丝裂霉素C用于不同屈光度LASEK术中的对比研究

目的探讨丝裂霉素C（MMC）对不同屈光度准分子激光上皮瓣下角膜磨镶术（LASEK）后角膜上皮下雾状浑浊（haze）与屈光回退的影响。方法将接受LASEK手术者先根据屈光度分为低、中、高度组,再将各组分为LASEK组和LASEK联合MMC组。低、中、高度LASEK联合MMC组在激光切削完毕后用浸有0.02%MMC的绵片覆于角膜切削区,时间分别为20～25s、40～50s、60～80s。术后早期观察眼部刺激症状及角膜上皮愈合情况;1、3、6、12个月复查视力、角膜haze及角膜地形图。结果 （1）术后疼痛反应、角膜上皮愈合时间低、中、高度的LASEK组与LASEK联合MMC组无显著性差异（P〉0.05）;（2）术后1、3、6、12个月,haze发生率低度近视LASEK组与LASEK联合MMC无显著性差异,中、高度近视LASEK联合MMC组haze发生率低于LASEK组（P〈0.05）;（3）低、中、高度近视LASEK联合MMC组角膜曲率术后1a与1个月相比,差别无统计学意义（P〉0.05）,高度近视LASEK组角膜曲率术后1a与1个月相比差异有统计学意义（P〈0.05）;（4）术后1a低、中近视LASEK联合MMC组与LASEK组达最佳矫正视力者差异无统计学意义（P〉0.05）,但高度近视LASEK联合MMC组达最佳矫正视力的眼数多于LASEK组（P〈0.05）。结论 LASEK术中MMC敷贴合适时间可以降低术后haze及屈光回退的发生率,高度近视组尤为显著;术前屈光度越高,所需MMC敷贴时间越长。

A clinical application of mitomycin C in LASEK in for different diopter myopia

Objective To explore the clinical effect of application of mitomycin C （MMC） on preventing haze after LASEK in different diopter myopia. Methods The patients who accepted LASEK were firstly divided into the groups of low myopia （〈-3.00D）、medium myopia （-3.00D～-6.00D） and high myopia （〉-6.00D） according to their myopic diopter.Then each group was randomly divided into LASEK group and LASEK＋MMC group. LASEK＋MMC group was covered by 0.02% MMC cotton pad on the corneal stroma after excimer laser ablation,the times of low、medium and high myopia were 20-25 s、40-50 s and 60-80 s. Stimulus syndrome and corneal epithelial healing time were observed at the early stage after operation. Visual acuity,diopter,haze and corneal topograph were measured in 1,3,6,12 months after operation.Results （1）Stimulus syndrome and time for healing of the corneal epithelium in the LASEK group and LASEK＋MMC group of low myopia group,medium myopia group and high myopia group was not significantly different （P〉0.05）; （2） In low myopia group,haze in the LASEK group and LASEK＋MMC group was not significantly different in 1,3,6,12 months after operation （P〉0.05）.In medium myopia and high myopia group,haze in the LASEK＋MMC group was significantly lower than that in LASEK group in 1,3,6,12 months after operation （P〈0.05）; （3）There was no significant difference of corneal refraction between one year and one month after operation in LASEK＋MMC group of low myopia,medium myopia and high myopia groups （P〉0.05）.However,corneal refraction in the LASEK group of high myopia group was significantly different between one year and one month （P〈0.05）. （4）In low myopia group and medium myopia group,the best correctted visual acuity in the LASEK＋MMC group and LASEK group was not significant different one year after operation （P〉0.05）. In high myopia group,the best correctted visual acuity in LASEK＋MMC group was higher than that in LASEK group （P〈0.05）. Conclusion The introperative application of the lower concentration MMC in LASEK can effectively refrain the occurrence of haze,and prevent the recession of the refractive condition,especially in high myopia;the higher the diopter is,the longer covered by MMC cotton pad.