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PRK術中預防性使用Mitomycin-C處理Button-Hole Flap
Management of Button-Hole Flap with Prophylactic Use of Mitomycin-C after PRK
摘要
目的：報告PRK術中以Mitomycin-C 0.02%(MMC)做為預防性局部治療－LASIK造成buttonhole之病例。 方法：病例報告。 結果：一名23歲女性進行右眼之LASIK治療，當角膜板層刀進行右眼角膜瓣切割時，8.5毫米角膜瓣中心形成了一個button hole，我們將此角膜瓣撫平蓋回原來位置，決定不繼續施打雷射；另一眼也放棄LASIK治療。一週後，右眼最佳矯正視力降至0.7，之後右眼最佳矯正視力仍恢復至1.2。我們使用前導波(Wavefront, Zywave, B&L)分析其視力品質，發現右眼之高階像差較無治療的左眼高。一個月後，我們為病人進行雷射屈光角膜切削術(PRK)治療，術中右眼使用輔助性MMC 0.02%以預防角膜發生霧濁(haze)。左眼亦進行標準程序之PRK，不使用MMC。術後1個月，3個月，6個月，12個月返診追蹤顯示未矯正視力雙眼為1.2，左眼未矯正視力於術後12個月為1.5；兩眼角膜清澈無霧濁現象。雖然術後1個月，3個月，6個月追蹤顯示右眼buttonhole角膜瓣之高階像差較另一眼高；但病人無主觀症狀，所以對手術結果感到滿意。 結論：PRK術中加上輔助性的Mitomycin-C可用於處理buttonhole flap等LASIK的角膜瓣併發症。
關鍵字
無資料並列摘要
Purpose: To report a case in which prophylactic mitomycin-C (0.02%) was used to prevent haze following photorefractive keratectomy in an eye with a previous button-hole flap. Method: Case report Result: A 23-year-old woman underwent laser in situ keratomileusis in the right eye. A central button-hole flap was created during the microkeratome pass. The flap was repositioned without further laser ablation and the other eye did not undergo the procedure. Corrected visual acuity of the right eye was initially decreased, then returned to the pre-operation level in 3 weeks. The quality of vision was reviewed by wave-front analysis. Increase of high order aberration of right eye was noted compared to the untreated left eye. One month later, the patient had PRK with adjunctive MMC 0.02% application in the right eye and standard PRK in the left eye. During 6-months of follow-up, the uncorrected visual acuity of both eyes were 1.2 and the corneas were clear without haze. The uncorrected visual acuity of the left eye even improved to 1.5 at 12-month follow-up. Although the high order aberration of the right eye was higher than the other eye throughout the follow-up period, the patient was satisfied with the result because of no discernible visual symptoms. Conclusion: Adjunctive application of MMC 0.02% in PRK may be used in the management of button-hole flap as well as other complicated LASIK flaps.