Das Sujata, Langenbucher Achim, Seitz Berthold
Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany.
J Refract Surg. 2005 Nov-Dec;21(6):727-31. doi: 10.3928/1081-597X-20051101-12.
To compare the visual and refractive outcome after excimer laser phototherapeutic keratectomy (PTK) for superficial comeal opacities in granular and lattice dystrophy.
Phototherapeutic keratectomy was performed in 62 eyes of 40 patients (granular dystrophy [n = 50] and lattice dystrophy [n = 12]) after epithelial debridement and pannus removal. Data regarding pre-and postoperative best spectacle-corrected visual acuity, changes in spherical equivalent of manifest refraction, Zeiss keratometry, astigmatism, and corneal topography were analyzed and compared between granular and lattice dystrophy. Recurrence, if any, was noted during a mean follow-up of 3.0 +/- 2.7 years.
Best spectacle-corrected visual acuity improved in 79% and 62% of eyes with granular and lattice dystrophy, respectively. Spherical equivalent refraction increased by a mean of 1.3 +/- 1.7 diopters (D) (median: 1.0 D) for granular dystrophy and a mean of 1.0 +/- 1.8 D (median: 0.5 D) for lattice dystrophy. The keratometric central power decreased by a mean of -0.8 +/- 4.3 D (median: -1.6 D) for granular dystrophy and a mean of -0.3 +/- 1.6 D (median: -0.7 D) for lattice dystrophy. No significant changes were noted regarding keratometric astigmatism in either granular or lattice dystrophy. The proportion of "regular" and "mild irregular" keratometry mires increased (39% vs 67% for granular dystrophy and 0% vs 50% for lattice dystrophy). In granular dystrophy, the surface regularity index/surface asymmetry index (SRI/SAI) decreased significantly from 2.14/2.24 preoperatively to 1.31/0.80 postoperatively (P = .006/P = .01). In contrast, decrease of SRI/SAI from 1.97/1.65 preoperatively to 1.35/1.16 postoperatively did not reach statistical significance in lattice dystrophy. Recurrences were observed in 10 (20%) eyes with granular dystrophy and 2 (17%) eyes with lattice dystrophy.
Our results suggest that PTK may be tried in all patients with superficially accentuated opacities in granular and lattice dystrophy before undergoing a more invasive procedure, such as lamellar or penetrating keratoplasty.
比较准分子激光光治疗性角膜切削术（PTK）治疗颗粒状和格子状角膜营养不良浅层角膜混浊后的视力和屈光结果。
对40例患者的62只眼（颗粒状角膜营养不良[n = 50]和格子状角膜营养不良[n = 12]）进行上皮清创和血管翳切除后行光治疗性角膜切削术。分析并比较颗粒状和格子状角膜营养不良术前和术后最佳矫正视力、明显验光等效球镜度变化、蔡司角膜曲率计测量值、散光及角膜地形图数据。在平均3.0±2.7年的随访期间记录复发情况（如有）。
颗粒状和格子状角膜营养不良患者中，分别有79%和62%的患眼最佳矫正视力得到改善。颗粒状角膜营养不良患者等效球镜度平均增加1.3±1.7屈光度（D）（中位数：1.0 D），格子状角膜营养不良患者平均增加1.0±1.8 D（中位数：0.5 D）。颗粒状角膜营养不良患者角膜中央曲率平均降低-0.8±4.3 D（中位数：-1.6 D），格子状角膜营养不良患者平均降低-0.3±1.6 D（中位数：-0.7 D）。颗粒状或格子状角膜营养不良患者角膜散光均未观察到显著变化。“规则”和“轻度不规则”角膜曲率计图像的比例增加（颗粒状角膜营养不良从39%增至67%，格子状角膜营养不良从0%增至50%）。颗粒状角膜营养不良患者表面规则性指数/表面不对称性指数（SRI/SAI）从术前的2.14/2.24显著降至术后的1.31/0.80（P = 0.006/P = 0.01）。相比之下，格子状角膜营养不良患者SRI/SAI从术前的1.97/1.65降至术后的1.35/1.16未达到统计学显著性。颗粒状角膜营养不良患者中有10只眼（20%）复发，格子状角膜营养不良患者中有2只眼（17%）复发。
我们的结果表明，对于颗粒状和格子状角膜营养不良浅层混浊加重的所有患者，在进行如板层或穿透性角膜移植等更具侵入性的手术之前，可尝试PTK。
