再次准分子激光角膜原位磨镶术中夹层或多层角膜瓣分析

The formation,treatment and prevention of the interlayer or multilayer corneal cap in repeat LASIK surgery

目的 :探讨准分子激光原位角膜磨镶术 (laserinsitukeratomileusis,LASIK)中夹层或多层角膜瓣的形成原因及合理的处理方法 ,力求最大限度地减轻其对视功能的损害 ,保证最佳的视觉质量 ,并预防其发生。方法 :对二次或三次行LASIK术中形成夹层或多层角膜瓣的 2 2眼 ,观察其术中情况和术后不同时期的视力、矫正视力、屈光度、角膜刺激症状、角膜混浊程度、角膜上皮层间植入、角膜地形图、对比敏感度、眩光情况 ,并行视功能检查 ,对其形成原因和处理方法的合理性进行分析。结果 :在再次手术形成夹层角膜瓣的2 2眼中 ,其中 19眼继续完成手术 ,3眼再次手术失败 :1眼在第三次LASIK手术中形成多层角膜瓣 ,后改做准分子激光角膜切削术 (phtorefractivekeratectomy ,PRK)成功 ;1眼直接改做PRK恢复良好 ;1眼放弃激光治疗。结论 :LASIK治疗近视安全有效 ,通过切实到位的设备维护、严格执行正确的手术操作和合理的处理方法 ,能够减少、避免夹层或多层角膜瓣的发生 ,最大限度地减轻视功能损害 ,提高视觉质量。

Objective: To study the causes of and treatments for the interlayer or multilaye r corneal cap in repeat LASIK surgery in order to find a way to reduce the damag e to visual function.Methods: 22 eyes with interlayer or multilayer corneal cap resulting from a seco nd or third LASIK surgery were enrolled in this study. Average follow-up was (1 2±3)months. The vision examination included refraction,reported symptoms,corne al haze,corneal epithelium implantation,corneal topographic mapping,contrast sensitivity function,glare and visual acuity. The causes and rationales for tre atments were analyzed.Results: Among 22 eyes with an interlayer corneal cap,treatment was successful for 19 eyes. Of the 3 eyes that were not successfully treated:a multilayer corn eal cap formed during the third LASIK surgery in 1 eye but later treatment with PRK was successful;1 was treated with PRK directly and recovered well;treatmen t was abandoned for 1 eye. Conclusion: LASIK is an effective and safe surgery for myopia. With careful main tenance of the equipment,accurate surgery and proper treatment,the formation o f interlayer or multilayer corneal caps can be greatly reduced or avoided.