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LASIK术后角膜上皮植入的分型及原因分析

李莹 主任医师 北京协和医院 眼科
2009-07-03 3890人已读
李莹 主任医师
北京协和医院

李莹  张潇  罗岩  钟刘学颖 丁欣  陈秉钧

中国医学科学院 北京协和医学院 北京协和医院眼科  100730北京协和医院眼科李莹

通讯作者:李莹 liyingpumch@sohu.com

摘要:目的:分析LASIK手术后角膜上皮植入(Epithelial ingrowthEI)的原因,进行分型和指导治疗。方法:对2002年到2008年我院门诊LASIK术后角膜上皮植入随诊半年以上患者45人(49眼),进行分析。男性28眼,女性21眼。就诊时角膜上皮植入时间6~31天,最佳矫正视力手动~0.6,除眼部刺激症状外,多数患者伴有不同程度的角膜瓣水肿、混浊、融解。掀开角膜瓣治疗43眼。根据上皮植入的位置、发展速度进行分类。按上皮植入到角膜中央距离和范围分为:周边型、旁中央型、中央型;分别为73210只眼。按照发展的速度分为:进展性、稳定性、静止性;分别为3144只眼。结果:一.引起上皮植入的主要原因:①角膜上皮水肿、剥脱,②角膜瓣不良,③角膜瓣对合异常;分别占比例为152113只眼。二.对视力影响:中央型〉依次为旁中央型〉周边型;进展的旁中央和中央型上皮植入超过一周,92%可导致角膜瓣基质融解,严重影响视力。三.治疗方案:密切观察,原瓣掀开刮除植入上皮29眼,上皮刮除联合PTK14眼,非掀瓣保守观察治疗6眼。再次角膜瓣掀开后全部角膜伤口一期愈合,未见再次植入病例。34眼达到了术前预期视力,7眼低于术前视力1行以内,8低于术前预期视力2行及其以上。结论:角膜上皮和角膜瓣水肿是导致LASIK术后角膜上皮植入的主要原因,92%进展的中央型和旁中央型的上皮植入,一周左右就可以导致角膜瓣融解,严重影响视力。积极掀瓣刮除植入上皮和局部PTK治疗是使患者恢复视力的首选治疗手段。

Types and causal analysis of epithelial ingrowth after LASIK

LI Ying, Zhang Xiao, Luo Yan, Zhongliu Xueying,Ding Xin,Chen Bjingjun

 

Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China

Correspondence author: LI Ying, Email: liyingpumch@sohu.com

[Abstract] Objective To analyze the causes and types of epithelial ingrowth (EI) after LASIK, in order to direct treatment.  Method A retrospective review of 45 patients (49 eyes) with EI after LASIK from 2002 to 2008. All the patients were followed up for more than half a year. There were 25 male (28 eyes) and 20 female (21 eyes). The duration of EI at the time of visit ranged from 6 days to 31 days. Best correct visual acuity ranged from hand motion to 0.6. Despite irritation, most patients had different degrees of corneal flap edema, opacity, and melting. 43 eyes were treated by lifting the corneal flaps. According to the distance to central cornea and extension of EI, there were three types, including 7 eyes of the peripheral type, 32 eyes of the paracentral type, and 10 eyes of the central type, respectively. According to the speed of progression, there were three types, including 31 eye of the progressive type, 4 eyes of the stable type, and 4 eyes of the static type. Results Causes for EI included corneal epithelium edema and exofoliation (15 eyes), unsuccessful corneal flaps (21 eyes), and abnormal apposition of corneal flaps (13 eyes). According to degrees of visual acuity influence from severe to slight, there were the central type, paracentral type and periphery type, respectively. If progressive paracentral and central EI lasted for more than a week, corneal flap melting happened in 92% of cases, and visual acuity impaired severely. Among these patients, 29 eyes received corneal flap lifting and ingrowthed epithelium sweeping; 14 eyes received ingrowthed epithelium sweeping combined with PTK; 6 eyes received conservative observation without corneal flap lifting. All the cornea healed after corneal flap lifting, and there was no secondary EI. Visual acuity of 34 eyes achieved the preoperative expected visual acuity; 7 eyes were one line and 8 eyes were two lines or more below the preoperative expected visual acuity. Conclusions Edema of corneal epithelium and corneal flap are the main cause of EI after LASIK. Corneal flap melting happen in 92% of progressive paracentral and central EI for more than a week, and visual acuity are impaired severely. Corneal flap lifting, ingrowthed epithelium sweeping, as well as PTK, are the first choice of treatment to help recovering their visual acuity.

 

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李莹 主任医师

北京协和医院 眼科

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