准分子激光原位角膜磨镶术后角膜瓣皱褶的原因及处理

Folds and striae in the cornea flap after laser in situ keratomileusis,etiology and treatment

目的探讨准分子激光原位角膜磨镶术(laserinsitukeratomileusis,LASIK)后角膜瓣皱褶的原因及处理。方法对LASIK术后19例角膜瓣皱褶的原因及处理进行回顾性分析。结果术后第1d发现的角膜瓣皱褶可能与术前配戴角膜接触镜及术中过度冲洗等操作不当有关,处理上采用重新复瓣加戴角膜接触镜。术后第10d发现的角膜瓣皱褶原因不明,10d后发生的角膜瓣皱褶与外伤有关,处理上采用去上皮水化角膜瓣加戴角膜接触镜,经以上处理的所有患者裸眼视力均达到或超过术前最佳矫正视力,角膜透明,未见明显皱褶,角膜瓣位置正常,无上皮植入。结论术后LASIK早期角膜瓣皱褶可能与过度冲洗及术前配戴角膜接触镜有关,晚期角膜瓣皱褶与外伤有关。术后第1d角膜瓣皱褶仅需采用重新复瓣加戴角膜接触镜法。术后10d后角膜瓣皱褶需采用去上皮水化角膜瓣加戴角膜接触镜法。

Objective To investigate the causes and treatment of cornea flap folds and striae after laser in situ keratomileusis （LASIK）. Methods To make retrospective analysis of etiology and treatment in 19 cases who had cornea flap folds and striae after LASIK. Results Cornea flap folds and striae on the first day after LASIK might have connection with wearing contact lens before operation and false manipulation such as overirrigation during operation. Relocation flap and contact lens were used in such cases. It had unclear reason of cornea flap folds and striae on the tenth day after LASIK. Cornea flap folds and striae after 10 days＇ LASIK had connection with trauma. Scraping epithelial and hydrating the cornea flap were used under such situation. All patients who received those treatments had regained the best-uncorrected visual acuity. Cornea was clear and had no obvious folds and striae. The flap had perfect location and no epithelial cell ingrowth. Conclusions Cornea flap folds and striae after LASIK happening in early period might have connection with overirrigation and wearing contact lens before operation. Relocation flap and wearing contact lens may be choice in such cases to eliminate folds and striae. Corneal flap folds and striae after LASIK also happening in later period had connection with trauma, which should receive scraping epithelial and hydration the cornea flap.