丝裂霉素 C 经上皮表面消融治疗腺病毒性角结膜炎后慢性中央性角膜瘢痕。

Transepithelial Surface Ablation With Mitomycin C for the Treatment of Chronic Central Corneal Scars Following Adenoviral Keratoconjunctivitis.

出版信息

J Refract Surg. 2020 Jan 1;36(1):55-61. doi: 10.3928/1081597X-20191203-01.

DOI:10.3928/1081597X-20191203-01

PMID:31917852

Abstract

PURPOSE

To assess visual and refractive outcomes and recurrence rates of subepithelial infiltrates after corneal surface ablation with mitomycin C (MMC) 0.02% for the treatment of chronic corneal scars following epidemic keratoconjunctivitis and to compare these results with a control group receiving only medical treatment.

METHODS

This was a retrospective case series enrolling patients with central corneal scars following epidemic keratoconjunctivitis. Patients were divided into two groups: (1) control with clinical follow-up and refractive correction with glasses or rigid gas-permeable contact lenses when necessary and (2) transepithelial phototherapeutic keratectomy (PTK) with MMC 0.02%, combined with photorefractive keratectomy (PRK) in selected cases (treatment group). Signs and symptoms, corrected distance visual acuity (CDVA) in logMAR units, manifest and cycloplegic refraction, and depth of the corneal opacities were assessed.

RESULTS

Thirty-five eyes of 27 patients (11 men [40.7%] and 16 women [59.3%]) were enrolled, with a mean follow-up of 54.4 ± 19.7 and 27.5 ± 22.8 months in the control and treatment groups, respectively. Mean improvement in CDVA was 0.13 ± 0.17 logMAR (P = .007) in the control group and 0.29 ± 0.24 logMAR (P = .001) in the treatment group. Intergroup comparison showed a greater improvement in the treatment group (P = .041). Mean hyperopic shift induced in the treatment group was +0.46 ± 1.20 diopters. The recurrence rate of subepithelial infiltrates was 77.7% in the control group and 11.7% in the treatment group throughout the follow-up (54.4 ± 19.7 and 27.5 ± 22.8 months, respectively).

CONCLUSIONS

Corneal surface ablation with MMC 0.02% was efficient in treating corneal scars following adenoviral epidemic keratoconjunctivitis, with greater visual improvement in comparison to clinical treatment and a decreased rate of infiltrate recurrence. [J Refract Surg. 2020;36(1):55-61.].

摘要

目的

评估在腺病毒性流行角膜结膜炎后使用丝裂霉素 C（MMC）0.02％进行角膜表面消融术治疗慢性角膜瘢痕后的视力和屈光结果以及复发率，并与仅接受药物治疗的对照组进行比较。

方法

这是一项回顾性病例系列研究，纳入了腺病毒性流行角膜结膜炎后出现中央角膜瘢痕的患者。患者分为两组：（1）对照组，进行临床随访，并在必要时通过眼镜或硬性透气性隐形眼镜进行屈光矫正；（2）在选择的病例中进行经上皮光化学角膜切削术（PTK）联合 MMC 0.02％，并结合准分子激光屈光性角膜切削术（PRK）（治疗组）。评估体征和症状、对数视力记录（logMAR）单位的矫正远视力（CDVA）、显性和睫状肌麻痹屈光、角膜混浊深度。

结果

共有 27 名患者（11 名男性[40.7％]和 16 名女性[59.3％]）的 35 只眼被纳入研究，对照组和治疗组的平均随访时间分别为 54.4±19.7 和 27.5±22.8 个月。对照组 CDVA 的平均改善为 0.13±0.17 logMAR（P=0.007），治疗组为 0.29±0.24 logMAR（P=0.001）。组间比较显示治疗组的改善更大（P=0.041）。治疗组诱导的远视漂移平均值为+0.46±1.20 屈光度。对照组的上皮下浸润复发率在整个随访期间为 77.7％，治疗组为 11.7％（分别为 54.4±19.7 和 27.5±22.8 个月）。