准分子激光上皮瓣下角膜磨镶术的角膜上皮瓣异常

目的　探讨准分子激光上皮瓣下角膜磨镶术 (laserepithelialkeratomileusis ,LASEK)角膜上皮瓣异常的类型和相关原因 ,总结保护角膜上皮瓣完好的技术和重要性。方法　在行LASEK的16 7例 (30 9只眼 )患者中 ,对在术中和术后出现不同类型角膜上皮瓣异常的 9例患者 (14只眼 )进行相关原因分析 ,并观察术后视力、角膜雾状混浊和角膜刺激症状的程度。平均随访时间 (6 1± 3 7)个月。结果　LASEK术中和术后角膜上皮瓣异常表现为上皮瓣游离、溶解、碎片、皱褶、滑动 ,以及术后4 8～ 72h迟发性角膜上皮瓣局限缺损和存留穿透上皮层异物。角膜上皮瓣异常的发生与微环钻切角膜上皮过浅、角膜上皮瓣预制环过小、酒精溶液浓度不当、溶液预置渗漏、角膜上皮瓣中心区干燥、冲洗性角膜上皮损害、角膜接触镜过早取出等因素有关。术后平均残余屈光度数为 0 0 7D。结论LASEK虽具有较好的安全性和有效性 ,但完好的角膜上皮瓣是LASEK优越性的基础 ,把握手术环节 ,避免角膜上皮瓣发生异常 ,是保证LASEK成功的关键

The epithelial-flap abnormality of laser epithelial keratomileusis

Objective To investigate the technique of epithelial flap performance and reposition and the factors related to the complication to improve the quality of laser epithelial keratomileusis (LASEK). Methods Fourteen eyes (9 cases) of epithelial flap abnormality occurring in and after the operation in 309 eyes were observed and analyzed. The factors related to the abnormal flap were listed and discussed. Results The abnormal epithelial flaps of LASEK during and after the operation were free epithelial flap, dissolution, fragments, fold, slip, and the late epithelial flap abnormalities including epithelial defect and sub epithelial foreign body 48 72 hours postoperatively. The related factors of complication included the shallow cut of micro trephine, improper (too small) cut ring, improper concentration of alcohol, the invasion of alcohol solution, dry center of epithelial flap, corneal epithelial injury by irrigation, and too early removal of contact lens. Conclusion The epithelial flap of LASEK is frailer than that of LASIK. The key point in the performance of a fine epithelial flap is to manage every procedure carefully.