准分子激光屈光性角膜切削术并发症分析

为了解ＰＲＫ术后并发症对用ＶＩＳＸ２０／２０型准分子激光仪行ＰＲＫ手术３０６例（５２９眼）近视、散光患者作观察分析。术前等值球镜屈光度为－１．００—１６．００Ｄ（－６．５５±３．１９Ｄ），随诊３—１２月。术后６—１２月，全组７．１％术眼最佳矫正视力下降２行以上，２２％术眼视力进行性下降超过２行。术后１年，在低、中度近视眼中，欠矫（＞１Ｄ）、过矫（＞１Ｄ）、屈光回退（≥１Ｄ）、角膜雾状混浊的发生率分别为６．３％、１．３％、５．０％、８．８％，而在高度近视眼中分别为５０．８％、６．６％、２４．６％、６２．１％。术后还出现了激素性高眼压、偏中心、角膜“中央岛”、眩光及夜间视力下降、重影等并发症。结果表明，低中度较高度近视有良好的预测性、稳定性，而且并发症明显减少。     

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。     

准分子激光角膜原位磨镶术矫治高度近视准分子激光屈光性角膜切削术后屈光回退的临床观察

目的评价准分子激光角膜原位磨镶术（LASIK）矫治高度近视准分子激光屈光性角膜切削术（PRK）后屈光回退的疗效。方法回顾性临床研究。对PRK术后2年以上、屈光回退且屈光度稳定的患者8例14眼行LASIK,对LASIK术后术眼进行评价。患眼PRK术前屈光度为-6.25～-12.50 D,PRK术后屈光度为-1.50～-6.25 D。随访观察LASIK矫正1年后术眼的裸眼视力、最佳矫正视力、屈光度、上皮下雾状混浊（haze）形成和角膜厚度的变化。结果所有患眼术后主观症状较轻。LASIK术后1年平均球镜度数为（-0.62±0.94）D。LASIK术后0.5≤裸眼视力〈0.8者4眼,≥0.8者9眼,1眼（7.1%）最佳矫正视力下降2行。4眼术后出现不同程度的haze,包括2级haze 3眼、3级haze 1眼。应用氟米龙滴眼液1个月后,haze及屈光回退减轻;术后1年,1级haze 2眼,2级haze 2眼,3级haze 1眼。LASIK术前角膜厚度为（467±38）μm,术后为（422±21）μm。结论高度近视PRK术后屈光回退行LASIK矫治是一种可行的方法,但少数患者术后可出现haze,仍需治疗。     

准分子激光屈光性角膜切削术治疗高度近视探讨

目的探讨准分子激光角膜切削术(PRK)治疗高度近视的效果.方法应用VISX20/20B型准分子激光仪,采用多光区切削法治疗-15D以上超高度近视.术后随访19～38月,并对结果进行分析.结果术前最佳矫正视力0.69±0.19,术后裸眼视力0.61±0.11.术后3月左右角膜上皮下混浊(haze)明显,1年后最轻,该组haze平均(0.53±0.17)级,屈光度回退平均(3.15±1.56)D.结论对于角膜较薄,不适于准分子激光原位角膜磨削术(LASIK)的超高度近视患者,PRK的多光区切削方式仍不失为一种安全、有效且稳定性较好的方法.     

准分子激光屈光性角膜切削术后眼压测量值的变化

目的：探讨影响准分子激光屈光性角膜切削术（laser photorefractive keratectomy,PRK)后眼压测量值变化的因素。方法：对209例（364只眼）近视患者行PRK,手术前、后采用Goldemann压平式眼压计测量患者的眼压,并测量角膜厚度和角膜曲率,进行量角膜厚度和角膜曲率,进行统计学分析。术后随访时间＞1年。结果：术后6个月和12个月术眼的眼压测量值低于术前,差异有非常显著意义（P＜0．001）,术后12个月的眼压测量值低于术后6个月,差异有非常显著意义（P＜0．001）,术后12个月的眼压测量值低于术后6个月,差异有非常显著意义（P＜0．001）。术后眼压测量值的降低与角膜厚度的减少和角膜曲率的降低均呈高度正相关（P＜0．01）,其二元回归方程为Y（手术前、后眼压差,mmHg）＝1．156＋0．022X1（手术前、后角膜厚度差,μm)＋0．052X2（手术前、后角膜曲率差,D）。结论：PRK术后眼压测量值低于术前;角膜厚度和角膜曲率是导致手术前、后眼压测量值变化的因素。     

丝裂霉素C对准分子激光屈光性角膜切削术后角膜混浊的实验研究

目的探讨丝裂霉素Ｃ对准分子激光屈光性角膜切削术后角膜上皮下雾状混浊（ｈａｚｅ）的影响。方法对４５只新西兰白兔的双眼行准分子激光屈光性角膜切削术,术中、术后分别给予０．００８％丝裂霉素Ｃ、０．１％地塞米松治疗及空白对照。术后分别进行裂隙灯、角膜内皮镜、光镜和透射电镜检查。结果术后４及８周,丝裂霉素Ｃ组角膜ｈａｚｅ轻于对照组和地塞米松组;地塞米松组轻于对照组。术后１、４及８周,丝裂霉素Ｃ组术区前基质内角膜细胞数较对照组和地塞米松组少,后两组间差异不明显。三组间角膜上皮愈合时间、角膜上皮厚度及内皮细胞密度差异无显著性（Ｐ＞０．０５）。结论丝裂霉素Ｃ能通过抑制角膜细胞的生长而减轻ｈａｚｅ的形成,其效果优于地塞米松,且无明显副作用,是一种较理想的抑制ｈａｚｅ形成的药物     

准分子激光角膜切削术治疗屈光不正体会

准分子激光角膜切削术治疗屈光不正体会武警河南总队医院眼科聂晓丽，刘苏冰，王增叶，吴志鸿，辛宝丽准分子激光角膜切削术（ＰＲＫ）是近几年发展的一种光学微电脑技术与医学相结合的现代高科技治疗屈光不正的方法。我们应用美国ｌａｓｅｒｓｉｇｈｔ公司推出的氟化氩准...     

准分子激光屈光性角膜切削术矫治视网膜复位术后屈光不正的效果

目的 探讨准分子激光屈光性角膜切削术（photorefractive keratectomy,PRK)对视网膜复位术后屈光不正的矫治疗效。方法 对因不同原因引起视网膜脱离行视网膜复位手术,且术后随访病情稳定时间＞7个月的屈光不正患者11例（11只眼）行PRK,术后随访时间＞12个月,观察视力、角膜内皮细胞密度和眼底情况。结果 全部患者PRK术后视力均达到或超过术前最佳矫正视力;平均角膜内皮细胞密度与术前比较,差异无显著意义（t检验,P＝0．36）。结论 PRK是治疗视网膜复位术后屈光不正安全、有效的方法;严格掌握手术适应证和手术时机是手术成功的关键。     

准分子激光屈光性角膜切削术治疗近视的临床分析

目的：评价准分子激光屈光性角膜切削术（PRK）治疗不同程度近视的疗效。方法：应用SchwindKeratomF准分子激光机对1995眼不同程度近视（－0．75～15．50D）行PRK治疗。按屈光度分三组：组Ⅰ≤－6．00D,873眼;组Ⅱ－6.25D—－10．00D,774眼;组Ⅲ＞－10．00D,348眼。术后12个月,对三组术后的视力、屈光度及Haze进行随访比较。结果：术后12个月Ⅰ、Ⅱ、Ⅲ组裸眼视力≥0．5者分别为986%,94．2％和60.04％;≥1.0者分别为85．5％,71.3％和25.9％;屈光度在±1．00D以内分别为90．5％,68．8％和29．3％。角膜雾状混浊（Haze）≥2级者分别为0.8％,11．5％和13．7％。结论：PRK治疗中低度近视疗效较好,对高度和超高度近视由于术后Haze和屈光度回退发生率增高,疗效受到明显影响,有待进一步完善手术方法和术后用药等问题。     

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。     

PRK术后口服加巴喷丁止痛效果的临床观察

AIM:To evaluate the antalgic effect of oral gabapendin for postoperative pain after photorefractive keratectomy(PRK).METHODS:Prospective randomized clinical trial at 88 cases undergone PRK. In additional to a standard regimen of topical antibiotics, topical steroids, and topical non-steroid Anti-Inflammatory Drugs (NSAIDs) at all patients, and 40 cases as trial group taken gabapendin protocol for herpes zoster after surgery.Patients completed a maximum pain assessment survey in postoperative 5 days using a pain scale (from zero to four, means 0= no pain,1=mild pain,2=moderate pain,3=severe pain, 4=worst severe pain.). The maximum pain values of postoperative 3 days were recorded.RESULTS:The recovery rate of pain questionnaire was 100%. In gabapendin group, there were 18 cases of 0 degree（45.00%）, 18 cases of 1 degree（45.00%）, 4 cases of 2 degree（10.00%）. In control group, there were 18 cases of 0 degree（37.50%）, 21 cases of 1 degree（4375%）, 4 cases of 2 degree（8.33%）and 5 cases of 3 degree（10.42%）. Welch's test and Tukey post-hoc test showed no statistic significant difference between the gabapendin groups and control group in maximum pain score（P>0.05）.CONCLUSION:There was no additional contribution to PRK pain control under a postoperative standard regimen by oral gabapendin protocol in our experimental design.      

Plasminogen activator activity and inhibition in rabbit tears after photorefractive keratectomy

Plasminogen activator is a normal component of tear fluid that plays a role in corneal wound healing processes. This work examines whether inhibitor-induced low levels of plasminogen activator activity (PAA) during corneal re-epithelialization after excimer laser photorefractive keratectomy (PRK) correlates with the eventual occurrence of haze in rabbit eyes. Tear samples were collected with glass capillaries from 16 eyes of eight New Zealand rabbits, using i.m. injection of pilocarpine hydrochloride for stimulation. Tears were collected before and after PRK surgery, and then daily for 5 days, and every fourth day thereafter for 3 months. Both eyes underwent PRK treatment. One eye of each rabbit was treated as a control while the contralateral eye was treated with aprotinin, a serine protease inhibitor, over the first 7 days. PAA in the tear samples was measured by a spectrophotometric method using human plasminogen and chromogenic peptide substrate S-2251. For the eight control eyes after PRK, the PAA values were significantly lower (day 1) and higher (days 2 and 3) than the equilibrium PAA (p<0.001). The corneas remained clear in each of these control eyes. For the eight contralateral aprotinin-treated eyes after PRK, the PAA values on days 1-7 were significantly lower than the equilibrium PAA (p<0.001). All eight of these aprotinin-treated eyes developed corneal haze after 2 months. There was no significant difference (p=0.06) between control and aprotinin-treated eyes for the equilibrium PAA after 19 days. We conclude that a corneal wound healing abnormality (haze) develops in rabbit eyes after PRK when PAA levels are reduced using aprotinin for a week following PRK.     

准分子激光角膜屈光手术在儿童屈光不正中的应用

准分子激光角膜屈光手术用于治疗成人近视、复性近视散光、远视已被广泛地研究,且显示在成人中其具有良好的安全性、有效性和预测性[1～5].     

地塞米松对兔准分子激光角膜切削术后角膜修复的影响

目的研究地塞米松对PRK术后角膜修复的影响及其作用机理。方法对15只新西兰白兔双眼行准分子激光角膜切削术，术后右眼给予地塞米松，左眼为对照。术后分别进行裂隙灯、光镜和透射电镜检查。结果术后4、8wk，地塞米松组角膜Haze轻于对照组，两组间角膜上皮厚度和角膜基质细胞数无显著性差异（P＞0．05）。结论地塞米松通过减少细胞外基质的合成而减轻Haze的形成，对角膜上皮细胞和角膜基质细胞的增生无影响。     

准分子激光二次切削治疗近视性角膜切削术后欠矫

本研究共１５人（２３眼）于准分子激光角膜切削术后因欠矫而实施二次切削。术前平均屈光度为－９．８６Ｄ（－５．００—－２０．００Ｄ），其中２眼为中度近视（－３．２５—－６．００Ｄ），６眼为高度近视（－６．２５—－９．００Ｄ），１５眼为超高度近视（≥－９．２５Ｄ）。准分子激光二次切削采用治疗性角膜切削术（ＰＴＫ）和光学性角膜切削术（ＰＲＫ）相结合的方法。术后６个月随访结果表明：９１％的裸眼视力≥０．５，７０％的裸眼视力≥１．０，７０％的屈光度在±１．００Ｄ，角膜无明显混浊。由此证明：准分子激光二次切削治疗近视性角膜切削术后欠矫及角膜混浊是有效的。     

Photorefractive keratectomy

Photorefractive keratectomy (PRK) is the alteration of corneal curvature by photoablation with an excimer laser to eliminate or significantly reduce refractive errors. In this paper, we present a comprehensive review of the literature on this procedure, from the principles and development of the laser system, to its clinical application, Melbourne particularly for the correction of myopia. Both animal and human studies have shown promising results and the procedure is fundamentally superior to radial keratotomy and other refractive surgical procedures; patient response is encouraging, refractive results are reasonably predictable and serious adverse effects on the cornea are infrequent. However, a number of concerns remain, including stromal haze and opacification, regression and instability of the refractive effect, decreased visual performance, due to light scattering and an imperfect refracting surface, and potential long-term side-effects. Optometrists should be well informed regarding PRK, so as to provide expert, independent advice for prospective patients, as well as pre- and post-operative follow- up care.     

PRK术后角膜上皮下雾状混浊的相关因素分析

为探讨准分子激光角膜切削术（ｐｈｏｔｏｒｅｆｒａｃｔｉｖｅｋｅｒａｔｅｃｔｏｍｙ，ＰＲＫ）后角膜上皮下雾状混浊（ｈａｚｅ）的原因及影响因素，对ＰＲＫ后６个月时屈光度在－１．００～－１８．５０Ｄ的３１６例（６１５只眼）近视眼的ｈａｚｅ相关因素进行观察和比较。结果：ＰＲＫ后６个月时ｈａｚｅ发生率为４４．７％，１级或以上ｈａｚｅ为１３．３％。ｈａｚｅ的发生率及密度随屈光度增高而增加（Ｐ＜０．０００１），也随切削深度的增加而增加（Ｐ＜０．０００１），术前非接触眼压超过１８ｍｍＨｇ者，ｈａｚｅ的发生率和密度增加（Ｐ＜０．００５），男性较易发生ｈａｚｅ（Ｐ＝０．０００１），与年龄呈负相关（Ｐ＜０．０５）。而角膜厚度、术前戴用接触镜及散光对ｈａｚｅ的影响不显著。结论：高度近视（＞－６．０Ｄ）和过深的切削（＞８０μｍ）是引起ｈａｚｅ的主要原因。术前眼压偏高、年龄偏低对ｈａｚｅ也有明显影响。对ＰＲＫ治疗高度近视应持审     

准分子激光屈光性角膜切削术后的再治疗

目的 评价准分子激光屈光性角膜切削术（ｐｈｏｔｏｒｅｆｒａｃｔｉｖｅ ｋｅｒａｔｅｃｔｏｍｙ,ＰＲＫ）术后因屈光回退,欠矫出现的残留近视及严重角膜上皮下雾状混沌（ｈａｚｅ）而再次手术治疗的疗效及安全性。方法 采用准分子激光仪对－１．００～－１６．５０Ｄ的近视眼及近视散光患者进行治疗。ＰＲＫ术后３５例（５１只眼）患者出现残留近视及严重ｈａｚｅ。结合ＰＲＫ手术及准分子激光治疗性角膜切削术（ｐｈｏｔｏｐ