丝裂霉素C对高度近视患者Epi-LASIK术后Haze及泪膜的影响

发布时间：2018-09-14 16:45

【摘要】：目的通过将0.02%的丝裂霉素C应用于机械法准分子激光上皮瓣下角膜磨镶术(epipolis laser in-situ keratomileusis，Epi-LASIK)治疗高度近视的患者，观察丝裂霉素C对患者术后角膜刺激症状、角膜上皮愈合、裸眼视力、Haze及泪膜等指标的影响，探讨安全有效应用丝裂霉素C的方法，为眼科屈光医生的临床手术提供参考。方法选择2010年7月到10月在我院接受Epi-LASIK手术治疗的高度近视患者57例(114眼)。将其随机分为两组，设术中应用丝裂霉素C组（MMC组）29例（58眼），术中不应用丝裂霉素C组（对照组）28例（56眼）。术后随访1年。观察术后1d、3d、5d、7d患者角膜刺激症状及裂隙灯显微镜下的眼前节情况；角膜上皮愈合时间及裸眼视力；观察术后1m、3m、6m、12m两组Haze分级情况；观察术前及术后1m、3m、6m、12m两组患者双眼裸眼视力、泪液分泌量、泪膜破裂时间、泪液蕨类试验及结膜印记细胞学检查等指标。结果1.术后角膜刺激症状评分比较，术后1d、3d、5d、7d两组t值分别为-0.19，0.00，-1.00，1.00，P值均㧐0.05，两组间比较差异无统计学意义；术后早期裂隙灯显微镜下观察两组患者双眼结膜均无明显充血，角膜基质无水肿，，巩膜无坏死等情况发生。2.术后角膜上皮愈合时间比较，MMC组平均为(5.17±1.03)d，对照组平均为(5.11±1.00)d，两组间比较差异无统计学意义（t=0.00，P㧐0.05）。3.术后早期UCVA比较，两组术后1d比较差异有统计学意义（t=-2.62，P㩳0.05）；术后3d，5d，7d比较差异均无统计学意义（t=-1.61，t=-1.80，t=-1.83，P㧐0.05）。4.术后1m、3m、6m、12m两组间裸眼视力比较差异无统计学意义（t=0.73，t=0.43，t=-0.74，t=0.96，P㧐0.05）。5.术后1m、3m、6m两组间Haze的形成情况比较差异有统计学意义（χ2=12.43，χ2=10.94，χ2=11.51，P㩳0.05）；术后12m Haze比较(χ2=0.46，P㧐0.05)，差异无统计学意义。6.术前及术后1m、3m、6m、12m两组间的泪液分泌试验、泪膜破裂时间、泪液蕨类试验及结膜印记细胞检查比较差异无统计学意义P㧐0.05；术后1m、3m两组泪液分泌试验、泪膜破裂时间、泪液蕨类试验分别与其术前相比P㩳0.05，差异有统计学意义；术后6m、12m两组泪液分泌试验、泪膜破裂时间、泪液蕨类试验分别与其术前比较P㧐0.05，差异无统计学意义。术后1m、3m、6m两组印记细胞学检查与其术前比较P㩳0.05，差异有统计学意义；术后12m两组印记细胞学检查与其术前比较P㧐0.05，差异无统计学意义。结论Epi-LASIK治疗高度近视术中应用0.02%丝裂霉素C作用于切削区，应用时间控制在20-30s，BSS液冲洗时间不少于80s，冲洗量不少于200ml，可有效预防Haze，且无明显毒副作用，不加重术后的角膜刺激症状和泪膜损伤，对角膜上皮愈合及早期裸眼视力恢复无明显影响，有利于后期视力的稳定。
[Abstract]:Objective To observe the effect of 0.02% mitomycin C on corneal irritation, corneal epithelial healing, naked eye vision, Haze and tear film after Epipolis laser in-situ keratomileusis (Epi-LASIK) for high myopia. The effective application of mitomycin C is a reference for ophthalmologists.
Methods 57 patients (114 eyes) with high myopia who underwent Epi-LASIK surgery in our hospital from July to October 2010 were randomly divided into two groups. 29 patients (58 eyes) were treated with mitomycin C during operation and 28 patients (56 eyes) were not treated with mitomycin C during operation. The visual acuity, tear secretion, tear film rupture time, tear Pteridophyte test and conjunctival imprint cytology were observed before and after operation.
Results 1. Comparing the scores of corneal irritation symptoms after operation, the T values of the two groups were - 0.19, 0.00, - 1.00, 1.00, P values were - 0.05 on the 1st, 3rd, 5th and 7th day after operation, and there was no significant difference between the two groups. The average healing time of corneal epithelium in MMC group was (5.17 (+ 1.03) days, and that in control group was (5.11 (+ 1.00) days. There was no significant difference between the two groups (t = 0.00, P? 0.05). 3. There was significant difference in the early postoperative UCVA between the two groups (t = - 2.62, P? 0.05) on the first day after surgery; there was no significant difference between the three, five and seven days after surgery (t = - 1.61, t = - 1.01, t = - 1.05). 80, t = - 1.83, P? 0.05). 4. 1 m, 3 m, 6 m, 6 m, 6 m, 12 m after surgery had no significant difference in naked visual acacuitbetween the two groups (t = 0.73, t = 0.43, t = - 0.74, t = - 0.74, t = 0.96, P? 0.05). 5. There was significant difference in the formation of Haze between the 1 m, 3 m, 6 m groups (962 = 12.43, 962 = 10.94, 962 = 10.94, 962 = 11.51, P? 0.05) 1 m, 1 m, 3 m, 3 m, 3 m, 3 m, 6 m, 6 m, 6 m after surgery (962 = 12 = 12 m = 12.73, 11.51, The difference was not statistically significant. Significance. 6. There was no significant difference in tear secretion test, tear film rupture time, tear fern test and conjunctival imprinted cell test between the two groups at 1 m, 3 m, 6 m and 12 m before and after operation (P?0.05); there was no significant difference in tear secretion test, tear film rupture time and tear fern test between the two groups at 1 m and 3 m after operation (P?0.05). There was no significant difference between the two groups in tear secretion test, tear film rupture time, tear fern test and preoperative P? 0.05 at 6 m and 12 m after operation. Academic significance.
Conclusion The application of 0.02% mitomycin C in the ablation area of high myopia treated with Epi-LASIK can effectively prevent Haze without obvious side effects, aggravation of corneal irritation symptoms and tear film injury, corneal epithelial healing and early naked eyes. Visual recovery has no obvious effect and is conducive to the stability of late vision.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.63

【参考文献】