摘要:
Objective To evaluate the efficacy and safety of phototherapeutic keratectomy (PTK)and photoreffactive keratectomy (PRK) combined with corneal collagen cross-linking (CXL) in preventing the progression of post-laser-assisted in situ keratomileusis (LASIK) keratectasia.Methods In this prospective,self-controlled study,16 eyes of 14 patients with post-LASIK keratectasia underwent PTK and PRK combined with CXL procedures.None of the 14 patients had keratoconus before LASIK.The main outcomes were measured and recorded at baseline and at months 1,3,and 6 after LASIK.The measured parameters included logarithm of the minimum angle of resolution (LogMAR) of the uncorrected visual acuity (UCVA),LogMAR of the best-corrected visual acuity (BCVA),central comeal thickness (CCT),maximum front keratometry (Kmax),and endothelial cell density (ECD).Data were analyzed using Wilcoxon rank sum test.Results PTK and PRK combined with CXL appeared to halt the progression of post-LASIK keratectasia without apparent complications.LogMAR UCVA improvements were statistically significant (P<0.01) at 1,3,and 6 months postoperatively (M=0.10,0.10,and 0.00,respectively).There was also a significant reduction in Kmax (P<0.05) at postoperative months 1,3 and 6.At 6 months after surgery,M of CCT was decreased (P<0.01).There were no significant changes in LogMAR BCVA or ECD during 6 months of follow-up.Conclusion PTK+PRK+CXL is effective and safe in treating post-LASIK keratectasia.Without apparent complications,it can improve UCVA and reduce Kmax after surgery.%目的 联合准分子激光治疗性角膜切削术(PTK)、准分子激光屈光性角膜切削术(PRK)和核黄素诱导的长波紫外线角膜胶原交联术(CXL)对准分子激光原位角膜摩镶术(LASIK)术后角膜膨隆进行交联和屈光重建,评价该方法对LASIK术后角膜膨隆的临床疗效.方法 前瞻性自身对照研究.选择早中期LAISK术后角膜膨隆患者14例(16眼),均采用PTK+PRK+CXL进行治疗,记录术前及术后1、3、6个月的裸眼视力(UCVA)、最佳矫正视力(BCVA)、角膜前表面最大曲率(Kmax)值、中央角膜厚度(CCT)、角膜内皮细胞密度(ECD).应用Wilcoxon符号秩和检验行数据分析.结果 16只患眼术前的LogMAR UCVA中位数为0.50,术后1、3、6个月的logMAR UCVA中位数分别为0.10、0.10和0.00,与术前相比均提高(P<0.01);术后1、3、6个月Kmax的中位数值分别为44.80、44.85、45.20 D,均较术前(47.15 D)降低(P<0.05);角膜厚度的中位数值在术后1、3、6个月分别为450、422、420 μm,与术前差异均有统计学意义(P<0.01).而术后1、3、6个月的BCVA、ECD与术前差异均无统计学意义.结论 PTK+PRK+CXL治疗LAISK术后角膜膨隆安全、有效,术后UCVA提高、Kmax降低.