LASIK术后角膜上皮内生的处理

Treatment of corneal epithelial ingrowth after LASIK

目的：分析准分子激光原位角膜磨镶术（ LASIK）后角膜上皮植入及内生发生的原因,总结治疗经验。 方法：回顾性分析2008-01/2012-12于我院行LASIK患者1256例2256眼,术后发生角膜上皮植入及内生18例30眼的临床资料。对所有患眼进行治疗后,对治疗前后患者整体视觉质量评分进行分析。 结果：行LASIK术后角膜上皮植入及内生18例30眼,发生率为1.3%。18例30眼患者中12眼为术后外伤致角膜瓣移位上皮内生,12眼为术中多次角膜瓣下冲洗,2眼为术中制作角膜瓣出现不规则瓣,4眼术中无特殊。30眼角膜上皮内生的程度：I级11例18眼,Ⅱ级4例8眼,Ⅲ级3例4眼。 I-Ⅱ级者予妥布霉素地塞米松滴眼液点眼并辅予降眼压药物治疗为主,Ⅲ级者先予药物治疗,若情况无好转,则予手术治疗。治疗后11例18眼I级者中8例13眼内生均消失,3例5眼植入上皮灶缩小；4例8眼Ⅱ级者中2例4眼上皮植入消失,2例4眼上皮植入程度减轻至I级；3例4眼Ⅲ级者中2例2眼角膜缘1 mm处瓣缘有0.5-1mm宽瓣下浅灰白色带,视力0.8-1.2,1例2眼患者予刮除植入角膜上皮及内生上皮,随访无复发。治疗后18例角膜上皮内生患者整体视觉质量评分低于治疗前（Hc=10.511,P〈0.01）。 结论：规范手术操作、术后及早发现并予积极治疗是对预防和治疗LASIK 术后并发症有重要意义。

AIM： To analyze the reason of corneal epithelial implantation and ingrowth after laser in situ keratomileusis （ LASlK ） , and summarize the treatment experiences. METHODS： The clinical data of postoperative corneal epithelial ingrowth on 18 cases （30 eyes） from 1 256 cases （2 256 eyes） after LASlK were retrospectively analyzed in our hospital from January 2008 to December 2012. After the treatment of all eyes, patients’ general visual quality scores before and after treatment were analyzed. RESULTS：There were 18 cases （ 30 eyes ） with corneal epithelial implantation and ingrowth after LASlK, and the incidence rate was 1. 3%. ln the 18 cases （30 eyes）, there were 12 eyes corneal flap epithelial ingrowth caused by postoperative trauma, 12 eyes caused by multiple corneal flap flush, 2 eyes caused by intraoperative irregular corneal flap, and nothing special for 4 eyes. The classification of corneal epithelial ingrowth of 30 eyes：grade I, 11 cases （18 eyes）;gradeII, 4 cases （8 eyes）;grade Ⅲ, 3 cases （ 4 eyes ） . Grade I-II were treated with TobraDex eye drops and intraocular pressure lowering drug. Grade Ⅲ firstly were treated by drugs, otherwise by surgery if it didn’t improve. After treatment, 8 cases （13 eyes） epithelial ingrowth disappeared from 11 cases （ 18 eyes ） , 3 cases （ 5 eyes ） implanted epithelial tumor shrank in grade l;epithelial implantation of 2 cases （4 eyes） in grade II disappeared, implantation degree of 2 cases （4 eyes） reduced to grade I;2 cases （2 eyes） in grade Ⅲ had 0. 5 - 1mm wide flap edge shallow gray ribbon 1 mm inside the limbus, visual acuity was 0. 8 -1. 2, 1 case （ 2 eyes ） treated with curettage corneal epithelial implantation and endophytic epithelium hadn’t relapsed in the follow-up. After the treatment, 18 cases of corneal epithelial ingrowth got lower visual quality scores than those before therapy （Hc=10. 511, P〈0. 01）. CONCLUSION： Operation standardized, postoperative early detection and aggressive treatment are important for prevention and treatment of complications after LASlK.