CAJ | 학술논문

目的：为了减轻患者准分子激光角膜切削术术后的疼痛,提高角膜上皮的愈合速度,现将激光切削与酒精剥除角膜上皮进行对比分析,旨在检测经角膜上皮的准分子激光角膜表层切削术(Trans-PRK)与准分子激光角膜表面切削术(PRK)相比的可预测性、安全性、有效性。方法60例需行PRK手术的患者全部纳入临床观察研究,所有患者均为右眼行酒精去上皮的PRK手术,左眼行激光去上皮的Trans-PRK手术,术前未与患者特别说明两种方式的区别,术后第1、3、7天通过询问患者双眼疼痛感、异物感、畏光流泪等不适感觉,对患者双眼自我感觉进行对比分析,然后术后1、3 d行裂隙灯下观察,术后7 d、1、3、6个月行裂隙灯下观察、角膜染色等方式检查术眼角膜上皮修复情况,然后分析两种手术方式在屈光矫正的可预测性、安全性、有效性。结果 Trans-PRK和PRK两种手术方式,患者在术后1 d双眼不适的自我感觉方面无明显差异,3 d时行PRK的术眼较行Trans-PRK的术眼不适感明显(60例,38例主诉右眼较左眼不适感明显),术后3 d观察行Trans-PRK术眼的角膜上皮修复较行PRK术眼恢复快(60例左眼角膜上皮3 d均恢复,可以取下角膜接触镜,46例右眼角膜上皮3 d恢复,余下14例更换角膜接触镜后,延迟1 d,于术后第4天取下角膜接触镜)。患者术后3 d的裸眼视力,左眼视力明显高于右眼视力。结论 Trans-PRK手术方式较传统20%酒精去上皮的PRK手术更加简便易行,不但利于临床医生掌握操作,也能加速术后角膜创面的恢复,减轻患者术后的痛苦,加快患者术后视力的恢复,虽然观察数量为60例,为期6个月,但仍能证实较传统PRK手术的优越性。
목적：위료감경환자준분자격광각막절삭술술후적동통,제고각막상피적유합속도,현장격광절삭여주정박제각막상피진행대비분석,지재검측경각막상피적준분자격광각막표층절삭술(Trans-PRK)여준분자격광각막표면절삭술(PRK)상비적가예측성、안전성、유효성。방법60례수행PRK수술적환자전부납입림상관찰연구,소유환자균위우안행주정거상피적PRK수술,좌안행격광거상피적Trans-PRK수술,술전미여환자특별설명량충방식적구별,술후제1、3、7천통과순문환자쌍안동통감、이물감、외광류루등불괄감각,대환자쌍안자아감각진행대비분석,연후술후1、3 d행렬극등하관찰,술후7 d、1、3、6개월행렬극등하관찰、각막염색등방식검사술안각막상피수복정황,연후분석량충수술방식재굴광교정적가예측성、안전성、유효성。결과 Trans-PRK화PRK량충수술방식,환자재술후1 d쌍안불괄적자아감각방면무명현차이,3 d시행PRK적술안교행Trans-PRK적술안불괄감명현(60례,38례주소우안교좌안불괄감명현),술후3 d관찰행Trans-PRK술안적각막상피수복교행PRK술안회복쾌(60례좌안각막상피3 d균회복,가이취하각막접촉경,46례우안각막상피3 d회복,여하14례경환각막접촉경후,연지1 d,우술후제4천취하각막접촉경)。환자술후3 d적라안시력,좌안시력명현고우우안시력。결론 Trans-PRK수술방식교전통20%주정거상피적PRK수술경가간편역행,불단리우림상의생장악조작,야능가속술후각막창면적회복,감경환자술후적통고,가쾌환자술후시력적회복,수연관찰수량위60례,위기6개월,단잉능증실교전통PRK수술적우월성。
Objective To comparatively analyze laser cutting and alcohol removal corneal epithelium, in order to detect the predictability, safety, and effectiveness of trans-corneal epithelium photorefractive keratectomy (Trans-PRK) and photorefractive keratectomy (PRK), and to relieve patients’ pain and improve healing speed. Methods A total of 60 patients, who needed PRK surgery, were enrolled in the clinical research. All the patients received PRK by alcohol removal epithelium in right eyes, and PRK by laser cutting epithelium in left eyes. Specific explanation of the difference between the two methods was not told. Inquiry of pain feeling, foreign body sensation, and photophobia tearing was made for analyzing patients’ self feeling after 1 d, 3 d, and 7 d of the treatment. Observation under slit lamp was performed after 1 d and 3 d of treatment. Observation under slit lamp and cornea dyeing for corneal epithelium recover were made after 7 d, 1 month, 3 months and 6 months of treatment. The predictability, safety, and effectiveness of the two methods were analyzed.Results The difference  of self feeling after 1 d of treatment between Trans-PRK and PRK was not significant. After 3 d, the discomfort feeling of PRK was more obvious than Trans-PRK (38 cases with more discomfort right eye than left eye in 60 cases). The corneal epithelium recover was faster in Trans-PRK than PRK after 3 d of treatment (left eyes of 60 cases recovered in 3 d, corneal contact lens could be taken off, right eyes of 46 cases recovered in 3 d, the left 14 cases changed corneal contact lens for 1 more day and took off at the fourth day). Uncorrected visual acuity of the left eyes was better than the right eyes after 3 d of treatment.Conclusion Trans-PRK is easier for operation than the traditional method of 20% alcohol removal epithelium PRK. This method is easy operational, and can promote corneal wound recovery, reduce postoperative pain, increase sight recovery. Although the observation just lasts for 6 months on 60 cases, it can still prove the superiority of Trans-PRK over PRK.