Nakamura Tomoaki, Kataoka Takahiro, Kojima Takashi, Yoshida Yoko, Sugiyama Yasuo
Nagoya Eye Clinic, Nagoya, Japan.
Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
Cornea. 2018 May;37(5):548-553. doi: 10.1097/ICO.0000000000001548.
This retrospective study aimed to evaluate the effectiveness of a novel procedure named phototherapeutic refractive keratectomy (PTRK), which is a sequential procedure composed of phototherapeutic keratectomy ablation for removal of opacities, followed by smoothing ablation for reducing the corneal surface irregularities and photorefractive keratectomy ablation for correcting refractive errors in eyes with primary granular corneal dystrophy.
Twenty-three eyes of 17 patients with granular corneal dystrophy were treated with PTRK. Preoperative and postoperative visual acuity, corneal topography, and changes in spherical equivalent and cylindrical refraction were examined and analyzed.
The mean spherical equivalent power changed from -0.11 ± 1.36 diopters (D) to 0.19 ± 0.91 D postoperatively (P = 0.121). The change in the mean spherical equivalent was +0.30 ± 0.99 D. The mean preoperative uncorrected distance visual acuity (logMAR) of 0.40 ± 0.26 significantly improved to 0.075 ± 0.145 at 3 months after PTRK (P < 0.001). The mean preoperative corrected distance visual acuity (logMAR) of 0.18 ± 0.17 significantly improved to -0.02 ± 0.11 at 3 months after PTRK (P < 0.01). The surface regularity index was significantly decreased from 0.93 ± 0.46 preoperatively to 0.60 ± 0.30 postoperatively (P < 0.001).
Our results showed that PTRK could improve corneal surface irregularities and remove opacities. Furthermore, both corrected visual acuity and uncorrected visual acuity improved by the addition of refractive correction. PTRK is a promising surgical procedure for improving postoperative quality of life with a high degree of patient satisfaction.
本回顾性研究旨在评估一种名为光治疗性屈光性角膜切除术（PTRK）的新手术的有效性，该手术是一种序贯手术，包括用于清除混浊的光治疗性角膜切除术消融，随后进行用于减少角膜表面不规则性的平滑消融，以及用于矫正原发性颗粒状角膜营养不良患者眼睛屈光不正的准分子激光原位角膜磨镶术消融。
对17例颗粒状角膜营养不良患者的23只眼睛进行了PTRK治疗。检查并分析术前和术后的视力、角膜地形图以及球镜等效度和柱镜屈光度的变化。
术后球镜等效度平均屈光度从术前的-0.11±1.36屈光度（D）变为0.19±0.91 D（P = 0.121）。球镜等效度的平均变化为+0.30±0.99 D。PTRK术后3个月时，术前平均未矫正远视力（logMAR）为0.40±0.26显著提高至0.075±0.145（P < 0.001）。术前平均矫正远视力（logMAR）为0.18±0.17在PTRK术后3个月时显著提高至-0.02±0.11（P < 0.01）。表面规则性指数从术前的0.93±0.46显著降至术后的0.60±0.30（P < 0.001）。
我们的结果表明，PTRK可以改善角膜表面不规则性并清除混浊。此外，通过增加屈光矫正，矫正视力和未矫正视力均得到改善。PTRK是一种有前景的手术方法，可提高术后生活质量，患者满意度高。
