准分子激光上皮下角膜磨镶术中应用丝裂霉素C对角膜内皮及后表面的影响

摘要

目的 探讨准分子激光上皮下角膜磨镶术(LASEK)术中应用0.02％丝裂霉素C(MMC)对角膜内皮及后表面的影响.方法 前瞻性连续性双盲病例研究.在复旦大学附属眼耳鼻喉科医院行LASEK手术的连续病例33例(66眼),随机选择一眼,在准分子激光切削后在基质床面留置0.02％MMC棉片20 s,另一眼不应用MMC;对比患者术后3、6个月中央角膜内皮细胞计数、变异系数以及角膜后表面前移量.采用配对t检验进行统计学分析.结果 术后3、6个月MMC应用眼的内皮细胞密度分别为(3353.3±290.3)个/mm2、(3407.6±298.4)个/mm2；变异系数分别为(13.36±6.29)％、(13.48±4.34)％；对照眼相应时间段的内皮细胞密度分别为(3258.7±284.6)个/mm2、(3339.2±213.4)个/mm2；变异系数分别为(14.52±7.85)％、(14.06±6.50)％,各参数差异均无统计学意义.术后3、6个月MMC应用眼的角膜后表面前移量分别为(-0.67±2.26)μm、(-0.52±2.67)μm；角膜后表面曲率改变分别为(0.01±0.20)D、(0.01±0.21)D；对照眼相应时间段的角膜后表面前移量分别为(-0.85±2.31)μm、(-0.15±3.00)μm；角膜后表面曲率改变分别为(-0.01±0.22)D、(0.05±0.17)D,差异均无统计学意义.结论 LASEK术中使用0.02％ MMC对角膜内皮细胞密度、变异系数、角膜后表面高度等无明显影响,安全性较高.%Objective To investigate the clinical effect of mitomycin C (MMC) on the corneal endothelium and corneal posterior surface after laser subepithelial keratomileusis (LASEK).Methods In a continuity prospective double-blind study,0.02％ MMC was used topically for 20 seconds in 33 eyes of 33 patients who had undergone LASEK after excimer laser ablation in the Fudan EENT Hospital.The other eye of these patients without MMC treatment was used as the control.Three and 6 months after surgery,the changes in the curve and elevation of the corneal posterior surface,and the density and variation coefficient of corneal endothelial cells were observed to evaluate the MMC toxicity.Data were analyzed using a paired t test.Results In the MMC-treated eyes,3 and 6 months after the operation,the average corneal endothelium cell density was 3353.3±290.3 cells/mm2 and 3407.6±298.4 cells/mm2; the variation coefficient was 13.36％±6.29％ and 13.48±4.34％.In the control eyes 3 and 6 months after the operation,the average corneal endothelium cell density was 3258.7±284.6 cells/mm2 and 3339.2±213.4 cells/mm2; the variation coefficient was 14.52％±7.85％ and 14.06％±6.50％.The changes in the elevation and curve of the corneal posterior surface in the MMC treated eyes were-0.67±2.26 μm and-0.52±2.67 μm and 0.01±0.20 D and 0.01±0.21 D,3 and 6 months after the operation.The changes in the control eyes were-0.85±2.31 μm and -0.15±3.00 μm and-0.01±0.22 D and 0.05+0.17 D at the respective time points after the operation.There were no significant differences in the above parameters either between preoperative or postoperative data or between these two groups.Conclusion The study showed that the application of 0.02％ mitomycin C in LASEK is safe.