地形图引导的经上皮准分子激光屈光性角膜切削术治疗穿透性角膜移植术后散光

目的评价地形图引导的经上皮准分子激光屈光性角膜切削术（T-PRK）治疗穿透性角膜移植（PKP）术后高度散光及不规则散光的安全性和有效性。方法非随机、回顾性研究。收集PKP术后因高度散光或不规则散光而接受地形图引导的T-PRK治疗的患者18例（20眼）。记录并分析术前及进行本研究时末次随访的裸眼视力（UDVA）、最佳矫正视力（CDVA）、屈光状态、角膜地形图及视觉症状变化等，应用秩和检验对视力、屈光状态、角膜地形图变化进行比较。结果术后平均随访（12.15±2.06）个月。平均logMAR UDVA由1.36±0.42提高到0.65±0.40（Z=-3.727，P＜0.01）；平均CDVA由0.34±0.22提高到0.17±0.14（Z=-3.607，P＜0.01），10眼CDVA提高≥2行。术后平均球镜度由（1.48±3.14）D下降到（-0.19±2.11）D （Z=-2.373，P＜0.05）；术后平均柱镜度由（-7.81±3.43）D下降到（-3.06±1.99）D （Z=-3.792，P＜0.01）；术后平均等效球镜矫正度（术后实际值与术前目标值之差）为（-1.72±2.55）D，其中3眼在目标值±0.50 D范围内，9眼在目标值±1.00 D范围内。平均角膜不规则指数由（66.33±22.03）μm 降低为（59.11±14.66）μm（Z=-0.831，P＞0.05），而平均角膜正交曲率不对称性由（8.96±4.36）D降低为（7.44±3.56）D （Z=-2.576，P＜0.05）。患者术后视觉症状均不同程度好转，无一症状恶化。结论地形图引导的T-PRK是治疗PKP术后高度散光及不规则散光的一种安全、有效的方法。

Clinical research on topography-guided transepithelial photorefractive keratectomy in the treatment of astigmatism after penetrating keratoplasty

ObjectiveTo evaluate the safety and efficacy of topography-guided transepithelial photorefractive keratectomy （T-PRK） in the treatment of high and irregular astigmatism after penetrating keratoplasty （PKP）. MethodsIn this non-randomized retrospective study， 18 patients （20 eyes） with high or irregular astigmatism after PKP were treated with topography-guided T-PRK. Uncorrected distance visual acuity （UDVA）， corrected distance visual acuity （CDVA）， refraction， corneal topography， and subjective evaluation of visual symptoms were recorded and analyzed both preoperatively and at the last follow-up visit during this study. A Wilcoxon signed-rank test was used for the statistical analysis of UDVA， CDVA， refraction and corneal topography. ResultsAt a mean follow-up time of 12.15±2.06 months postoperatively， mean UDVA and CDVA improved from 1.36±0.42 to 0.65±0.40 （Z=-3.727， P＜0.01）， and from 0.34±0.22 to 0.17±0.14 （Z=-3.607，P＜0.01）， respectively， with 10 eyes gaining two or more lines of CDVA. Moreover， mean sphere decreased from 1.48±3.14 D to -0.19±2.11 D （Z=-2.373， P＜0.05）； mean cylinder was reduced from -7.81±3.43 D to -3.06±1.99 D （Z=-3.792， P＜0.01）； the mean postoperative spherical equivalent （SE） refraction adjusted by intended SE was -1.72±2.55 D. Of all eyes， 3 eyes were within ±0.50 D of the intended refraction， 9 eyes were within ±1.00 D of the intended refraction. The mean corneal irregularity index （IRI） and orthogonal curvature asymmetry decreased from 66.33±22.03 μm to 59.11±14.66 μm （Z=-0.831， P＞0.05）， and from 8.96±4.36 D to 7.44±3.56 D （Z=-2.576， P＜0.05） respectively. All patients reported visual symptoms had improved or remained unchanged. ConclusionTopography-guided T-PRK appears to be a safe and effective treatment for post-PKP high and irregular astigmatism.