摘要目的 在机械法准分子激光上皮瓣下角膜磨镶(Epi-LASIK)术中分别应用丝裂霉素(MMC)及低温平衡盐溶液(CBSS),比较两者术后疗效及并发症.方法 回顾性病例对照研究.将2013年5-12月在广州军区武汉总医院接受Epi-LASIK手术的患者40例(80眼)根据术中处理方式不同分为2组:MMC组和CBSS组,各20例.术中基质层切削后,MMC组将浸有0.02％ MMC溶液的海绵片置于基质切削面20 s,再用20 ml常温平衡盐液冲洗;CBSS组用4℃平衡盐溶液10 ml冲洗基质切削面.记录患者术前和术后1周,1、2、3、4、6个月裸眼视力(UCVA)、眼压(IOP)、屈光度,记录角膜上皮下混浊(haze)发生情况及术后半年时的残余屈光度.采用独立样本t检验、重复测量资料的方差分析、x2检验等进行统计学分析.结果 所有患者均顺利完成手术.MMC组上皮愈合时间为4～6 d,平均(4.2±0.1)d,CBSS组为4～13 d,平均(4.5±0.3)d,差异无统计学意义;术后1、2、3、4、6个月时的裸眼视力(UCVA):MMC组为4.98±0.01、5.02±0.01、5.04±0.01、5.04±0.01、5.05±0.01,CBSS组为5.02±0.01、5.09±0.01、5.08±0.01、5.09±0.01、5.11±0.01,除术后1个月时2组UCVA差异无统计学意义外,术后2、3、4、6个月时差异均有统计学意义(F=17.503,P＜0.01);2组术后1周,1、2、3、4、6个月的IOP差异均无统计学意义;术后半年残余等效球镜度(SE):MMC组为(+0.43±0.06)D,CBSS组为(+0.35±0.09)D,差异有统计学意义(t=2.680,P＜0.05).结论 在Epi-LASIK术中应用0.02％MMC或CBSS处理角膜基质切削面,术后上皮愈合时间、角膜haze形成、IOP及残余SE等方面无显著差异,CBSS处理者术后UCVA稍优于MMC.

abstractsObjective To compare the postoperative efficacy and complications of using an intraoperative application of either mitomycin (MMC) or a chilled balanced salt solution (CBSS) during epipolis laser in situ keratomileusis (Epi-LASIK).Methods Forty patients (80 eyes) who underwent Epi-LASIK from May to December 2013 in our center were randomly divided into two groups of 20 patients (40 eyes) each based on MMC or CBSS treatment.In the MMC group, a sponge with 0.02％ MMC was used after laser ablation to cover the corneal stromal bed for 20 s and then rinsed with a 20 ml balanced salt solution at normal temperature;in the CBSS group, 10 ml 4 ℃ of a balanced salt solution was used to flush the stromal bed after laser ablation.Patients' preoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), IOP, UCVA, corneal haze, intraocular pressure, residual refractive error were recorded preoperatively and postoperatively at 6 months.Data were analyzed using a t test, repeated measures ANOVA, and a chi-square test.Results The surgery was successfully completed on all patients.The epithelial healing time for the MMC group was 4-6 d (average 4.2±0.1 d), and was 4-13 d (average 4.5±0.3 d) for the CBSS group.There was no statistically significant difference between the groups.UCVA at 1 month was not significantly different between the two groups but the differences at 2, 3, 4 and 6 months were significant (F=17.503, P＜0.01).The differences in average IOP at 1, 2, 3, 4 and 6 months were not statistically significant.The residual refractive error (SE) in the MMC group was +0.43±0.06 D, and was +0.35±0.09 D in the CBSS group.The difference was statistically significant (t=2.680, P＜0.05).Conclusion There were no significant differences postoperatively when epithelial healing, corneal haze, curative efficacy, IOP and residual refractive error were compared between patients treated intraoperatively with applications of MMC or CBSS.The UCVA of patients treated with CBSS is slightly better than for MMC.