飞秒激光制瓣LASIK术后角膜层间上皮植入

Postoperative corneal epithelial ingrowth after femtosecond laser

目的探讨飞秒激光制瓣准分子激光原位角膜磨镶术（LaSIK）后角膜上皮植入的发生率及防治。方法回顾性系列病例研究。选择天津爱尔眼科医院2013年10月至2014年7月接受飞秒激光制瓣LASIK手术患者1122例（2236眼）。术前最佳矫正视力（BCVA）均〉1．0。应用60kHz的Intralase飞秒激光制作角膜瓣，常规基质切削后完成手术，数码摄像机记录手术全程，术后随诊3个月。结果术后1个月15例（28眼，1．25％）发生角膜层间上皮植入。其中18眼（0．81％）为Ⅰ级上皮植入；8眼（0．36％）为Ⅱ级上皮植入，未出现局部角膜瓣融解及不规则散光；2眼（0．09％）于术后1d发生Ⅱ级弥漫性层间角膜炎，应用1％醋酸泼尼松龙滴眼液点眼4次／d，1周后消失，但在术后1个月时发生Ⅲ级角膜层间上皮植入伴角膜瓣边缘融解。结论飞秒激光术后上皮植入发生率低，术前严格筛查、规范手术操作，术后密切观察及时处理，是防治角膜层间上皮植入的有效手段。

Objective To study the occurrence and prevention and treatment of corneal epithelial ingrowth after femtosecond laser assisted laser in situ keratomileusis （LASIK）. Methods A retrospective analysis was performed on 1 122 patients （2 236 eyes） who underwent femtosecond laser surgery at our hospital from October 2013 to July 2014. BCVA〉1.0 was found in a routine preoperative check. Intralase femtosecond laser at 60 kHz was used to complete the surgery and a digital camera was used to record the entire procedure. Patients were followed up for 3 months postoperatively to monitor corneal epithelial ingrowth. Results Corneal epithelial ingrowth occurred in 28 eyes （1.25%） by one month postoperatively. Of these, 18 eyes （0.81%） had level Ⅰ epithelial ingrowth. On the first day postoperatively 8 eyes （0.36%） had level Ⅱ epithelial ingrowth but did not appear to have local flap melting or irregular astigmatism. On postoperative day 1, two eyes （0.09%） had level Ⅱ diffuse lamellar keratitis. This condition disappeared after one week of applying 1% prednisolone acetate eyedrops 4 times a day, but at 1 month after surgery, they developed level Ⅲ epithelial ingrowth with corneal flap edge fusion. Conclusion The incidence of epithelial implantation was low after femtosecond laser surgery. A combination of preoperative screening, standardized surgery, close postoperative observation and timely treatment are effective means for the prevention and treatment of corneal epithelial endogenous.