准分子激光原位角膜磨镶术后DLK的临床治疗

Clinical treatment of diffuse lamellar keratitis after laser in situ keratomileusis

目的:探讨准分子激光原位角膜磨镶术后弥漫性层间角膜炎的临床分级治疗。方法:收集2008-04/2009-09我院的准分子激光原位角膜磨镶术后弥漫性层间角膜炎患者19例21眼,根据角膜层间炎性细胞浸润程度和浸润范围,制定分级标准,予以相应分级治疗方案。观察其治疗前和治疗后1,3,5,7,10d及1mo时临床症状,角膜浸润程度和范围,视力,屈光度数及眼压等情况。结果:19例21眼准分子激光原位角膜磨镶术后弥漫性层间角膜炎病例多为轻度,其中Ⅰ度18眼,Ⅱ度2眼,Ⅲ度1眼,经过相应分级糖皮质激素治疗,角膜瓣下炎性细胞浸润灶多在1wk内消退,随访至治疗后1mo,裸眼视力显著提高,达术前最佳矫正视力。角膜体征,视力及屈光不正恢复程度在各分级DLK之间,及在接受不同分级治疗方案的病例之间,差异均无统计学意义。无糖皮质激素性高眼压发生。结论:弥漫性层间角膜炎的临床综合分级对糖皮质激素分级治疗准分子激光原位角膜磨镶术后弥漫性层间角膜炎具有治疗指导作用。

·AIM：To evaluate the clinical classification treatment of diffuse lamellar keratitis（DLK）after LASIK.·METHODS：Nineteen patients 21 eyes of DLK after LASIK from April 2008 to September 2009 in our hospital were collected.They were given clinical classification treatment according to corneal layer inflammatory extent.The clinical symptoms,corneal infiltration and scope of vision,refractive and intraocular pressure were observed before and after treatment 1 day,3,5,7,10 days and 1 month.·RESULTS：Most of patients presented mild symptom,including degrees Ⅰ：18 eyes,degree Ⅱ：2 eyes,degree Ⅲ：1 eye.Through the appropriate classification of glucocorticoid treatment,corneal flap lesions of inflammatory cell infiltration mostly subsided within 1 week.1 month after treatment,uncorrected visual acuity was significantly increased,reaching preoperative best-corrected visual acuity.Corneal signs,visual acuity and refractive error recovery levels among the various DLK gradings and also among the different treatments in the cases.Were not significantly differenct.There was no glucocorticoid-induced high intraocular pressure.·CONCLUSION：Clinical classification has a guiding role in glucocorticoid classification treatment of DLK.·