丝裂霉素在准分子激光角膜上皮瓣下磨镶术中的应用

摘要

目的观察丝裂霉素在准分子激光矫正近视手术中的临床疗效和安全性。方法对照研究将812眼随机分为术中使用丝裂霉素与不使用丝裂霉素组，术后随访两组患者的刺激症状，角膜上皮生长情况，术后视力，验光，眼压和haze情况并进行总结。结果所有病例均按预期完成手术。随诊时间3个月至3年，两组刺激症状较轻，多发生在手术后第1天，一般术后第2天就会好转，术后第3天检查，实验组有40眼为1～2级刺激症状，对照组有38眼为1～2级刺激症状，两组差异无统计学意义（P＞0．05）。两组角膜上皮完全愈合时间为3～5d，其中实验组平均为（3．75±0．72）d，对照组平均为（3．54±0．85）d，两组差异无统计学意义（P＞0．05）。3～5d摘镜时，实验组有382眼（94．1％），对照组有396眼（97．5％），角膜上皮愈合良好。术后3个月检查，实验组术后视力满意为390眼（93．6％），对照组为344眼（84．7％），两组差异有统计学意义（P＜0．05）。术后3个月检查，屈光度较术后3个月时回退超过0．50D，丝裂霉素组有22眼（5．4％），对照组有46眼（11．3％）。术后3月检查，实验组有336眼（82．8％）为0级haze，对照组有252眼（62．1％）为0级haze，两组差异有统计学意义（P＜0．05）。结论在准分子矫正近视手术中，一次性应用0．2g/L丝裂霉素可以减轻术后haze的反应，减少术后视力的回退，无明显不良反应。%Objective The explore the therapeutic effectiveness and safety of mitomycin C in eximer laser epi-thelial keratomileusis (ELEK) .Methods 812 eyes were divided into two groups ,including experiment group with mitomycin C application and control group without mitomycin C application ,and irritative symptom ,growth of epi-thelium ,postoperative visual acuity ,optometry ,intraocular pressure and haze conditions were compared between the two groups .Results Operation of all cases were accomplished as expected .During follow-up from 3 months to 3 years ,the irritation in both groups was slight ,most of which happened on the 1st day after surgery ,improve on the 2nd day .On 3rd day after surgery ,40 eyes in experiment group and 38 eyes in control group were with I - Ⅱ level irritative symptoms ,and the difference was not significant (P>0 .05) .The average time of healing of the epithelium in experiment group and control group were (3 .75 ± 0 .72) and (3 .54 ± 0 .85)d ,and the difference was not signifi-cant (t=1 .522 ,P>0 .05) .After 3 to 5 days ,the lens could be taken off ,and 382 eyes (94 .1% ) in experiment group and 396 eyes (97 .5% ) in control group were with satisfactory healing of epithelium .Three months after oper-ative ,390 eyes (93 .6% ) in experiment group were with satisfactory visual acuity ,higher than control group [344 eyes (84 .7% ) ,P<0 .5] .Compared with before surgery ,diopter of 22 eyes (5 .4% ) in experiment group ,detected three months after surgery ,returned -0 .50D ,and 46 eyes (11 .3% ) in control group were with the same changes . Besides ,there were 334 eyes (82 .3% ) of 0 level haze in experiment group ,higher than control group [250 eyes (61 .6% ) , P<0 .05] .Conclusion Application of 0 .2 g/L mitomycin C at once in ELEK operation could reduce the postoperative haze-reaction and the return of the visual acuity ,meanwhile without obvious side effect .