飞秒激光制瓣LASIK术后角膜层间上皮植入

摘要

Objective To study the occurrence and prevention and treatment of corneal epithelial ingrowth after femtosecond laser assisted laser in situ keratomileusis (LASIK).Methods A retrospective analysis was performed on 1 122 patients (2 236 eyes) who underwent femtosecond laser surgery at our hospital from October 2013 to July 2014.BCVA＞1.0 was found in a routine preoperative check.Intralase femtosecond laser at 60 kHz was used to complete the surgery and a digital camera was used to record the entire procedure.Patients were followed up for 3 months postoperatively to monitor corneal epithelial ingrowth.Results Corneal epithelial ingrowth occurred in 28 eyes (1.25％) by one month postoperatively.Of these, 18 eyes (0.81％) had level Ⅰ epithelial ingrowth.On the first day postoperatively 8 eyes (0.36％) had level Ⅱ epithelial ingrowth but did not appear to have local flap melting or irregular astigmatism.On postoperative day 1, two eyes (0.09％) had level Ⅱ diffuse lamellar keratitis.This condition disappeared after one week of applying 1％ prednisolone acetate eyedrops 4 times a day, but at 1 month after surgery, they developed level Ⅲ epithelial ingrowth with corneal flap edge fusion.Conclusion The incidence of epithelial implantation was low after femtosecond laser surgery.A combination of preoperative screening, standardized surgery, close postoperative observation and timely treatment are effective means for the prevention and treatment of corneal epithelial endogenous.%目的 探讨飞秒激光制瓣准分子激光原位角膜磨镶术(LASIK)后角膜上皮植入的发生率及防治.方法 回顾性系列病例研究.选择天津爱尔眼科医院2013年10月至2014年7月接受飞秒激光制瓣LASIK手术患者1 122例(2236眼).术前最佳矫正视力(BCVA)均＞1.0.应用60 kHz的Intralase飞秒激光制作角膜瓣,常规基质切削后完成手术,数码摄像机记录手术全程,术后随诊3个月.结果 术后1个月15例(28眼,1.25％)发生角膜层间上皮植入.其中18眼(0.81％)为Ⅰ级上皮植入;8眼(0.36％)为Ⅱ级上皮植入,未出现局部角膜瓣融解及不规则散光;2眼(0.09％)于术后ld发生Ⅱ级弥漫性层间角膜炎,应用1％醋酸泼尼松龙滴眼液点眼4次/d,1周后消失,但在术后1个月时发生Ⅲ级角膜层间上皮植入伴角膜瓣边缘融解.结论 飞秒激光术后上皮植入发生率低,术前严格筛查、规范手术操作,术后密切观察及时处理,是防治角膜层间上皮植入的有效手段.