LASIK术后角膜上皮植入的发生及处理

Incidence and Management of Epithelial Ingrowth After Laser in Situ Keratomileusis

目的 :探讨 L ASIK术后角膜上皮植入的发生、影响因素、处理方法和效果。方法 :回顾性分析由同一位医生所行 L ASIK术后随访 6个月以上并有完整记录的所有病例。结果 :共 63 3例病人 12 4 0只眼 ,其中 61眼曾行二次 L ASIK手术。有 10人 10眼 ( 0 .81% )发生角膜上皮植入。其中 ,1眼为二次手术后发生 ( 1.6% ) ;6眼有戴接触镜史 ;5眼术中发生瓣或上皮异常 :游离瓣 1眼、上皮缺损 2眼、上皮松解 2眼 ;6眼术后 1天时发现荧光素染色阳性 ( 5眼 )或角膜瓣皱折 ( 1眼 ) ;9眼上皮植入发生于角膜瓣的边缘 ,4眼见于原上皮缺损或易脱落方向。除 1眼待术外 ,其余 9眼 ( 5眼药物治疗 ,4眼手术治疗 )的最终裸眼视力为 0 .72± 0 .3 2 ( 0 .0 2～ 1.0 ) ,最佳矫正视力为 0 .93± 0 .1( 0 .8～ 1.0 ) ,球镜为 - 0 .3 1± 0 .97D( - 2 .2 5～ 1.5 D) ,柱镜为 0 .61± 0 .5 0 D( 0～ 1.2 5 D) ,无异物感、眩光、荧光素着染等 ,上皮植入消失 5眼 ,变小 1眼 ,静止 3眼。结论 :术者应通过提高手术操作技能和完善各手术步骤尽可能地减少此并发症的发生。发现后恰当处理 ,可获得很好效果。

Objective: To investigate the incidence and risk factors of epithelial ingrowth after laser in situ keratomileusis(LASIK), as well as the management methods and outcomes. Methods: Results were reviewed for all LASIK procedures performed by one surgeon and followed up over 6 months. Results: 1240 eyes of 633 patients had primary LASIK, and 61 eyes had LASIK reoperation. 10 eyes(0.81%)developed epithelial ingrowth postoperatively. 1 of 10 eyes was noted to have epithelial ingrowth after LASIK reoperation (1.6%). Six eyes had contact lens wearing histories. 1 eye had free flap, 2 eyes had epithelial defect, and 2 eyes had loose epithelium intraoperatively. 5 eyes had positive fluorescein staining, and 1 eye had wrinkle flap at 1 day postoperatively. All epithelial ingrowth occurred at the edge (9 eyes) or near the edge (1 eye) of the flaps. 4 eyes had the lesion at their original areas of epithelial defect or loose epithelium. We treated epithelial in-growth by drugs(5 eyes) or surgeries (4 eyes). The final uncorrected visual acuity and best-corrected visual acuity of the 9 eyes were satisfactory. Epithelial in-growth disappeared in 5 eyes, got smaller in 1 eye, and had no change in 3 eyes. The patients had no complains of foreign body sensitivity, glare and so on. The other 1 eye was about to have surgery. Conclusions: The surgeon can markedly reduce the incidence of this complication by improving the surgical techniques and procedures. Properly treating for epithelial ingrowth can give patients satisfactory results.