Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2020, Vol. 34 ›› Issue (2): 79-84.doi: 10.6040/j.issn.1673-3770.1.2020.011

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Recent advances and clinical applications in excimer laser surface ablation surgery

PIAO JunjieOverview,LI YingGuidance   

  1. Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
  • Published:2020-04-07

Abstract: Laser corneal refractive surgery is widely performed, and corneal surface excimer laser ablation surgery is one of the main surgical options. Corneal surface excimer laser ablation surgery includes: photorefractive keratectomy(PRK), laser-assisted subepithelial keratomileusis(LASEK), epipolis laser-assisted in situ keratomileusis(Epi-LASIK), transepithelial photorefractive keratectomy(TransPRK), and phototherapeutic keratectomy(PTK). It is mainly used to correct various refractive errors and corneal disorders. From epithelium-off PRK, alcohol soaking assistant LASEK, microkeratome-associated Epi-LASIK, to laser ablation corneal epithelial TransPRK, all of the procedures have no flap-related complications and they are of less corneal injury, painess and betrer visual quality after surgery. This review summarized the choice of current commonly used surgical options, clinical applications, and recent advances in excimer laser surface ablation surgery.

Key words: Refractive error, Refractive surgery, Excimer laser, Cornea, Surface ablation surgery

CLC Number: 

  • R779.6
[1] Verhoeven VJ, Wong KT, Buitendijk GH, et al. Visual consequences of refractive errors in the general population[J]. Ophthalmology, 2015, 122(1): 101-109. doi:10.1016/j.ophtha.2014.07.030.
[2] Resnikoff S, Pascolini D, Mariotti SP, et al. Global magnitude of visual impairment caused by uncorrected refractive errors in 2004[J]. Bull World Health Organ, 2008, 86(1): 63-70. doi:10.2471/blt.07.041210.
[3] Huang JH, Wen DZ, Wang QM, et al. Efficacy comparison of 16 interventions for myopia control in children: a network meta-analysis[J]. Ophthalmology, 2016, 123(4): 697-708. doi:10.1016/j.ophtha.2015.11.010.
[4] Munnerlyn CR, Koons SJ, Marshall J. Photorefractive keratectomy: a technique for laser refractive surgery[J]. J Cataract Refract Surg, 1988, 14(1): 46-52. doi:10.1016/s0886-3350(88)80063-4.
[5] Claringbold TV 2nd. Laser-assisted subepithelial keratectomy for the correction of myopia[J]. J Cataract Refract Surg, 2002, 28(1): 18-22. doi:10.1016/s0886-3350(01)01234-2.
[6] Pallikaris IG, Katsanevaki VJ, Kalyvianaki MI, et al. Advances in subepithelial excimer refractive surgery techniques: Epi-LASIK[J]. Curr Opin Ophthalmol, 2003, 14(4): 207-212. doi:10.1097/00055735-200308000-00007.
[7] Jun I, Kang DSY, Arba-Mosquera S, et al. Comparison between Wavefront-optimized and corneal Wavefront-guided Transepithelial photorefractive keratectomy in moderate to high astigmatism[J]. BMC Ophthalmol, 2018, 18(1): 154. doi:10.1186/s12886-018-0827-x.
[8] 张巧思, 邹吉新, 靳琳, 等. 表层屈光手术的最新进展[J]. 医学综述, 2017, 23(20): 4070-4074. doi:10.3969/j.issn.1006-2084.2017.20.023. ZHANG Qiaosi, ZOU Jixin, JIN Lin, et al. Latest progress of the surface refractive surgery[J]. Medical Recapitulate, 2017, 23(20): 4070-4074. doi:10.3969/j.issn.1006-2084.2017.20.023.
[9] Kalyvianaki MI, Kymionis GD, Kounis GA, et al. Comparison of Epi-LASIK and off-flap Epi-LASIK for the treatment of low and moderate myopia[J]. Ophthalmology, 2008, 115(12): 2174-2180. doi:10.1016/j.ophtha.2008.08.025.
[10] 龙琴,王中海,金玉梅,等. 去除或保留角膜上皮瓣对LASEK治疗中高度近视的临床疗效和并发症回顾分析[C]. 第十二届全国角膜及眼表疾病学术大会, 2012.
[11] Braunstein RE, Jain S, McCally RL, et al. Objective measurement of corneal light scattering after excimer laser keratectomy[J]. Ophthalmology, 1996, 103(3): 439-443. doi:10.1016/s0161-6420(96)30674-x.
[12] Shojaei A, Ramezanzadeh M, Soleyman-Jahi S, et al. Short-time mitomycin-C application during photorefractive keratectomy in patients with low myopia[J]. J Cataract Refract Surg, 2013, 39(2): 197-203. doi:10.1016/j.jcrs.2012.09.016.
[13] Virasch VV, Majmudar PA, Epstein RJ, et al. Reduced application time for prophylactic mitomycin C in photorefractive keratectomy[J]. Ophthalmology, 2010, 117(5): 885-889. doi:10.1016/j.ophtha.2009.10.024.
[14] Reilly CD, Panday V, Lazos V, et al. PRK vs LASEK vs Epi-LASIK: a comparison of corneal haze, postoperative pain and visual recovery in moderate to high myopia[J]. Nepal J Ophthalmol, 2010, 2(2): 97-104. doi:10.3126/nepjoph.v2i2.3715.
[15] Sia RK, Ryan DS, Edwards JD, et al. The US Army Surface Ablation Study: comparison of PRK, MMC-PRK, and LASEK in moderate to high myopia[J]. J Refract Surg, 2014, 30(4): 256-264. doi:10.3928/1081597X-20140320-04.
[16] Chen J, Chen Y, Han SN. Comparison of TGF-β1 in tears and corneal haze following Epi-LASIK with and without mitomycin C[J]. Int J Ophthalmol, 2013, 6(3): 312-315. doi:10.3980/j.issn.2222-3959.2013.03.10.
[17] Ang RE, Reyes KB, Hernandez JA, et al. Wavefront-guided epithelial laser in situ keratomileusis with mitomycin-C for myopia and myopic astigmatism: flap-on versus flap-off technique[J]. J Cataract Refract Surg, 2011, 37(6): 1133-1139. doi:10.1016/j.jcrs.2010.12.052.
[18] Zhang Y, Chen YG, Xia YJ, et al. Comparison of Tear cytokines and clinical outcomes between off-flap and on-flap epi-LASIK with mitomycin C[J]. J Refract Surg, 2012, 28(9): 632-638. doi:10.3928/1081597X-20120815-01.
[19] Lee HK, Lee KS, Kim JK, et al. Epithelial healing and clinical outcomes in excimer laser photorefractive surgery following three epithelial removal techniques: mechanical, alcohol, and excimer laser[J]. Am J Ophthalmol, 2005, 139(1): 56-63. doi:10.1016/j.ajo.2004.08.049.
[20] Hanna KD, Pouliquen YM, Waring GO 3rd, et al. Corneal wound healing in monkeys after repeated excimer laser photorefractive keratectomy[J]. Arch Ophthalmol, 1992, 110(9): 1286-1291. doi:10.1001/archopht.1992.01080210104035.
[21] Campos M, Hertzog L, Wang XW, et al. Corneal surface after deepithelialization using a sharp and a dull instrument[J]. Ophthalmic Surg, 1992, 23(9): 618-621.
[22] Piao JJ, Li YJ, Whang WJ, et al. Comparative evaluation of visual outcomes and corneal asphericity after laser-assisted in situ keratomileusis with the six-dimension Amaris excimer laser system[J]. PLoS One, 2017, 12(2): e0171851. doi:10.1371/journal.pone.0171851.
[23] Seiler TG, Wegner A, Senfft T, et al. Dissatisfaction after trifocal IOL implantation and its improvement by selective wavefront-guided LASIK[J]. J Refract Surg, 2019, 35(6): 346-352. doi:10.3928/1081597X-20190510-02.
[24] 张丰菊, 孙明甡. 飞秒激光时代浅谈表层角膜屈光手术的临床意义[J].中华眼视光学与视觉科学杂志, 2017, 19(11): 641-645. doi:10.3760/cma.j.issn.1674-845X.2017.11.001. ZHANG Fengju, SUN Mingshen. The clinical status of corneal surface refractive surgery in the era of femtosecond lasers[J]. Chinese Journal of Optometry Ophthalmology and Visual Science, 2017, 19(11): 641-645. doi:10.3760/cma.j.issn.1674-845X.2017.11.001.
[25] 徐婧, 李莹, 王忠海, 等. 经上皮准分子激光角膜切削术治疗近视的临床疗效[J]. 中华眼视光学与视觉科学杂志, 2015, 17(12): 717-721. doi:10.3760/cma.j.issn.1674-845X.2015.12.004. XU Jing, LI Ying, WANG Zhonghai, et al. Clinical results of transepithelial photorefractive keratectomy for myopia[J]. Chinese Journal of Optometry Ophthalmology and Visual Science, 2015, 17(12): 717-721. doi:10.3760/cma.j.issn.1674-845X.2015.12.004.
[26] 王忠海, 姜洋, 张庆生, 等. 经上皮准分子激光角膜切削术与准分子激光上皮下角膜磨镶术治疗近视眼的临床效果比较[J]. 中华眼科杂志, 2019, 55(2): 122-126. doi:10.3760/cma.j.issn.0412-4081.2019.02.010. WANG Zhonghai, JIANG Yang, ZHANG Qingsheng, et al. Clinical outcomes after laser epithelial keratomileusis(LASEK)and transepithelial photorefractive keratectomy(TPRK)in myopia[J]. Chinese Journal of Ophthalmology, 2019, 55(2): 122-126. doi:10.3760/cma.j.issn.0412-4081.2019.02.010.
[27] Arba Mosquera S, Awwad ST. Theoretical analyses of the refractive implications of transepithelial PRK ablations[J]. Br J Ophthalmol, 2013, 97(7): 905-911. doi:10.1136/bjophthalmol-2012-302853.
[28] Reinstein DZ, Archer TJ, Gobbe M, et al. Epithelial thickness in the normal cornea: three-dimensional display with Artemis very high-frequency digital ultrasound[J]. J Refract Surg, 2008, 24(6): 571-581. doi:10.3928/1081597X-20080601-05.
[29] Reinstein DZ, Archer TJ, Gobbe M. Improved effectiveness of transepithelial PTK versus topography-guided ablation for stromal irregularities masked by epithelial compensation[J]. J Refract Surg, 2013, 29(8): 526-533. doi:10.3928/1081597X-20130719-02.
[30] Fagerholm P. Phototherapeutic keratectomy: 12 years of experience[J]. Acta Ophthalmol Scand, 2003, 81(1): 19-32. doi:10.1034/j.1600-0420.2003.00015.x.
[31] Li LM, Zhao LQ, Qu LH, et al. Excimer laser phototherapeutic keratectomy for the treatment of clinically presumed fungal keratitis[J]. J Ophthalmol, 2014, 2014: 963287. doi:10.1155/2014/963287.
[32] 段嘉欢, 郭秀瑾, 马月磊, 等. PTK治疗大泡性角膜病变的临床疗效观察[J]. 中国实用眼科杂志, 2016, 34(5): 478-484. doi:10.3760/cma.j.issn.1006-4443.2016.05.019. DUAN Jiahuan, GUO Xiujin, MA Yuelei, et al. Clinical efficacy of phototherapeutic keratectomy for bullous keratopathy[J]. Chinese Journal of Practical Ophthalmology, 2016, 34(5): 478-484. doi:10.3760/cma.j.issn.1006-4443.2016.05.019.
[33] 祁媛媛, 张立军, 董贺, 等. 前节OCT辅助准分子激光治疗性角膜切削术治疗真菌性角膜溃疡[J]. 眼科新进展, 2017, 37(3): 263-266. doi:10.13389/j.cnki.rao.2017.0066. QI Yuanyuan, ZHANG Lijun, DONG He, et al. Anterior segment optical coherence tomography assisted excimer laser phototherapeutic keratectomy for fungal corneal ulcer[J]. Recent Advances in Ophthalmology, 2017, 37(3): 263-266. doi:10.13389/j.cnki.rao.2017.0066.
[34] Alio JL, Javaloy J, Merayo J, et al. Automated superficial lamellar keratectomy augmented by excimer laser masked PTK in the management of severe superficial corneal opacities[J]. Br J Ophthalmol, 2004, 88(10): 1289-1294. doi:10.1136/bjo.2004.045070.
[35] Wilson SE, Marino GK, Medeiros CS, Santhiago MR. Phototherapeutic keratectomy: Science and Art[J]. J Refract Surg, 2017, 33(3):203-210. doi:10.3928/1081597x-20161123-01.
[36] de Macedo JP, de Oliveira LA, Hirai F, et al. Femtosecond laser-assisted deep anterior lamellar keratoplasty in phototherapeutic keratectomy versus the big-bubble technique in keratoconus[J]. Int J Ophthalmol, 2018, 11(5): 807-812. doi:10.18240/ijo.2018.05.15.
[37] Krueger RR, Kanellopoulos AJ. Stability of simultaneous topography-guided photorefractive keratectomy and riboflavin/Uva cross-linking for progressive keratoconus: case reports[J]. J Refract Surg, 2010, 26(10): S827-S832. doi:10.3928/1081597x-20100921-11.
[38] Hernández-Quintela E, Samapunphong S, Khan BF, et al. Posterior corneal surface changes after refractive surgery[J]. Ophthalmology, 2001, 108(8): 1415-1422. doi:10.1016/s0161-6420(01)00634-0.
[39] Miyata K, Kamiya K, Takahashi T, et al. Time course of changes in corneal forward shift after excimer laser photorefractive keratectomy[J]. Arch Ophthalmol, 2002, 120(7): 896-900. doi:10.1001/archopht.120.7.896.
[40] Kanellopoulos AJ, Asimellis G. Corneal refractive power and symmetry changes following normalization of ectasias treated with partial topography-guided PTK combined with higher-fluence CXL(the Athens protocol)[J]. J Refract Surg, 2014, 30(5): 342-346. doi:10.3928/1081597x-20140416-03.
[41] 王君喆, 徐琳琳, 朱伟, 等. PTK、PRK和CXL联合治疗LASIK术后角膜膨隆的临床疗效[J]. 中华眼视光学与视觉科学杂志, 2017, 19(1): 20-24. doi:10.3760/cmaj.issn.1674-845x.2017.01.005. WANG Junzhe, XU Linlin, ZHU Wei, et al. Efficacy and safety of PTK and PRK combined with CXL on post-LASIK keratectasia[J]. Chinese Journal of Optometry & Ophthalmology, 2017, 19(1): 20-24. doi:10.3760/cmaj.issn.1674-845x.2017.01.005.
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