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。

Phototherapeutic keratectomy combined with photorefractive keratectomy for the treatment of myopia with corneal scars

OBJECTIVE: To evaluate the effects of phototherapeutic keratectomy (PTK) combined with photorefractive keratectomy (PRK) in the treatment of myopia with corneal scars. METHODS: Corneal epithelium was removed with laser plus scraping (d=7.0 mm). Corneal scars were removed with PTK (d=7.0 mm) and followed by PRK for myopia (d=6.0 mm). Healon was used to make corneal surface smoother during operation. RESULTS: 79 eyes of 54 cases of myopia with corneal scars were followed up at least for one year. Mean refractive degree was (-6.73 +/- 4.17) D and corrected vision was 0.63 before operation. After operation,corneal scars in 50 eyes (63.3%) were removed in operative zone and corneal haze was less than I degree. The vision acuity in 69 eyes (89.9%) was equal to or better than preoperative best correction. Mean postoperative vision was 0.74.Corneal surface was smoother and astigmatism was reduced after surgery. CONCLUSION: PTK combined with PRK is a safe and effective treatment for myopia with corneal scars.