Kuo Irene C, Lee Salena M, Hwang David G
Cornea and Refractive Surgery Service of the Department of Ophthalmology, University of California, San Francisco, San Francisco, CA 94143, USA.
Cornea. 2004 May;23(4):350-5. doi: 10.1097/00003226-200405000-00007.
To report the incidence and clinical course of a series of patients who developed both delayed-onset, clinically significant progressive haze and myopic regression after photorefractive keratectomy (PRK).
In this retrospective case series, the charts of 542 consecutive patients who had undergone PRK with the VISX Star Excimer or Nidek EC-5000 laser between July 1996 and October 1998 and who had a minimum of 6 months of follow-up were reviewed. Ten eyes of 8 patients developed progressive haze to greater than 1+ and myopic regression equal to or more than -1 D 3 months or more after PRK. The historical and clinical features were reviewed.
The incidence of combined progressive haze and myopic regression was 1.8%. The average age was 40.5 years. Three of the 8 patients were female. The median spherical equivalent (SE) attempted correction was -6.69 D (range -4.00 to -12.25 D). Five patients who underwent bilateral PRK had unilateral involvement. The mean SE regression was -2.01 +/- 0.79 D (range -1.00 to -3.00 D). Regression plateaued at a mean of 9.8 months. Haze ranging up to 4+ peaked at a mean of 7.4 months. Topical steroid treatment and/or epithelial scraping was attempted in 3 eyes but was ineffective.
Combined delayed-onset progressive haze and myopic regression can occur after PRK. In such cases, the amount of haze appears to correlate with the magnitude of attempted initial correction (r = 0.639, P = 0.046) although not with the magnitude of subsequent regression. Patients may need at least 10 months of follow-up to achieve a stable refraction and level of haze. These observations suggest a need for improved understanding of corneal wound healing following PRK and of biologic factors that may contribute to variability in outcomes.
报告一系列在准分子激光原位角膜磨镶术（PRK）后出现延迟性、具有临床意义的渐进性角膜混浊及近视回退的患者的发病率及临床病程。
在这个回顾性病例系列中，对1996年7月至1998年10月期间连续542例行VISX Star准分子激光或Nidek EC - 5000激光PRK且随访至少6个月的患者病历进行了回顾。8例患者的10只眼在PRK后3个月或更长时间出现渐进性角膜混浊加重至超过1+且近视回退等于或超过-1 D。对其病史及临床特征进行了回顾。
渐进性角膜混浊合并近视回退的发病率为1.8%。平均年龄为40.5岁。8例患者中有3例为女性。尝试矫正的等效球镜（SE）中位数为-6.69 D（范围-4.00至-12.25 D）。5例行双侧PRK的患者为单侧受累。平均SE回退为-2.01±0.79 D（范围-1.00至-3.00 D）。回退在平均9.8个月时趋于平稳。角膜混浊程度高达4+在平均7.4个月时达到峰值。3只眼尝试了局部类固醇治疗和/或上皮刮除，但无效。
PRK后可出现延迟性渐进性角膜混浊合并近视回退。在这些病例中，角膜混浊程度似乎与最初尝试矫正的度数相关（r = 0.639，P = 0.046），尽管与随后回退的度数无关。患者可能需要至少10个月的随访以获得稳定的屈光状态和角膜混浊水平。这些观察结果表明需要更好地理解PRK后的角膜伤口愈合以及可能导致结果变异性的生物学因素。
