摘要
目的探讨表层准分子激光原位角膜磨镶术（Epi—LASIK）矫正近视及散光术中使用Moria机械角膜上皮剥离器制作角膜上皮瓣切人角膜基质的影响因素及最佳处理方法。方法回顾性研究。收集2004年1月至2009年1月，在北京大学第三医院眼科进行Epi—LASIK矫正近视及散光的患者355例（708只眼），研究其术中发生切人角膜基质的比例和可能的影响因素，以及使用不同的处理方法，对于术后最佳矫正视力（BCVA）及角膜形态的影响。结果355例（708只眼）中有4例（4只眼，0．56％）在制作角膜上皮瓣过程中切人角膜基质。其中2只眼即时进行上皮瓣下的准分子激光角膜基质切削，按原定方案矫正近视及散光。1只眼复位角膜上皮瓣并终止后续手术，待术后6个月使用机械角膜板层切开刀进行常规LASIK。另1只眼复位角膜上皮瓣，终止后续手术，待术后1个月先用治疗性角膜切削术（1YFK）模式去除角膜上皮，随后用光学性角膜切削术（PRK）模式矫正近视及散光。术后最后的随访中，上皮瓣下即时行准分子激光切削的病例BCVA丢失1行，角膜地形图显示原角膜基质切入区域形态不规则。2例（1例即时行准分子激光角膜切削术、另1例术后6个月行常规LASIK）术后BCVA与术前相同；术后1个月行PTK去除角膜上皮加PRK矫正近视散光的病例BCVA与术前相比提高1行，这3只眼的角膜地形图中央区显示规则形态。结论使用Moria机械角膜上皮剥离器制作角膜上皮瓣时，有切人角膜基质的可能。对于此并发症，术后1个月改行PTK去除角膜上皮，然后行PRK矫正近视及散光，对于视力的恢复及角膜形态的规则性可能是最佳的选择。
Objective To investigate the risk factors of inadvertent cornea stromal dissection during mechanical epikeratome separation of the corneal epithelium using a Moria Epi-keratome and to explore the best procedure for the treatment of this complication. Methods We retrospectively reviewed inadvertent stromal dissections in central or peri-central areas of the cornea during mechanical epi-keratome separation of the corneal epithelium from a series of 708 eyes （ 355 patients） who received myopic Epi-laser-assisted in situ keratomileusis （Epi-LASIK） procedures during the past five years. The best spectacle corrected visual acuities （BCVA） and topographies at the final follow-up after the last procedures were compared. Results From the total of treated eyes, 4 eyes of 4 patients （0.56%） suffered inadvertent stromal dissection. In two of them, an excimer laser ablation under the flaps was performed immediately. One patient was treated with LASIK 6 month after the first procedure and another one received an excimer laser photo-therapeutic keratectomy （PTK） removing the corneal epithelium and photorefractive keratectomy （PRK） for refractive correction 1 month after Epi-LASIK. Postoperatively, BCVA lost one line in one eye which received immediate excimer laser ablation under complicated flap. Topography demonstrated irregularity corresponding to the site of stromal dissection. Two eyes （one received immediate excimer laser ablation and another received LASIK 6 month after stromal dissection） recovered to the pre-Epi-LASIK BCVA. One eye that received PTK and PRK 1 month after Epi-LASIK obtained an increase of one line in BCVA. Topography in all three eyes showed regular patterns in the middle of the cornea. Conclusions Stromal dissection during mechanical separation of the corneal epithelium with Moria Epi-K epikeratome is a potential complication of Epi-LASIK. One month postoperative PTK and PRK turned out to be the option of proper management for good recovery without severe visual impairment.
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2013年第4期315-319,共5页
Chinese Journal of Ophthalmology
