LASIK后严重角膜上皮植入并角膜瓣融解的处理

The management of severe corneal epithelial ingrowth and flap melt after laser in-situ keratomileusis

探讨 L ASIK术后严重角膜上皮内生所致角膜瓣融解缺损的治疗方法。病例和方法 :L ASIK术后经本院确诊为角膜上皮内生合并角膜瓣融解的 12例 13眼 ,根据角膜瓣厚度及角膜瓣融解的程度 ,9眼接受翻开角膜瓣清除层间上皮的治疗 ,3眼行异体角膜磨镶术 ,1眼去除角膜瓣。结果 :翻开角膜瓣清除角膜上皮的 9眼中 ,2眼复发 ,但再次治疗后正常愈合。异体角膜磨镶术组的 3眼角膜瓣均正常愈合。去除角膜瓣的 1眼角膜上皮正常 ,但出现 2级角膜雾状混浊。所有患眼术后均获得 0 .3～ 1.0的裸眼视力 ,而矫正视力较 L ASIK术前下降 0～ 4行。结论 :L ASIK术后角膜上皮内生合并角膜瓣融解是一较严重并发症 。

Purpose:To investigate the treatments of corneal epithelial ingrowth with flap melt after LASIK.Patients and Method:Thirteen eyes in 12 patients with corneal epithelial ingrowth and flap melt after LASIK were treated based on the thickness and the extent of melting of the flap.Nine eyes were treated by lifting the flap and scraping the epithelium in the interface.Three eyes underwent allogenic keratomileusis.The flap was removed in one eyes.Results:Recurrence occurred in 2 eyes treated with lifting the flap.The flaps,however,healed normally after re treatment.The grafts healed normally in the allogenic keratomileusis group.The corneal epithelium healed over the stromal bed after removing the flap.Corneal haze of grade 2 was present at 6 months.The uncorrected visual acuity was between 0 3 and1 0,and the best corrected visual acuity lost 0 to 4 lines.Conclusions:Corneal epithelial ingrowth with flap melt is a severe complication after LASIK.However,with proper treatment,vision can be salvaged in most cases.