准分子激光原位角膜磨镶术后角膜瓣下上皮细胞植入的临床及病理学研究

Corneal epithelium implantation under corneal flap after excimer laser in situ keratomileusis: a clinical pathological and cytological study and management

目的探讨准分子激光原位角膜磨镶术（ｅｘｃｉｍｅｒｌａｓｅｒｉｎｓｉｔｕｋｅｒａｔｏｍｉｌｅｕｓｉｓ，ＬＡＳＩＫ）后角膜瓣下上皮细胞植入的临床细胞学、病理学特点及术后并发症的处理方法。方法对ＬＡＳＩＫ术后１５～６５天发生角膜瓣下上皮细胞增生的４只患眼行向鼻侧撕开角膜瓣，刮除植入及增生的有形物质，冲洗层间，重新将角膜瓣复位。结果术后１～１２个月，无新的上皮细胞植入。将刮除的植入及增生的有形物质行临床细胞学、病理学检查，可见较多变性、坏死且呈散在或小团状分布的角膜上皮细胞及部分细长形的纤维细胞样细胞。膜样有形成分行组织学ＨＥ染色，可见淡蓝色的细颗粒状无结构物质，其中夹杂少量变性坏死的细胞。结论ＬＡＳＩＫ术后角膜上皮瓣下植入增生可出现瓣下乳白色有形物质，主要由细颗粒状无结构物质构成，夹杂变性坏死的细胞成分。具有不规则、匍匐性进展的特征，应尽早清除。

Objective To study the clinical pathological and cytological characteristics of corneal epithelial cells implanted under the cap of laser in situ keratomileusis and the method of management. Methods For 4 eyes with epithelial cell implantation, the corneal cap was torn from temporal side to nasal, and the implanted material was removed from the flap and the stromal base. After washing between the interface, the cap was repositioned. Result No epithelial implantation occurred again in these 4 cases after follow up for 1～12 months. The clinical pathological and cytological studies showed the material removed was degenerated and necrotic epithelial cells mixed with some unknown materials. Conclusion Clinically, the material formed under the cap white and yellow in color should be removed as soon as it happens. The material consists mainly of non structural material with necrotic and degenerated epithelial cells.