Guglielmetti Stefano, Kirton Amy, Reinstein Dan Z, Carp Glenn I, Archer Timothy J
J Refract Surg. 2017 Oct 1;33(10):714-719. doi: 10.3928/1081597X-20170721-04.
To evaluate the outcome of transepithelial phototherapeutic keratectomy (PTK) in the management of irregularly irregular astigmatism.
This was a case series of two patients who underwent transepithelial PTK for irregularly irregular astigmatism. In the first case, the patient complained of diplopia due to corneal scarring caused by a metallic foreign body injury. The topography demonstrated irregularly irregular astigmatism with significant asymmetry in the inferotemporal to superonasal axis. In the second case, the patient complained of blurred vision and ghosting caused by significant central epithelial ingrowth through a buttonhole LASIK flap, which was causing a localized irregularity on topography. Due to the localized nature of the irregularities, a transepithelial PTK treatment was preferred to custom ablation given the degree of epithelial masking present.
Transepithelial PTK was performed in both cases using the Schwind Amaris 500E excimer laser (Schwind eye-tech-solutions, Kleinostheim, Germany) and an 8-mm optical zone. The ablation depth was planned to reach the depth of the epithelium using a stepwise protocol, reviewing the pattern of the remaining epithelium and regularity of the stromal surface between each ablation. A marked improvement in the regularity of the topography was achieved in both cases, with only regular astigmatism remaining. Both patients reported a subjective improvement in quality of vision and the corrected distance visual acuity improved by one and two lines, respectively.
Transepithelial PTK was effective in treating these cases of localized irregularly irregular astigmatism, achieving both objective and subjective improvement in vision. Compensatory epithelial remodeling over the irregularities enabled the transepithelial PTK approach to target the stromal surface irregularities. [J Refract Surg. 2017;33(10):714-719.].
评估经上皮光治疗性角膜切削术（PTK）治疗不规则散光的效果。
这是一个包含两名因不规则散光接受经上皮PTK治疗患者的病例系列。在第一个病例中，患者因金属异物损伤导致角膜瘢痕而出现复视。角膜地形图显示为不规则散光，在颞下至鼻上轴存在明显不对称。在第二个病例中，患者因LASIK瓣纽扣孔处严重的中央上皮内生导致视力模糊和重影，这在角膜地形图上造成了局部不规则。由于不规则的局限性，考虑到存在的上皮遮盖程度，相较于定制消融，经上皮PTK治疗更为可取。
两例患者均使用Schwind Amaris 500E准分子激光（德国克莱诺施泰姆的Schwind眼科技解决方案公司）及8毫米光学区进行经上皮PTK治疗。采用逐步方案规划消融深度，以达到上皮深度，在每次消融之间检查剩余上皮的形态和基质表面的规则性。两例患者的角膜地形图规则性均有显著改善，仅残留规则散光。两名患者均报告视力质量有主观改善，矫正远视力分别提高了一行和两行。
经上皮PTK治疗这些局限性不规则散光病例有效，在视力方面实现了客观和主观的改善。不规则区域上的代偿性上皮重塑使经上皮PTK方法能够针对基质表面不规则性。[《屈光手术杂志》。2017年；33(10):714 - 719。]
