Corbett M C, O'Brart D P, Warburton F G, Marshall J
Department of Ophthalmology, St. Thomas' Hospital, London, England, UK.
Ophthalmology. 1996 Sep;103(9):1381-91. doi: 10.1016/s0161-6420(96)30494-6.
BACKGROUND/PURPOSE: After photorefractive keratectomy (PRK), the final refraction in the majority of patients is near the intended refraction. However, a significant proportion of patients show regression, which is commonly associated with corneal haze. This study aims to determine whether biologic and environmental factors influence the outcome of PRK.
One hundred patients prospectively underwent -3.00- or -6.00-diopter corrections. Three months after surgery, 100% of patients answered a questionnaire that recorded their biologic characteristics, medical and ocular history, and postoperative exposure to physical and chemical insults. Multivariable analysis identified those factors associated with regression.
Multivariable analysis showed that the risk of regression was increased significantly in patients who underwent higher dioptric or smaller diameter treatments (P = 0.045) and in those who had had regression after treatment of the first eye (P = 0.019). There was no difference between the sexes, but regression was 13.5 times more likely in females who were taking oral contraceptives. Regression was increased in those exposed to solar radiation (odds ratio, 7.6; 95% confidence interval, 1.82-32.22) and sun beds (odds ratio, 2.4; 95% confidence interval, 0.64-9.39), and was significantly greater in patients with ocular-surface disorders (on univariable analysis only; P = 0.034). Regression was not associated with previous contact lens wear, swimming, cigarette smoking, or minor ocular trauma.
The questionnaire identified biologic and environmental risk factors for regression. The biologic risk factors may be used preoperatively to counsel patients and, where necessary, advise them against surgery. The environmental risk factors are largely avoidable by modification of patient behavior.
背景/目的：准分子激光角膜切削术（PRK）后，大多数患者的最终屈光状态接近预期屈光状态。然而，相当一部分患者会出现回退，这通常与角膜 haze 有关。本研究旨在确定生物因素和环境因素是否会影响 PRK 的手术效果。
100 例患者前瞻性地接受了 -3.00 或 -6.00 屈光度的矫正。术后 3 个月，100%的患者回答了一份问卷，该问卷记录了他们的生物特征、病史和眼部病史，以及术后遭受的物理和化学损伤。多变量分析确定了与回退相关的因素。
多变量分析显示，接受更高屈光度或更小直径治疗的患者（P = 0.045）以及第一眼治疗后出现回退的患者（P = 0.019）回退风险显著增加。性别之间没有差异，但服用口服避孕药的女性回退的可能性是未服用者的 13.5 倍。暴露于太阳辐射（优势比，7.6；95%可信区间，1.82 - 32.22）和日光浴床（优势比，2.4；95%可信区间，0.64 - 9.39）的患者回退增加，眼表疾病患者的回退显著更高（仅单变量分析；P = 0.034）。回退与既往佩戴隐形眼镜、游泳、吸烟或轻微眼外伤无关。
该问卷确定了回退的生物和环境风险因素。生物风险因素可在术前用于咨询患者，并在必要时建议他们不要进行手术。通过改变患者行为，环境风险因素在很大程度上是可以避免的。
