滑石粉对LASIK术后发生弥漫性板层角膜炎的影响观察

Observation of talc's influence on the diffuse lamellar keratitis after laserin situ keratomileusis

目的:观察是否戴无菌滑石粉手套影响准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)术后弥漫性板层角膜炎(diffuse lamellar keratitis,DLK)的发生率,证实残留滑石粉对DLK发生起重要作用。方法:收集单纯手消毒法行LASIK手术的患者563例1 126眼作为观察组,采用手消毒戴无菌手套法行手术的患者592例1 184眼作为对照组。术后第1,7d复查,观察DLK的发生情况。采用卡方检验及秩和检验对DLK的发生情况进行统计分析。结果:术后第1d,观察组DLK发病率为7.4%(83眼),其中Ⅰ期为4.6%(52眼),Ⅱ期为2.8%(31眼);对照组为12.2%(144眼),其中Ⅰ期为7.7%(91眼),Ⅱ期为4.5%(53眼)。术后第7d,两组DLK均消退。对照组2例3眼(术后第8d首次复查,未按时行氟米龙点眼治疗)出现Ⅳ期DLK。观察组DLK的发生率(P<0.01)及严重程度(P<0.01)明显低于对照组。结论:滑石粉是LASIK术后DLK发生的一个重要因素,采用单纯手消毒法可以去除滑石粉的刺激作用,明显降低DLK的发生率。

AIM： To observe the influence on the incidence of diffuse lamellar keratitis （DLK） after laser in situ keratomileusis （LASIK） whether or not wearing sterile gloves with talc during operation, and to confirm the role of residual talc in the occurrence of DLK. METHODS： Totally 563 patients （1126 eyes） accepted operation with the method of surgical hand antisepsis only were set as the experimental group, while 592 patients （1 184 eyes） with the method of surgical hand antisepsis and sterile gloves as the control group. Each patient was rechecked to observe the occurrence of DLK on the first day and the seventh day after the operation. Then the data of DLK were statistically analyzed by χ2 test and rank sum test. RESULTS：On the first postoperative day, the incidence of DLK was 7.4% （83 eyes） in experimental group and 12.2% （144 eyes） in control group. In the former group, stage Ⅰ of DLK accounted for 4.6% （52 eyes） and stage Ⅱfor 2.8% （31 eyes）; while in the latter, stage Ⅰ did for 7.7% （91 eyes） and stage Ⅱ for4.5% （53 eyes）. Onthe seventh day, all DLK were cured. The other 2 cases （3 eyes） occurred in stage Ⅳ DLK （the first time recheck was on the eighth day after operation and fluorometholone ophthalmic solution was not used on time）. The incidence and the severity were both significant lower in the experimental group than in the control （, both P〈0.01 ）. CONCLUSION. Talc is one of the most important factors resulting in DLK after LASIK. The method of surgical hand antisepsis without wearing gloves could avoid the stimulation of talc and reduce the incidence of DLK obviously.