【摘要】：目的通過(guò)將0.02%的絲裂霉素C應(yīng)用于機(jī)械法準(zhǔn)分子激光上皮瓣下角膜磨鑲術(shù)(epipolis laser in-situ keratomileusis，Epi-LASIK)治療高度近視的患者，觀察絲裂霉素C對(duì)患者術(shù)后角膜刺激癥狀、角膜上皮愈合、裸眼視力、Haze及淚膜等指標(biāo)的影響，探討安全有效應(yīng)用絲裂霉素C的方法，為眼科屈光醫(yī)生的臨床手術(shù)提供參考。 方法選擇2010年7月到10月在我院接受Epi-LASIK手術(shù)治療的高度近視患者57例(114眼)。將其隨機(jī)分為兩組，設(shè)術(shù)中應(yīng)用絲裂霉素C組（MMC組）29例（58眼），術(shù)中不應(yīng)用絲裂霉素C組（對(duì)照組）28例（56眼）。術(shù)后隨訪1年。觀察術(shù)后1d、3d、5d、7d患者角膜刺激癥狀及裂隙燈顯微鏡下的眼前節(jié)情況；角膜上皮愈合時(shí)間及裸眼視力；觀察術(shù)后1m、3m、6m、12m兩組Haze分級(jí)情況；觀察術(shù)前及術(shù)后1m、3m、6m、12m兩組患者雙眼裸眼視力、淚液分泌量、淚膜破裂時(shí)間、淚液蕨類試驗(yàn)及結(jié)膜印記細(xì)胞學(xué)檢查等指標(biāo)。 結(jié)果1.術(shù)后角膜刺激癥狀評(píng)分比較，術(shù)后1d、3d、5d、7d兩組t值分別為-0.19，0.00，-1.00，1.00，P值均㧐0.05，兩組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義；術(shù)后早期裂隙燈顯微鏡下觀察兩組患者雙眼結(jié)膜均無(wú)明顯充血，角膜基質(zhì)無(wú)水腫，，鞏膜無(wú)壞死等情況發(fā)生。2.術(shù)后角膜上皮愈合時(shí)間比較，MMC組平均為(5.17±1.03)d，對(duì)照組平均為(5.11±1.00)d，兩組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義（t=0.00，P㧐0.05）。3.術(shù)后早期UCVA比較，兩組術(shù)后1d比較差異有統(tǒng)計(jì)學(xué)意義（t=-2.62，P㩳0.05）；術(shù)后3d，5d，7d比較差異均無(wú)統(tǒng)計(jì)學(xué)意義（t=-1.61，t=-1.80，t=-1.83，P㧐0.05）。4.術(shù)后1m、3m、6m、12m兩組間裸眼視力比較差異無(wú)統(tǒng)計(jì)學(xué)意義（t=0.73，t=0.43，t=-0.74，t=0.96，P㧐0.05）。5.術(shù)后1m、3m、6m兩組間Haze的形成情況比較差異有統(tǒng)計(jì)學(xué)意義（χ2=12.43，χ2=10.94，χ2=11.51，P㩳0.05）；術(shù)后12m Haze比較(χ2=0.46，P㧐0.05)，差異無(wú)統(tǒng)計(jì)學(xué)意義。6.術(shù)前及術(shù)后1m、3m、6m、12m兩組間的淚液分泌試驗(yàn)、淚膜破裂時(shí)間、淚液蕨類試驗(yàn)及結(jié)膜印記細(xì)胞檢查比較差異無(wú)統(tǒng)計(jì)學(xué)意義P㧐0.05；術(shù)后1m、3m兩組淚液分泌試驗(yàn)、淚膜破裂時(shí)間、淚液蕨類試驗(yàn)分別與其術(shù)前相比P㩳0.05，差異有統(tǒng)計(jì)學(xué)意義；術(shù)后6m、12m兩組淚液分泌試驗(yàn)、淚膜破裂時(shí)間、淚液蕨類試驗(yàn)分別與其術(shù)前比較P㧐0.05，差異無(wú)統(tǒng)計(jì)學(xué)意義。術(shù)后1m、3m、6m兩組印記細(xì)胞學(xué)檢查與其術(shù)前比較P㩳0.05，差異有統(tǒng)計(jì)學(xué)意義；術(shù)后12m兩組印記細(xì)胞學(xué)檢查與其術(shù)前比較P㧐0.05，差異無(wú)統(tǒng)計(jì)學(xué)意義。 結(jié)論Epi-LASIK治療高度近視術(shù)中應(yīng)用0.02%絲裂霉素C作用于切削區(qū)，應(yīng)用時(shí)間控制在20-30s，BSS液沖洗時(shí)間不少于80s，沖洗量不少于200ml，可有效預(yù)防Haze，且無(wú)明顯毒副作用，不加重術(shù)后的角膜刺激癥狀和淚膜損傷，對(duì)角膜上皮愈合及早期裸眼視力恢復(fù)無(wú)明顯影響，有利于后期視力的穩(wěn)定。
[Abstract]:Objective To observe the effect of 0.02% mitomycin C on corneal irritation, corneal epithelial healing, naked eye vision, Haze and tear film after Epipolis laser in-situ keratomileusis (Epi-LASIK) for high myopia. The effective application of mitomycin C is a reference for ophthalmologists.
Methods 57 patients (114 eyes) with high myopia who underwent Epi-LASIK surgery in our hospital from July to October 2010 were randomly divided into two groups. 29 patients (58 eyes) were treated with mitomycin C during operation and 28 patients (56 eyes) were not treated with mitomycin C during operation. The visual acuity, tear secretion, tear film rupture time, tear Pteridophyte test and conjunctival imprint cytology were observed before and after operation.
Results 1. Comparing the scores of corneal irritation symptoms after operation, the T values of the two groups were - 0.19, 0.00, - 1.00, 1.00, P values were - 0.05 on the 1st, 3rd, 5th and 7th day after operation, and there was no significant difference between the two groups. The average healing time of corneal epithelium in MMC group was (5.17 (+ 1.03) days, and that in control group was (5.11 (+ 1.00) days. There was no significant difference between the two groups (t = 0.00, P? 0.05). 3. There was significant difference in the early postoperative UCVA between the two groups (t = - 2.62, P? 0.05) on the first day after surgery; there was no significant difference between the three, five and seven days after surgery (t = - 1.61, t = - 1.01, t = - 1.05). 80, t = - 1.83, P? 0.05). 4. 1 m, 3 m, 6 m, 6 m, 6 m, 12 m after surgery had no significant difference in naked visual acacuitbetween the two groups (t = 0.73, t = 0.43, t = - 0.74, t = - 0.74, t = 0.96, P? 0.05). 5. There was significant difference in the formation of Haze between the 1 m, 3 m, 6 m groups (962 = 12.43, 962 = 10.94, 962 = 10.94, 962 = 11.51, P? 0.05) 1 m, 1 m, 3 m, 3 m, 3 m, 3 m, 6 m, 6 m, 6 m after surgery (962 = 12 = 12 m = 12.73, 11.51, The difference was not statistically significant. Significance. 6. There was no significant difference in tear secretion test, tear film rupture time, tear fern test and conjunctival imprinted cell test between the two groups at 1 m, 3 m, 6 m and 12 m before and after operation (P?0.05); there was no significant difference in tear secretion test, tear film rupture time and tear fern test between the two groups at 1 m and 3 m after operation (P?0.05). There was no significant difference between the two groups in tear secretion test, tear film rupture time, tear fern test and preoperative P? 0.05 at 6 m and 12 m after operation. Academic significance.
Conclusion The application of 0.02% mitomycin C in the ablation area of high myopia treated with Epi-LASIK can effectively prevent Haze without obvious side effects, aggravation of corneal irritation symptoms and tear film injury, corneal epithelial healing and early naked eyes. Visual recovery has no obvious effect and is conducive to the stability of late vision.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R779.63

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張磊;王強(qiáng);雷寧玉;任莉;戴慧琴;;絲裂霉素C對(duì)兔角膜準(zhǔn)分子激光切削術(shù)后角膜愈合、角膜上皮下混濁及轉(zhuǎn)化生長(zhǎng)因子β_2表達(dá)的影響[J];濱州醫(yī)學(xué)院學(xué)報(bào);2008年06期

2 顧寶文,胡建榮,嚴(yán)宗輝,孫勉;高三尖杉酯堿防治準(zhǔn)分子激光角膜切削術(shù)后角膜霧狀混濁22眼[J];國(guó)際眼科雜志;2005年04期

3 陳麗華;江萍;;LASEK術(shù)后Haze的防治研究進(jìn)展[J];國(guó)際眼科雜志;2006年05期

4 周浩東;姜德詠;;絲裂霉素C在Epi-LASIK術(shù)矯正高度和超高度近視中的應(yīng)用[J];國(guó)際眼科雜志;2009年04期

5 陳靜;韓蘇寧;龔小雪;吳軍麗;李欣;;Epi-LASIK術(shù)后角膜中央知覺(jué)及淚膜穩(wěn)定性的臨床觀察[J];國(guó)際眼科雜志;2009年06期

6 黃歡;王立;彭超;吳秀勻;;絲裂霉素C在LASEK術(shù)中應(yīng)用于高度近視患者預(yù)防haze的臨床研究[J];國(guó)際眼科雜志;2010年01期

7 史建江;任明玉;;0.2g/L絲裂霉素C對(duì)LASEK術(shù)后效果的影響[J];國(guó)際眼科雜志;2010年07期

8 鄭曉碩;林雅娜;鄭暉;李勤;祁勇軍;;LASEK+MMC治療近視的臨床療效[J];海南醫(yī)學(xué);2008年03期

9 朱冬梅;王新;劉平;李錚;劉永瑞;李金柳;高延慶;;不同濃度絲裂霉素C對(duì)準(zhǔn)分子術(shù)后家兔角膜上皮下混濁形成的影響[J];鄭州大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2009年02期

10 華明;劉明芳;;絲裂霉素C對(duì)PRK術(shù)后角膜上皮下霧狀混濁的影響[J];醫(yī)藥論壇雜志;2010年08期

相關(guān)碩士學(xué)位論文 前1條

1 杜娟;羊膜提取液對(duì)兔準(zhǔn)分子激光術(shù)后haze的影響機(jī)制[D];南華大學(xué);2008年

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