PTK联合角膜上皮瓣复位术治疗复发性角膜上皮糜烂综合征

复发性角膜上皮糜烂综合征是一种角膜上皮反复脱落伴有严重眼痛及视力下降的眼病。准分子激光治疗性角膜切削术(PTK)是治疗该病安全有效的方法。但其缺点是术后早期出现严重眼痛。为减轻术后眼痛、加快视力恢复,作者提出一改进的方法,即PTK联合角膜上皮瓣复位术,此法的原理和方法同准分子激光上皮瓣下角膜切削术(LASEK)。     

PTK联合角膜上皮瓣复位术治疗复发性角膜上皮糜烂综合征

复发性角膜上皮糜烂综合征是一种角膜上皮反复脱落伴有严重眼痛及视力下降的眼病。准分子激光治疗性角膜切削术(PTK)是治疗该病安全有效的方法。但其缺点是术后早期出现严重眼痛。为减轻术后眼痛、加快视力恢复，作提出一改进的方法，即PTK联合角膜上皮瓣复位术，此法的原理和方法同准分子激光上皮瓣下角膜切削术(LASEK)。     

准分子激光治疗性角膜切削术治疗角膜浅层病变的疗效观察

目的 :观察准分子激光治疗性角膜切削术 (PTK)对角膜浅层病变的疗效。方法 :利用PTK治疗 10例 11眼角膜病患者 ,其中男 4例 4眼 ,女 6例 7眼 ,平均年龄 6 5岁 ,术后随访 18个月。其中大泡性角膜病变 4例 4眼 ,复发性胬肉致角膜云翳 2例 2眼 ,带状角膜变性 1例 2眼 ,颗粒性角膜变性 1例 1眼 ,细菌性角膜炎致角膜云翳 1例 1眼 ,复发性角膜上皮糜烂 1例 1眼。结果 :术后视力提高 2行以上者 4例 5眼 ,提高 1行者 2例 2眼。刺激症状均明显改善。结论 :PTK治疗浅层角膜病变方法简单易行、安全可靠 ,值得推广     

准分子激光治疗性切削联合屈光性切削治疗伴有角膜混浊的近视眼

目的　了解准分子激光治疗性切削 (PTK)联合屈光性切削 (PRK)治疗伴有角膜混浊近视眼的方法及疗效。方法　激光加刮除去除角膜上皮 ,PTK切削混浊角膜 ,直径为 7 0mm。PRK作近视切削 ,直径为 6 0mm。对于角膜不平者术中用黏弹剂填平后再行上皮去除及PTK。PTK切削深度为影响视力的角膜混浊深度减去PRK及上皮切削厚度。结果　 5 4例 (79只眼 )伴有角膜混浊的近视眼治疗后随访 1年以上 ,术前平均屈光度数为 (- 6 73± 4 17)D ,平均最佳矫正视力为 0 6 3,角膜混浊原因包括感染、机械外伤、化学烧伤、热烧伤、手术后瘢痕及其他原因。术中PTK联合PRK平均切削深度为 (12 4 6 3± 5 3 31) μm。术后 5 0只眼 (6 3 3% )切削区角膜上皮下雾状混浊 (Haze)≤Ⅰ级 ,6 9只眼(89 9% )裸眼视力等于或超过术前最佳矫正视力 ,平均为 0 74。角膜表面较术前光滑 ,散光减轻。结论　PTK联合PRK是治疗伴有角膜混浊近视眼的一种安全有效的方法。     

准分子激光原位角膜磨镶术后角膜瓣下角膜上皮内生的治疗

目的　探讨准分子激光治疗性角膜切削术 (phototherapeutickeratectomy ,PTK)治疗准分子激光原位角膜磨镶术 (laserinsitukeratomileusis,LASIK)术后角膜瓣下角膜上皮内生的疗效。方法对LASIK术后发生角膜瓣下角膜上皮内生患者 6例 (6只眼 )行PTK ,术中重新掀开角膜瓣 ,刮除植入的角膜上皮组织 ,采用直径 7mm光斑 ,以 5～ 10个脉冲切削角膜瓣基质面和基质层表面 ,层间冲洗 ,复位角膜瓣 ,采用直径 3mm光斑 ,以 5 0～ 75个脉冲沿角膜瓣边缘进行切削。术后随访时间 5～ 12个月。结果　 5只眼表现为颞侧角膜瓣边缘下出现匍行性灰白色物质 ,局部角膜瓣边缘水肿和融解 ;1只眼表现为角膜瓣下局限性灰白色团块状物质 ,角膜瓣下基质层局部融解。全部术眼PTK术后无角膜瓣下角膜上皮内生复发 ;除 1只眼残留轻度角膜瘢痕外 ,余 5只眼角膜恢复透明 ;术后视力均达到LASIK术前最佳矫正视力。结论　采用PTK治疗LASIK术后角膜瓣下角膜上皮内生 ,不仅效果良好 ,而且可有效防止复发     

准分子激光治疗性角膜切削术在复发性角膜糜烂中的应用

目的:评价早期实施准分子激光治疗性角膜切削术(PTK)对复发性角膜糜烂(RCE)的临床治疗效果。方法:筛选经常规治疗方法无效,但未经基质穿刺及角膜接触镜治疗的RCE临床连续病例23例(25眼),平均病程为9.3mo(2mo～3a),经全面眼科检查后行PTK治疗,切削深度为10μm,光学区为4～8mm。对比PTK手术前后裸眼视力(UCVA)、最佳矫正视力(BCVA)、等效球镜(SE)以及散光度数(RC)。结果:术后平均随访10.1±5.5mo(4.2～19.2mo),免于复发率为96%,平均BCVA显著提高(术前为0.69±0.30,术后为0.90±0.23,P<0.001),平均SE变化不明显(术前0.41±1.67DS,术后0.35±1.63DS,P=0.26),但平均RC显著降低(术前-1.22±0.90DC,术后-0.57±0.57DC,P<0.001)。结论:对于早期RCE患者,PTK是一种安全有效的治疗方法,它可使绝大多数患者的角膜上皮快速愈合而迅速减轻症状,并可显著提高最佳矫正视力。     

激光治疗性角膜切削术治疗LASIK术后角膜上皮内生

目的 探讨激光治疗性角膜切削术(PTK)治疗LASIK术后角膜上皮内生的方法和效果,方法 LASIK术后较严重的角膜瓣下角膜上皮内生4例(4眼),进行内生的上皮刮除和PTK治疗后戴接触镜3～5天,随访10～24个月,结果 4例均治愈,随访期内无复发,视力均恢复至术前最佳矫正视力.眼部刺激症状、眩光消失.结论 LASIK术后瓣下角膜上皮内生,进行角膜瓣后面和角膜床表面的角膜上皮刮除及PTK术,术后戴角膜接触镜,是治疗LASIK术后瓣下角膜上皮内生的有效方法.     

准分了激光原位角膜磨镶术术角膜瓣下角膜上皮内生的治疗

目的：探讨准分子激光治疗性角膜切削术（phototherapeutic keratectomy,PTK）治疗准分子激光原位角膜磨镶术（laser in situ keratomileusis,LASIK）术后角膜瓣下角膜上皮内生的疗效。方法：对LASIK术后发生角膜瓣下角膜上皮内生患者6例（6只眼）行PTK，术中重新掀开角膜瓣，刮除植入的角膜上皮组织，采用直径7mm光斑，以5－10个脉冲切削角膜瓣基质面和基质层表面，层间冲洗，复位角膜瓣，采用直径3mm光斑，以50－75个脉冲沿角膜瓣边缘进行切削。术后随访时间5－12个月。结果：5只眼表现为颞侧角膜瓣边缘下出现匍行性灰白色物质，局部角膜瓣边缘水肿和融解；1只眼表现为角膜瓣下局限性灰白色团块状物质，角膜瓣下基质层局部融解。全部术眼PIK术后无角膜瓣下角膜上皮内生复发；除1只眼残留轻度角膜瘢痕外，余5只眼角膜恢复透明；术后视力均达到LASIK术前最佳矫正视力。结论：采用PTK治疗LASIK术后角膜瓣下角膜上皮内生，不仅效果良好，而且可有效防止复发。     

经角膜上皮准分子激光治疗性角膜切削术治疗复发性角膜上皮糜烂的疗效

目的观察经角膜上皮准分子激光治疗性角膜切削术（TPTK）治疗复发性角膜上皮糜烂的临床效果,探讨其手术设计要点、安全性、有效性。方法回顾性系列病例研究。选取2014年12月至2015年9月在重庆爱尔眼科医院采用德国阿玛仕准分子激光设备行TPTK治疗复发性角膜上皮糜烂的患者8例（8眼）,其中男4例,女4例,平均年龄（36.6±10.0）岁,观察角膜愈合速度,上皮糜烂有无再发,有无并发症尤其是角膜上皮下混浊（haze）等情况。对患者未发病的间歇期、发作期及术后6个月的裸眼视力（UCVA）进行重复测量方差分析,对眼压、TPTK计划切削深度、TPTK实际切削中央区深度及TPTK实际切削周边区最大深度等比较采用配对t检验。结果8例患者术后随访期（6~16个月）内均未再发角膜上皮糜烂,间歇期、发作期与术后6个月的UCVA总体差异具有统计学意义（F=5.165,P=0.015）,间歇期UCVA与术后6个月的UCVA差异无统计学意义。术后无haze发生,眼部刺激症状在术后4 d时均好转或消失。实际切削中央区深度与计划切削深度差异无统计学意义（t=0,P=1.000）,但低于周边区最大切削深度（t=-18.63,P＜0.001）。结论TPTK治疗复发性角膜上皮糜烂安全有效,是治疗复发性角膜上皮糜烂的可选方式之一。     

大泡性角膜病变的PTK治疗

我院自2002年始，应用准分子激光治疗性角膜切削术（Excimer laser phototherapeutic keratectomy，PTK）治疗大泡性角膜病变，对角膜损伤极轻，术后恢复快，效果良好。手术方法：应用Technolas217准分子激光机。0．4％倍诺喜滴眼表麻。根据上皮糜烂面积设计激光切削面积，一般不应小于5mm，修边面积8．6mm。切削深度根据角膜水肿及大泡的状态，约100μm左右。切削区尽量以瞳孔为中心。     

Small spot phototherapeutic keratectomy for recurrent corneal erosion

PURPOSE: To describe small spot phototherapeutic keratectomy (PTK) using the NIDEK EC-5000 excimer laser for the treatment of recurrent corneal erosion. METHODS: This retrospective study analyzed patients with recurrent comeal erosion who were treated using small spot PTK. An electronic medical records database was used to retrieve patient data. RESULTS: Ten consecutive eyes in nine patients were evaluated after small spot PTK. Eight (80%) recovered without further erosion. CONCLUSIONS: Small spot PTK is a safe and effective alternative to traditional PTK and to corneal micropuncture in the treatment of recurrent corneal erosion.     

Recurrence of corneal dystrophy after excimer laser phototherapeutic keratectomy.

BACKGROUND: Excimer laser phototherapeutic keratectomy (PTK) can be useful to treat anterior corneal dystrophies both before and after penetrating keratoplasty. OBJECTIVE: To evaluate the recurrence of corneal dystrophies after excimer laser PTK. DESIGN: Retrospective case series. PARTICIPANTS: Fifty excimer laser PTK procedures were performed in 43 eyes of 33 patients with corneal dystrophies. Preoperative diagnoses included Reis-Bücklers dystrophy (13 eyes), granular dystrophy (11 eyes), anterior basement membrane (ABM) dystrophy (11 eyes), lattice dystrophy (7 eyes), and Schnyder crystalline dystrophy (1 eye). INTERVENTION: Two excimer lasers (VISX 20/20 model B and VISX Star) were used to perform all PTKs. MAIN OUTCOME MEASURES: After PTK, patients were followed on a regular basis with measurement of best-corrected visual acuity and biomicroscopic examination. Evidence of recurrent dystrophy was noted according to specific criteria. RESULTS: Follow-up range was from 1.1 to 71.2 months (mean, 19.5 months). Clinically significant recurrent dystrophy occurred in 17 eyes. The ABM dystrophy recurred in the form of recurrent corneal erosions in 5 (42%) of the 12 eyes within 6 to 9 months of PTK. Four of these five eyes had mild erosions, which were treated successfully with topical medications while one eye required an additional PTK for an erosion outside the initial treatment area. Eight (47%) of 17 eyes with Reis-Bücklers dystrophy developed clinically significant recurrence an average of 21.6 months after PTK. Three (23%) of 13 eyes with granular dystrophy were found to have a significant recurrence a mean of 40.3 months after PTK. Only one (14%) of seven eyes with lattice dystrophy developed a significant recurrence at 6 months after PTK. Six eyes with significant recurrence after PTK were retreated successfully with additional PTK. Three eyes later developed recurrence of granular and Reis-Bücklers dystrophy after the second PTK. The probability of recurrence of these dystrophies after PTK was calculated using the Kaplan-Meier survival analysis. CONCLUSION: Phototherapeutic keratectomy can restore and preserve useful visual function for a significant period of time in patients with anterior corneal dystrophies. Even though corneal dystrophies are likely to recur eventually after PTK, successful retreatment with PTK is possible.     

自体带蒂角膜缘干细胞移植术治疗翼状胬肉

探讨改良翼状胬肉手术的新术式,以避免或降低翼状胬肉手术后的复发率。 方法：应用自行设计的治疗翼状胬肉的新术式,即自体带蒂角膜缘干细胞移植术治疗翼状胬肉患者28例31眼,术后随访8～24mo,分析患者的症状、创伤愈合情况、胬肉复发情况。 结果：患者31眼中2眼复发,复发率6.5%。 结论：自体带蒂角膜缘干细胞移植术治疗翼状胬肉,复发率低,是一种安全有效的新术式     

Long-term efficacy of phototherapeutic keratectomy on recurrent corneal erosion syndrome

PURPOSE: To assess the long-term sequelae, principally time-to-first-recurrence, of phototherapeutic keratectomy (PTK) for the treatment of recurrent corneal erosion syndrome (RCES). METHODS: A retrospective case series was performed. Thirty-nine eyes in 33 patients with RCES required PTK and were treated using the VISX STAR Excimer Laser System. The data were analyzed with the Kaplan-Meier survival estimate. RESULTS: Patients were characterized by the cause of their RCES. More than 50% had epithelial corneal dystrophies, 31% were posttraumatic, and 15% were idiopathic. Overall, 25% of eyes had a recurrence by 3 months, and 36% had a recurrence by 9 months. The mean follow-up time was 17.4 months (range, 0.4-67.6 months). Of those who had a primary recurrence, 38% had a second and 15% had a third. Visual acuity was slightly decreased within 2 weeks after surgery, and 10% of patients developed transient haze. No serious adverse effects were reported. CONCLUSION: PTK is an important treatment of RCES refractory to other therapies. Long-term data suggest that most patients treated with PTK do not develop recurrences, and side effects from PTK are minimal.     

角膜缘干细胞移植治疗翼状胬肉的疗效观察

目的:观察自体角膜缘干细胞转位术治疗翼状胬肉的临床疗效。方法:60例翼状胬肉眼(包括静止期、活动期和复发性胬肉),显微手术切除病变组织后,行自体角膜缘干细胞转位术。结果:随访12mo,60眼术后角膜上皮修复、植片存活,58眼痊愈,2眼复发。结论:翼状胬肉切除联合角膜缘干细胞转位术简单易操作,可降低复发率,是安全、理想的手术方法。     

Rezidivierende Erosio corneae

Recurrent corneal erosions in both traumatic and basal membrane dystrophy-associated conditions seem to show a similar pathogenesis for abnormal adhesion between corneal epithelium and stroma. The purpose of each conservative or surgical treatment is fast healing without any infections or recurrences. This paper compares the different excimer laser treatment options with emphasis on the so-called aggressive PTK. A total of 50 eyes of 50 patients with recurrent corneal erosions after mechanical trauma or with epithelial basement membrane dystrophy were treated with aggressive PTK after the second or third recurrence. Aggressive PTK was performed with an ablation of 10-15 microm. After the mean follow-up time of 41.8 months, a recurrence rate of 6% without a change of visual acuity and a hyperopic shift of +0.74 D were observed. The earliest recurrent erosion showed up after 33 and the latest after 65 months.In comparison to other forms of PTK such as transepithelial or conventional subepithelial PTK, aggressive PTK showed the lowest recurrence rate reported for a long-term follow-up.     

Visual and symptomatic outcome of excimer phototherapeutic keratectomy (PTK) for corneal dystrophies

PURPOSE: To determine the visual results and outcome of excimer laser phototherapeutic keratectomy (PTK) for corneal dystrophies. METHODS: Twenty-nine eyes of 19 patients who underwent excimer PTK for recurrent erosions and reduced vision due to corneal dystrophies, between February 1996 and July 1999, were reviewed. Data regarding the preoperative and postoperative best-corrected visual acuity (BCVA), change in spherical equivalent (SE), depth of excimer laser ablation, symptomatic relief, and incidence of recurrence were analysed by a retrospective chart review. RESULSTS: The range of follow-up was 12-48 months. Twenty-seven out of 29 eyes (93%) maintained or improved BCVA. All patients (17/17) were free of symptoms of recurrent erosions although two eyes needed repeat treatment to achieve this. In those eyes undergoing PTK for reduced vision, there was a trend towards a hyperopic shift postoperatively but this was not statistically significant. Five eyes showed recurrence of the dystrophy (Reis-Bücklers (one eye), Lattice (two eyes), and Granular (two eyes)) that required repeat treatment. Two of these eyes required a single repeat PTK procedure, and three eyes underwent three repeat treatments. There were no major complications during the follow-up period. CONCLUSIONS: Excimer PTK is a safe and effective procedure for relieving symptoms of recurrent erosions and improving visual acuity in patients with corneal dystrophies. Optimal visual results are achieved when treating more anterior disease. Multiple treatments are possible without significant detrimental effects for those patients with recurrence of their dystrophy.     

Alteration of the ocular surface with recurrence of granular/avellino corneal dystrophy after phototherapeutic keratectomy: report of five cases and literature review

PURPOSE: To study the changes in ocular surface findings with recurrence after phototherapeutic keratectomy (PTK) in patients with Avellino and granular dystrophy. DESIGN: Observational case series. PARTICIPANTS: Five eyes of five patients with recurrent granular/Avellino corneal dystrophy after PTK seen at Kobe Kaisei Hospital were studied. INTERVENTION: The patients underwent routine ophthalmic examinations, corneal sensitivity measurements, tear film breakup time (BUT), Schirmer test, tear film lipid layer interferometry, and conjunctival impression cytology. MAIN OUTCOME MEASURES: The alterations of clinical features, tear function, and conjunctival impression cytology parameters with a recurrence after PTK were investigated. RESULTS: The average pre-PTK corneal sensitivity and tear film breakup time were low in all five patients. Tear film lipid layer interferometry grade and conjunctival squamous metaplasia displayed higher grades before PTK. All of these parameters improved gradually after PTK and were maintained until a recurrence, which was associated with further worsening of the corneal sensitivity, tear function, and impression cytology parameters. CONCLUSIONS: Although PTK improves the ocular surface health in granular/Avellino corneal dystrophies, recurrence of the initial dystrophy is associated with decline of the ocular surface health parameters. Our findings also suggest that corneal epithelium is most probably involved in the recurrence of the disease process in Avellino/granular corneal dystrophy.     

Long-term results of phototherapeutic keratectomy for corneal map-dot-fingerprint dystrophy (Cogan-Guerry)

PURPOSE: Patients with corneal map-dot-fingerprint dystrophy suffer typically from recurrent corneal erosion, disturbed vision, or both. The purpose of this study was to assess the morphologic and functional long-term results of minimal invasive subepithelial phototherapeutic keratectomy (PTK) for corneal map-dot-fingerprint dystrophy. METHODS: Of a total of 390 PTKs performed between October 1994 and January 2004, 15 PTKs on 15 eyes of 11 patients were included in this single-center study. All patients had symptoms of recurrent corneal erosion; in 12 eyes, reduced visual acuity was observed. The median duration of complaints was 18 months. Using 193-nm excimer laser (MEL 60/70; Carl Zeiss-Meditec), a manually guided spot profile was applied in 7 cases (pulse energy, 12 mJ; repetition rate, 2/s or 3/s; 189-425 pulses). In 8 cases, a scanning slit mode was chosen (intended ablation, 1 microm/scan; repetition rate, 20/s; 150-483 pulses). In each case, a broad deepithelialization of the Bowman layer was followed by application of defocused overlapping laser pulses. RESULTS: Complete epithelial closure was achieved after an average of 3.5 +/- 0.6 days (median, 3 days). The mean follow-up was 4.8 +/- 3.0 years, with a maximum of 9.3 years. Best corrected visual acuity increased from 0.7 +/- 0.26 preoperatively to 0.9 +/- 0.16 postoperatively. The keratometric central power remained constant (preoperatively, 43.0 +/- 1.6 D; postoperatively, 42.6 +/- 1.0 D). The average keratometric astigmatism remained constant (1.3 +/- 0.9 D, preoperatively; 1.0 +/- 0.5 D, postoperatively). In the early postoperative stage, subtle superficial corneal opacities ("haze") were observed in 6 eyes (40%), being completely reversible during the follow-up in 5 cases. No recurrence of corneal erosion was observed during the follow-up. Asymptomatic dystrophic signs in the midperiphery became visible in 2 eyes 3 and 5 years after PTK. CONCLUSION: For corneal map-dot-fingerprint dystrophy, PTK using an excimer laser with low pulse energy and low number of pulses can be considered an effective and minimal invasive treatment modality to achieve a fast and durable epithelial closure, to prevent recurrent corneal erosions, and to increase visual acuity in most patients.