 7眼术前近视屈光度平均 -2 48± 1 14D (-1 2 5～ -8 0D) ,采用 2 3 %酒精浸泡 3 0秒制作角膜上皮瓣 ,激光切削采用Chiron117准分子激光系统。结果 :术后平均视力 :1周 0 92± 0 14 ,1月 1 2 8± 0 2 0 ,3月 1 2 5± 0 18。术后 3月角膜Haze 0级 2 8眼 ,0 5级 9眼。术后第 1天疼痛分级 :0级 12眼 (3 2 4% ) ,Ⅰ级 18眼 (4 8 2 % )、 >Ⅰ级 7眼 (19 4% )。结论 :准分子激光上皮下角膜磨镶术术后疼痛症状、角膜Haze明显减轻 ,但是疗效还需要长期观察及与PRK对比研究     

准分子激光屈光性角膜切削术后屈光回退的多因素分析

目的：探讨准分子激光屈光性角膜切削术后屈光回退的主要因素。方法：采用VISX20／20型准分子激光仪对121例214眼近视患者行准分子激光角膜切削术,术后随访2年。分二组进行比较,Ⅰ组为低中度近视（－1．00D－－6．00D）124眼,Ⅱ组为高度近视（－6．25D－－16．00D）90眼。结果：术后2年低中度近视回退率9．7％,高度近视回退率27．8％（P＜0．005）,高度近视中高龄组较低龄组回退率高（P＜0．005）,较严重的角膜上皮下雾状混浊与回退伴行。结论：准分子激光角膜切削术后屈光回退的主要因素有预期矫正屈光度,角膜Haze及年龄。     

麝珠明目滴眼液对PRK术后角膜上皮下混浊并发激素性高眼压的影响

目的：探讨准分子激光屈光性角膜切削术(PRK)术后非激素类药物代替激素的有效性及安全性。方法：对PRK术后发生一级以上Haze的患者分组，13只眼使用氟美童眼液(氟组)、22只眼在使用氟美童眼液的基础上加用麝珠明目滴眼液(氟 麝组)、对于有Haze及眼压增高的病例只使用麝珠明目滴眼液(麝组)，于术后3月、6月随访视力、Haze、屈光度。结果：氟美童组术后3月haze的情况与眼压增高伴haze组(麝组)有显著性差异，其余组间比较无显著性差异。6个月时haze观察各组均有效，组间比较无显著性差异。结论：麝珠明目滴眼液可明显减轻激素类眼液的副作用，可望成为防治角膜Haze的一种新药。     

准分子激光角膜表层切削术后的止痛措施

准分子激光角膜表层切削术因降低角膜膨隆的风险和避免准分子激光原位角膜磨镶术(LASIK)角膜瓣相关的并发症而受到青睐。但术后严重疼痛不适为表层切削的主要缺陷,因此表层切削术后疼痛不适的控制显得尤其重要。我们总结了表层切削术后疼痛的机制以及降低术后疼痛的措施的进展。     

透明质酸钠对上皮下角膜磨镶术后角膜上皮愈合的影响

目的 :研究促进准分子激光上皮下角膜磨镶术治疗近视后角膜上皮早期愈合的方法。方法 :LASEK治疗 2 5例 48眼近视。术后随机分成 2组 ,A组 3 2眼术后早期应用透明质酸钠滴眼剂 (0 1%爱丽 ) ,B组 16眼作为空白对照组。结果 :术后第一天A组较B组疼痛症状轻 (P <0 0 5 ) ,术后 3月两组角膜Haze、裸眼视力没有差别 (P >0 0 5 )。A组术后角膜接触镜粘附细胞较少 ,B组角膜接触镜粘附较多角膜上皮细胞。结论 :透明质酸钠滴眼剂可以促进LASEK后角膜上皮细胞愈合 ,明显减轻术后疼痛症状而对角膜Haze、术后视力没有影响。     

Transepithelial photorefractive keratectomy mode using SCHWIND-ESIRIS excimer laser: initial clinical results

AIM: To evaluate postoperative pain, uncorrected visual acuity (UCVA), and cornea haze value after transepithelial photorefractive keratectomy (T-PRK) performed with aspherical ablation profile using SCHWIND ESIRIS excimer laser. METHODS: Retrospective case series. Fifty-nice eyes (32 patients) with myopia associated with or without astigmatism underwent phototherapeutic keratectomy (PTK) followed by photorefractive keratectomy (PRK) which performed by Optimized Refractive Keratecomy (ORK)-CAM software based on aspherical ablation profile using SCHWIND ESIRIS excimer laser. Postoperative pain scale was measured on a questionnaire through five levels. Haze was graded by five grades, and UCVA, manifest refraction spherical equivalent (MRSE) were analyzed. RESULTS: Mean pain level was (1.37±0.613) (range: 1 to 3), the mean time picking out the soft contact lens was (6.22±1.73) days, at 3 months, UCVA was 1.0 for 40 eyes (67.8%), 0.5 for all eyes (100.0%). The UCVA was significantly less than the preoperative best spectacle corrected visual acuity (BSCVA) (t=-2.84, P=0.006), haze value was (0.27±0.25), no patients had a haze grade up to 2. Mean MRSE was (0.76±0.96) diopter(D) by 3 months. CONCLUSION: The outcomes from this study show that using the SCHWIND ESIRIS aspherical ablation profile for transepithelial PRK has a good visual result. The primary advantage is related to a spherical ablation profile, automatically considers the ablation volume of the stroma and the accurate and smooth removal of the epithelium with PTK. Additional studies are needed to determine long-term outcomes.     

Transepithelial photorefractive keratectomy mode using SCHWIND-ESIRIS excimer laser: initial clinical results

AIM: To evaluate postoperative pain, uncorrected visual acuity (UCVA), and cornea haze value after transepithelial photorefractive keratectomy (T-PRK) performed with aspherical ablation profile using SCHWIND ESIRIS excimer laser. METHODS: Retrospective case series. Fifty-nice eyes (32 patients) with myopia associated with or without astigmatism underwent phototherapeutic keratectomy (PTK) followed by photorefractive keratectomy (PRK) which performed by Optimized Refractive Keratecomy (ORK)-CAM software based on aspherical ablation profile using SCHWIND ESIRIS excimer laser. Postoperative pain scale was measured on a questionnaire through five levels. Haze was graded by five grades, and UCVA, manifest refraction spherical equivalent (MRSE) were analyzed. RESULTS: Mean pain level was (1.37±0.613) (range: 1 to 3), the mean time picking out the soft contact lens was (6.22±1.73) days, at 3 months, UCVA was 1.0 for 40 eyes (67.8%), 0.5 for all eyes (100.0%). The UCVA was significantly less than the preoperative best spectacle corrected visual acuity (BSCVA) (t=-2.84, P=0.006), haze value was (0.27±0.25), no patients had a haze grade up to 2. Mean MRSE was (0.76±0.96) diopter(D) by 3 months. CONCLUSION: The outcomes from this study show that using the SCHWIND ESIRIS aspherical ablation profile for transepithelial PRK has a good visual result. The primary advantage is related to a spherical ablation profile, automatically considers the ablation volume of the stroma and the accurate and smooth removal of the epithelium with PTK. Additional studies are needed to determine long-term outcomes.     

Transepithelial Laser versus Alcohol Assisted Photorefractive Keratectomy Safety and Efficacy: 1-Year Follow-up of a Contralateral Eye Study

PurposeTo compare single-step transepithelial photorefractive keratectomy (TPRK) to conventional alcohol assisted epithelial removal then photorefractive keratectomy (AAPRK) regarding pain, epithelial healing, visual acuity, corneal haze measured subjectively and objectively, higher order aberrations changes, contrast sensitivity and vector analysis of astigmatic correction with one year follow-up.MethodsA prospective double-blind randomized study of 29 subjects (58 eyes) who underwent myopic aberration-free laser correction by smart pulse technology using Schwind Amaris 1050 Hz with 1-year follow-up. Right eye was randomly treated by AAPRK or TPRK. Postoperative assessment was performed on day 1 and 3, at 1st week, and 1st, 3rd, 6th, and 12th months. Patients were assessed for pain, epithelial healing, visual acuity, corneal haze, astigmatic correction, higher order aberrations and contrast sensitivity.ResultsEpithelial healing was complete by the 3rd day in 62.1% of AAPRK eyes and in 89.7% of TPRK eyes. First day postoperative pain was higher in TPRK group (p = 0.0134). The decimal uncorrected visual acuity at 12 months was 1.47 ± 0.39 and 1.57 ± 0.38 in the AAPRK and TPRK groups respectively (p = 0.3719). Post-photorefractive keratectomy haze reached a final level of 0.04 ± 0.14 and 0.02 ± 0.1 in AAPRK and TPRK groups respectively (p = 0.5607). Contrast sensitivity was comparable in low and high frequency cycles per degree. Vector analysis of astigmatic correction showed correction index at one year of 0.99 and 1.05 for AAPRK and TPRK groups respectively.ConclusionsAlcohol assisted and transepithelial photorefractive keratectomy have comparable results regarding safety and efficacy.     

经上皮个性化表面切削术与器械法去上皮准分子激光角膜表面切削术在患者术后早期恢复情况的比较

目的比较经上皮个性化表面切削术与器械法去上皮准分子激光角膜表面切削术（PRK）的术后疼痛感、上皮愈合时间和早期视力恢复情况。方法非随机前瞻性临床对照研究。连续收集2009年3月18日至2009年10月28期间接受iVIS-Suite 100 Hz激光机切削的经上皮个性化表面切削手术患者15例（30眼，组1），接受Amoils刷器械法去上皮并由Wavelight Allegretto 400 Hz激光机切削的器械法去上皮PRK手术患者15例（30眼，组2）。术后每24小时评估患者上皮愈合情况及主观疼痛感直至上皮愈合。术后1、2、3、4周测量患者术后屈光度，裸眼视力以及最佳眼镜矫正视力。采用独立样本Wilcoxon秩和检验来比较两组患者主观疼痛程度的差别，其他数据比较使用独立样本t检验。结果组1和组2患者的平均上皮愈合时间分别为（2．6±0．5）d和（2．9±0．6）d，差异具有统计学意义（t=2．039，P=0．046）。术后第2天，组1患者疼痛感评分小于组2（Z=-3．535，P〈0．01），且组1患者在术后3d内的最强烈疼痛感评分和平均疼痛感评分均低于组2，差异均有统计学意义（Z=-2．261，P=0．024；Z=-2．982，P=0．003）。术后3周，组1患者平均裸眼视力为-0．068±0．088（10gMAR），组2为-0．024±0．069（10gMAR），差异有统计学意义（t=2．236，P=-0．030）。两组患者术后1至4周的最佳矫正视力和平均等效球镜度经分析差异均无统计学意义。结论单一步骤的经上皮个性化表面切削术与器械法去上皮PRK相比，上皮愈合时间更短，裸眼视力恢复更快，术后疼痛感更轻。两种手术的术后最佳眼镜矫正视力和屈光值无明显差异。     

智能脉冲技术辅助TPRK术的临床疗效

目的：观察智能脉冲技术(SPT)辅助的经上皮准分子激光角膜切削术(TPRK)的临床效果。

方法：回顾性非随机性研究。选取2017-08/2018-05在我院接受SPT辅助的TPRK手术的近视患者260例508眼,术后随访3mo,检测患者的裸眼视力(UCVA)和等效球镜度,观察角膜上皮愈合情况,评估患者的疼痛度及满意度情况。

结果：本组患者术后5d内在配戴角膜绷带镜的状态下可以进行日常生活及一般工作,术后1、3mo UCVA(-0.080±0.0798、-0.108±0.089)均达到甚至优于术前BCVA(-0.050±0.0561)。术后5d,所有患者的角膜上皮均完全修复,术后1、3mo随访,仅3例4眼患者在裂隙灯显微镜下观察到不影响视力的haze(0～1级)。本组患者208例术后当天感觉疼痛,均于1d后缓解,3d后完全消失。术后3mo进行满意度调查显示93.0%患者非常满意。

结论：SPT辅助的TPRK术治疗近视临床效果较好,术后视力恢复快,角膜上皮重塑时间短,能很好地缓解表层手术后疼痛,患者满意度较高。     

准分子激光角膜上皮瓣下磨镶术与准分子激光屈光性角膜切削术治疗近视的比较

目的　研究准分子激光角膜上皮瓣下磨镶术 (LASEK)与准分子激光屈光性角膜切削术(PRK)在治疗 - 8 0 0D以下近视的异同。方法　 4 6例近视度数在 - 1 75～ - 8 0 0D的患者在双眼同时治疗时 ,其中一只眼行PRK治疗 ,另一只眼行LASEK治疗 ,观察上皮愈合时间 ,记载疼痛程度 ,对比术后 6个月内视力、屈光状态及角膜上皮下雾状混浊 (Haze)程度。结果　LASEK组上皮愈合时间平均为 3 4 9d ,PRK组为 2 87d ,两者差异有显著意义 (P <0 0 5 ) ;平均疼痛指数LASEK组为 2 0 4 ,PRK组为 2 4 5 ,差异有显著意义 (P <0 0 5 ) ;术后 6个月内两组间视力及屈光度恢复的差异无显著意义 (P>0 0 5 ) ,并发症的发生无差异。LASEK组术后Haze程度明显低于PRK组 (P <0 0 5 )。结论　LASEK可以和PRK一样安全有效地治疗低于 - 8 0 0D的近视 ,并且与PRK相比 ,可以降低早期疼痛水平 ,减少Haze并发症的发生。     

Pain after epithelial removal by ethanol-assisted mechanical versus transepithelial excimer laser debridement

PURPOSE: To compare subjective pain responses between two techniques of epithelial removal prior to photorefractive keratectomy (PRK) treatment: ethanol-soaked pledget with mechanical debridement of the epithelium versus excimer laser transepithelial ablation. METHODS: Nine patients underwent bilateral PRK. Each had the epithelium in one eye debrided by placing a pledget soaked in 20% ethanol on the cornea for 2 minutes followed by gentle scraping with a blade. The epithelium in the other eye was removed by transepithelial phototherapeutic keratectomy (PTK) treatment. For each eye, PRK was initiated immediately after removal of the epithelium. On postoperative day one, each patient was asked to rate the level of pain suffered over the last 24 hours on a scale of 0 (minimal) to 10 (maximal). Data were analyzed in a masked fashion. RESULTS: Postoperative day one average pain level in the ethanol-assisted mechanically debrided eyes was 3.0 +/- 2.5 and in the transepithelial PTK eyes was 6.8 +/- 1.8. The difference was statistically significant by Student's t-test (P < .01). All epithelial defects healed within 3 days with no clinically significant difference in healing time between the two techniques. CONCLUSION: In preparation for PRK, ethanol-assisted mechanical debridement of the epithelium caused significantly less postoperative pain than epithelial removal using the excimer laser.     

丝裂霉素预防准分子激光屈光性角膜切削术后角膜混浊的临床研究

目的:探讨准分子激光屈光性角膜切削术中使用0.2g/L丝裂霉素(MMC)预防术后角膜上皮下混浊(haze)的安全性、有效性。方法:对120例(240眼)屈光不正的患者进行准分子激光屈光性角膜切削术,术中使用0.2g/L丝裂霉素,作用时间为20~90s,观察术后角膜上皮愈合时间、观察术后1,3,6,12mo时裸眼视力、矫正视力、屈光状态、haze形成情况及并发症、角膜内皮细胞计数等。结果:角膜上皮愈合时间为3.01±0.72d;手术前后角膜内皮细胞计数统计学上无显著性差异(P=0.62);术后1,3,6,12mo时裸眼视力、矫正视力、屈光状态统计学上无显著性差异;术后6mo0~0.5级haze218眼(90.8%),1级haze21眼(8.75%),2级haze1眼(0.83%),术后12mo1级haze12眼(5%);术后未见丝裂霉素毒性反应及并发症。结论:使用0.2g/L丝裂霉素预防准分子激光屈光性角膜切削术后角膜上皮下混浊安全、有效。     

Postoperative pain following epi-LASIK, LASEK, and PRK for myopia

PURPOSE: To compare mechanical epithelial separation using the epi-LASIK technique with alcohol assisted separation (LASEK). METHODS: Patients deemed suitable for surface ablation were randomized to receive epi-LASIK in one eye and LASEK in the other eye. If epi-LASIK failed, the procedure was converted to photorefractive keratectomy (PRK), forming the third comparison group. The outcome measures were postoperative pain, vision, refraction, and haze. Patients were followed for 3 months. RESULTS: Fifty-seven patients (95 eyes) were included in this study (38 epi-LASIK, 19 PRK, and 38 LASEK eyes). There was a 33% rate of conversion from intended epi-LASIK to PRK. Epi-LASIK patients were found to have significantly less pain in the first few hours after surgery but at 4 hours all patients had the same levels of pain, which improved to minimal or no pain at 24 hours. No significant difference was noted among groups for vision, refractive error, and haze; however, epi-LASIK patients had the best day 1 visual acuity. CONCLUSIONS: Epi-LASIK offers comparable visual and refractive results to other surface ablation techniques with lower levels of postoperative pain only for the first 2 hours. However, there was a high rate of flap failure and conversion to PRK.