Wiegand W, Krusenberg B, Volk J, Kroll P
Allgemeines Krankenhaus Heidberg, Hamburg.
Ophthalmologe. 1996 Jun;93(3):237-41.
Photorefractive keratectomy (PRK) by excimer laser is now a scientifically established treatment method in low and moderate myopia. In high and very high myopia, however, the formation of severe corneal haze or scars and a considerable regression of refraction remain obstacles to the use of PRK. One approach to these two problems is to perform an intrastromal keratectomy. PATIENTS AND METHOD. Between September 1992 and September 1994 intrastromal keratectomy was carried out in 42 eyes with myopia between -8.625 and -36 D. Twenty-one eyes (spherical equivalent of pre-operative refraction between -12.12 and -36 D) were treated by keratomileusis in situ, and 21 eyes (spherical equivalent of pre-operative refraction between -8.625 and -29.25 D) by intrastromal excimer laser keratectomy. Thirty-two eyes were followed up for at least 12 months. RESULTS. The post-operative refraction (spherical equivalent) ranged between +1.375 D and -5.0 D in the keratomileusis in situ group and between +1.5 D and -3.0 D in the intrastromal excimer laser keratectomy group. Nearly all patients regained their pre-operative visual acuity quickly. In the long-term follow-up (1 year) no significant regression of refraction occurred; the pre-operative visual acuity was regained in both groups after 1 year. Significant astigmatism was not induced. CONCLUSIONS. Intrastromal keratectomy is able to correct even very high myopias quite precisely and without regression of the refractive outcome. In addition, considerable haze can be avoided. For these reasons, in high and very high myopia intrastromal keratectomy seems to be superior to conventional anterior photorefractive keratectomy (PRK) by excimer laser.
准分子激光原位角膜磨镶术（PRK）目前是治疗低度和中度近视的一种科学认可的治疗方法。然而，在高度和超高度近视中，严重角膜混浊或瘢痕的形成以及屈光度的显著回退仍然是应用PRK的障碍。解决这两个问题的一种方法是进行基质内角膜切除术。患者和方法。1992年9月至1994年9月，对42只近视度数在-8.625至-36D之间的眼睛进行了基质内角膜切除术。21只眼睛（术前等效球镜度在-12.12至-36D之间）接受了原位角膜磨镶术治疗，21只眼睛（术前等效球镜度在-8.625至-29.25D之间）接受了基质内准分子激光角膜切除术治疗。32只眼睛至少随访了12个月。结果。原位角膜磨镶术组术后屈光度（等效球镜度）在+1.375D至-5.0D之间，基质内准分子激光角膜切除术组在+1.5D至-3.0D之间。几乎所有患者都迅速恢复了术前视力。在长期随访（1年）中，屈光度无显著回退；两组在1年后都恢复了术前视力。未诱发明显散光。结论。基质内角膜切除术能够非常精确地矫正甚至超高度近视，且屈光结果无回退。此外，还可避免相当程度的混浊。基于这些原因，在高度和超高度近视中，基质内角膜切除术似乎优于传统的准分子激光表面角膜切削术（PRK）。
