LASEK术后角膜上皮下雾状混浊防治的临床观察

目的 分析准分子激光上皮下角膜磨镶术(laser-assisted subepithelial keratomileusis,LASEK)后的角膜上皮下雾状混浊(Haze)的病例，探讨其发生原因及预防、治疗措施。 方法 回顾性研究2013年6月1日—12月31日期间50例92眼行LASEK术后，随诊12个月的病例，分析术后是否发生Haze,发生Haze的严重程度及治疗措施。 结果 术后发生Haze 36眼(39.1%)，平均(0.81±0.48)级，其中20眼为屈光度大于-5.0 D。经过局部应用非甾体抗炎药联合皮质类固醇药物，同时叮嘱患者术后眼部防晒等措施，术后6个月后患者角Haze 3眼(3.3%)，平均0.5级。发生Haze的36眼中有15例24眼为夏季手术。 结论 LASEK是一种治疗近视,提高视力安全而有效的手术，虽然不可避免地存在一些并发症，尤其要重视可能产生的严重Haze。Haze的发生与高度近视、过敏症、自身免疫疾病、经常暴露于紫外线中等因素密切相关，术前认真地做好筛查工作，严格掌握手术适应证；完善随访制度，督促患者术后定期复查，以便及时发现Haze的产生及其发展，并根据其严重程度结合眼压状况调整用药；除了合理用药，有效的护理措施亦对减少术后Haze的发生以及提高手术的预测性和准确性有帮助。 

Clinical observationof corneal haze after laser assisted sub-epithelial keratomileusis

Objective To analyze the etiology,prevention and treatment measures of corneal haze after the excimer laser corneal surgery(Laser Assisted Sub-Epithelial Keratomileusis,LASEK). Methods The clinical data of 50 cases undergoing LASEK between June 1,2013 and December 31 were analyzed retrospectively. LASEK was performed in 92 eyes.The follow-up of 12 months was carried out to study the incidence and severity of corneal haze. Results After LASEK,corneal hazeoccurred in 36 eyes(39. 1%) with an average grade of 0. 81 ±0. 48,and the diopter of 20 eyes was greater than- 5. 0 D. The local non-steroidal anti-inflammatory therapy and Corticosteroid were administrated and UV was avoided. Six months later,3 eyes were with corneal haze(3. 3%) with an average grade of 0. 5. 24 of 36 eyes with haze received LASEK in summer. Conclusion LASEK is a safe and effective operation for the treatment of high myopia. The complications such as severe haze are closely related to high myopia,allergies,autoimmune diseases,andfrequent exposure to ultraviolet light. The carefully preoperative screening and strictly control the indications will ensure the successful operation. The regular follow-up and reexamination can monitor the occurrence and development of haze,and adjust the dose of medicines according to theseverityandintraocular pressure. The effective nursing measures will also decrease the incidence of haze and improve the prediction and accuracy of LASEK.