山东大学耳鼻喉眼学报 ›› 2021, Vol. 35 ›› Issue (6): 25-32.doi: 10.6040/j.issn.1673-3770.0.2021.363

• 临床研究 • 上一篇    下一篇

SPT-TPRK联合0.02%MMC治疗中度近视术后角膜神经纤维再生的随机对照研究

闫春晓1,2,靳琳1,方石峰1,2,韦玉山3,王丽晶1,崔林1,赵丹1,牟亚男1,张立军1,2   

  1. 1.大连市第三人民医院/大连市眼科医院 眼科, 辽宁 大连 116033;
    2.大连医科大学, 辽宁 大连 116044;
    3.大连医科大学附属第一医院, 辽宁 大连 116011
  • 发布日期:2021-12-10
  • 通讯作者: 张立军. E-mail:lijunzhangw@gmail.com
  • 基金资助:
    辽宁省自然科学基金指导计划(20180550976);辽宁省自然基金资助计划(2020-MS-339);大连市科技创新基金项目(2019J13SN105);大连市医学科学研究计划项目(1911032)

Corneal nerve fiber regeneration after SPT-TPRK combined with 0.02% MMC for moderate myopia: a random control study

YAN Chunxiao1,2, JIN Lin1,2, FANG Shifeng1, WEI Yushan3, WANG Lijing1, CUI Lin1, ZHAO Dan1, MU Yanan1,   

  1. ZHANG Lijun1, 21. Department of Ophthalmology, The Third People's Hospital of Dalian/ Dalian Eye Hospital, Dalian 116033, Liaoning, China;
    2. Dalian Medical University, Dalian 116044, Liaoning, China;
    3. The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning, China
  • Published:2021-12-10

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摘要： 目的 观察智能脉冲技术辅助的经上皮准分子激光角膜切削术(SPT-TPRK)联合使用0.02%丝裂霉素C(MMC),术后角膜消融区神经纤维的再生情况。 方法 随机对照研究。入组患者25例(50只眼),等效球镜度数(SE)-3.00 D~-6.00 D, 随机一眼使用0.02%MMC,为SPT-TPRK+MMC组(25只眼),另一眼不使用0.02%MMC,为SPT-TPRK组(25只眼),利用HRTⅢ共聚焦显微镜观察术后14 d、1个月、3个月角膜上皮下激光消融区边缘、中央、周边的神经纤维密度(CNFD)、神经纤维长度(CNFL)较术前的变化。 结果 术前角膜中央区CNFD(52.40±12.61)根/mm2,CNFL(73.00±12.61)mm/mm2。角膜消融区中央神经纤维变化如下:术后14 d SPT-TPRK+MMC组CNFD(13.41±4.99)根/mm2,CNFL(17.44±7.30)mm/mm2。 SPT-TPRK组CNFD(5.73±3.27)根/mm2,CNFL(5.03±3.52)mm/mm2,两组间差异具有统计学意义(P<0.000 1)。术后1个月 SPT-TPRK+MMC组CNFD(20.57±5.43)根/mm2,CNFL(27.57±8.97)mm/mm2。SPT-TPRK组CNFD(8.46±5.07)根/mm2,CNFL(9.46±4.81)mm/mm2,两组间差异具有统计学意义(P<0.000 1)。术后3个月 SPT-TPRK+MMC组CNFD(23.47±7.28)根/mm2,CNFL(33.87±9.49)mm/mm2。SPT-TPRK组CNFD(13.75±5.78)根/mm2,CNFL(17.00±5.90 )mm/mm2,两组间差异具有统计学意义(P<0.0001)。 结论 通过HRTⅢ共聚焦显微镜观察到SPT-TPRK联合0.02%MMC在术后早期(14 d、1个月、3个月)可以促进神经纤维再生,术后3个月时角膜消融区中央神经纤维状态仍然未恢复至术前状态。

关键词: 智能脉冲技术辅助的经上皮准分子激光角膜切削术, 丝裂霉素C, 上皮下雾状混浊, 共聚焦显微镜, 神经纤维

Abstract: Objective To observe the regeneration of nerve fibers in the corneal ablation area after transepithelial photorefractive keratectomy with smart pulse technology(SPT-TPRK)combination of 0.02% mitomycin C(MMC). Methods This random control study included 25 patients(50 eyes)with spherical equivalent(SE)from -3.00D to -6.00D. After SPT-TPRK, MMC was applied for 20 s in a concentration of 0.02% on one random eye(SPT-TPRK+MMC group)and no MMC on the other eye(SPT-TPRK group)for the contrl. All patients were observed by HRTⅢ confocal microscopy in order to compare CNFD and CNFL in peripheral and centeral corneal ablation area at preoperatively and 14 days,1month,and 3months postoperatively. Results Preoperatively, the CNFD in the central corneal zone was(52.40±12.61)nerves/mm2, and the CNFL was(73.00±12.61)mm/mm2. The neural changes in the central cornea ablation area are described below. Fourteen days after surgery, the CNFD and CNFL in the SPT-TPRK+MMC and SPT-TPRK groups were(13.41±4.99)nerves/mm2 and(5.73±3.27)nerves/mm2, and(17.44±7.30)mm/mm2 and(5.03±3.52)mm/mm2, respectively. The difference between the two groups was statistically significant(P<0.000 1). One month postoperatively, the CNFD and CNFL in the SPT-TPRK+MMC and SPT-TPRK groups were(20.57±5.43)nerves/mm2 and(8.46±5.07)nerves/mm2, and(27.57±8.97)mm/mm2 and(9.46±4.81)mm/mm2, respectively, with statistically significant differences between the two groups(P<0.000 1). Three months postoperatively, the CNFD in the SPT-TPRK+MMC and SPT-TPRK groups were(23.47±7.28)nerves/mm2 and(13.75±5.78)nerves/mm2, and(33.87±9.49)mm/mm2 and(17.00±5.90)mm/mm2, respectively, with statistically significant differences between the two groups(P<0.000 1). Conclusion SPT-TPRK combined with 0.02% MMC may promote nerve fiber regeneration in the early postoperative period(14 days, 1 month, 3 months). The nerve fibers have not returned to the preoperative situation at three months postoperatively.

Key words: Transepithelial photorefractive keratectomy with Smart Pulse Technology, Mitomycin C, Haze, Confocal microscopy, Nerve fibers

中图分类号: 

  • R779.63
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