准分子激光上皮瓣下角膜磨镶术角膜上皮瓣并发症

Clinical investigation of the epithelial-flap abnormalities after laser subepithelial keratomileusis

目的探讨和分析准分子激光上皮瓣下角膜磨镶术(LASEK)角膜上皮瓣并发症的相关因素、预防及处理方法。方法应用德国Allegretto鹰视准分子激光器对近视110例(218眼)施行LASEK术。对在术中和术后出现不同类型角膜上皮瓣并发症进行相关原因分析。结果LASEK术中上皮瓣的主要并发症有:上皮瓣剥离困难,瓣撕裂或破碎,瓣游离、瓣皱褶、瓣偏离中心及瓣蒂位置变更等;术后瓣并发症主要有:迟发性(术后48～72h)上皮瓣局限性缺损、瓣下异物、上皮瓣丢失等。结论LASEK术后角膜上皮瓣成活与否,影响因素是多方面的。完好的角膜上皮瓣是LASEK优越性的基础,通过提高LASEK的手术技巧,充分保持上皮细胞的活性,正确处理上皮瓣的各种并发症是LASEK手术成功的关键。

Objective To investigate the complications of the epithelial-flap and the factors related to the laser subepithelial keratomileusis （LASEK）. Methods LASEK was performed on 218 eyes of 110 patients. The factors related to the abnormal epithelial flap were listed and discussed. Results The abnormal epithelial flap of LASEK during the operation were difficult detachment of epithelial-flap, flap rupture or fragments, flap free, flap fold, flap decentral, and change of epithelial-flap pedicle position. The main postoperative complications were delayed （48-72 hour） epithelialflap defect, sub-epithelial foreign body, and lost of epithelial-flap. Conclusion The key point in the performance of a fine epithelialflap is to improve the LASEK operative skill, to keep the epithelial cell activity and to manage each procedure carefully.