Starr M, Donnenfeld E, Newton M, Tostanoski J, Muller J, Odrich M
Phototherapeutic Keratectomy Section, Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA.
Cornea. 1996 Nov;15(6):557-65.
The objective of this study was to evaluate the safety and efficacy of excimer laser phototherapeutic keratectomy in the treatment of anterior corneal pathology in a group of 45 patients. Forty-five patients were treated with the Visx Excimer Laser System for various types of anterior corneal pathology including postinflammatory and postsurgical scars, stromal dystrophies, surface degenerations, pterygia, and epithelial basement membrane dystrophies. Excimer laser phototherapeutic keratectomy (PTK) has been used to treat anteriorly located corneal pathology since 1990; however, most published studies thus far have been composed of small numbers of patients with limited duration of follow-up. The present study is one of the largest domestic PTK series with one of the longest mean follow-ups. Forty patients were followed for > or = 6 months with a mean follow-up of just less than 1 year (11.25 months). Statistically significant improvement was achieved in irritative symptoms and visual acuity. Best spectacle corrected visual acuity (BSCVA) improved a mean of two lines (range, -3 to +7) with 20/50 or better BSCVA present in 29% of patients preoperatively improving to 60% postoperatively. Refractive changes were unpredictable. Mean spherical equivalent underwent a hyperopic shift of 2.81 diopters (D). Fifty percent of patients developed > or = 1 D of refractive astigmatism. Complications occurred in six patients with loss of BSCVA, three patients with topical corticosteroid associated increased intraocular pressure, and three patients with recurrent herpes simplex stromal keratouveitis. Excimer laser phototherapeutic keratectomy can consistently achieve a modest to a more substantial improvement in irritative ocular symptoms and/or visual acuity with significant potential for adverse results that appear to be less severe than the complications associated with alternative treatment by keratoplasty.
本研究的目的是评估准分子激光光治疗性角膜切削术治疗45例患者眼前段角膜病变的安全性和有效性。45例患者使用威视准分子激光系统治疗各种类型的眼前段角膜病变，包括炎症后和手术后瘢痕、基质营养不良、表面退变、翼状胬肉以及上皮基底膜营养不良。自1990年以来，准分子激光光治疗性角膜切削术（PTK）一直用于治疗眼前段角膜病变；然而，迄今为止大多数已发表的研究都是由少量患者组成，随访时间有限。本研究是国内最大的PTK系列研究之一，平均随访时间也是最长的之一。40例患者随访时间≥6个月，平均随访时间略少于1年（11.25个月）。刺激症状和视力有统计学意义的改善。最佳矫正视力（BSCVA）平均提高两行（范围为-3至+7），术前29%的患者BSCVA为20/50或更好，术后提高到60%。屈光变化不可预测。平均球镜当量有2.81屈光度（D）的远视性偏移。50%的患者出现≥1 D的屈光性散光。6例患者出现BSCVA下降，3例患者出现局部皮质类固醇相关的眼压升高，3例患者出现复发性单纯疱疹性基质性角膜葡萄膜炎。准分子激光光治疗性角膜切削术能够持续实现刺激性眼部症状和/或视力从适度到更显著的改善，且出现不良结果的可能性较大，但其不良结果似乎不如角膜移植术等替代治疗相关的并发症严重。
