准分子激光角膜屈光手术后丝状角膜炎的临床分析及治疗

目的:观察准分子激光角膜屈光手术后丝状角膜炎的发病情况,总结采用唯地息凝胶治疗的效果,探讨其发病相关因素及防治方法。方法:所有患者2139眼,按术前有无角膜接触镜配戴史分为Ia组493眼(有角膜接触镜配戴史)与Ib组1646眼(无角膜接触镜配戴史),按术式分为IIa组1916眼(LASIK术后)与IIb组223眼(LASEK术后),比较其发病率,观察准分子激光角膜屈光手术后丝状角膜炎的发生情况,发病者迅速、足量使用唯地息凝胶治疗,观察其疗效,分析该病变的临床特征,相关发病因素及防治措施。结果:Ia组与Ib组术后丝状角膜炎发病率分别为3.45%和1.76%,两者有显著差异(P<0.05);IIa组与IIb组术后丝状角膜炎发病率分别为1.93%和4.04%,两者有显著差异(P<0.05)。唯地息凝胶治疗准分子激光角膜屈光手术后丝状角膜炎的平均疗程1.22±0.63d,随访6mo未见复发。结论:与准分子激光角膜屈光手术后丝状角膜炎发生的相关因素包括:术前配戴角膜接触镜继发干眼及眼表炎症、术中角膜损伤、术后角膜上皮愈合及术后用药等。唯地息凝胶治疗准分子激光角膜屈光手术后丝状角膜炎,疗程短、效果显著。     

LASIK术后早期配戴角膜接触镜预防角膜瓣相关并发症的观察

准分子激光原位角膜磨镶术（laser in situ keratomileuses,LASIK）是目前矫正屈光不正的常用方法,该方法保存了前弹力层和角膜上皮,更符合角膜的解剖结构和生理功能,但可发生角膜瓣相关并发症,如角膜瓣移位、皱褶、层间混浊、角膜上皮植入等。我们观察LASIK术后早期配戴角膜接触镜对角膜瓣相关并发症的影响,报告如下。     

准分子激光屈光性角膜切削术后高透氧性角膜接触镜的应用

目的:探讨高透氧性角膜接触镜对准分子激光屈光性角膜切削术(photorefractive keratectomy,PRK)后眼刺激症状及角膜上皮愈合的影响。方法:共95例190眼PRK病例,术后随机选择一只眼戴软性亲水性高透氧的角膜接触镜,另一只眼配戴普通月抛型角膜接触镜。术后记录术眼自觉症状,观察角膜上皮愈合情况,检查术后6mo裸眼视力,同时进行haze评分。结果:高透氧角膜接触镜组术眼视物模糊、眼痛、畏光均轻于普通月抛型角膜接触镜组,两组比较差异有统计学意义(P<0.05)。高透氧角膜接触镜组平均角膜上皮愈合时间分别为3.11±2.12d,普通月抛型角膜接触镜组为4.02±2.21d,两组比较差异有统计学意义(P<0.05)。角膜上皮72h内愈合者高透氧角膜接触镜组占46%,普通月抛型角膜接触镜组占36%。术后第7d裸眼视力高于1.0者高透氧角膜接触镜组为60眼(63%),普通月抛型角膜接触镜组为48眼(51%)。术后6mo两组术后裸眼视力无显著性差异(P=0.35),两组haze发生率比较无显著性差异(P=0.55)。结论:PRK术后使用高透氧性角膜接触镜可以明显减轻术后患者的角膜刺激症状,减少患者的术后不适感,缩短角膜上皮的愈合时间。     

丝裂霉素预防准分子激光屈光性角膜切削术后角膜混浊的临床研究

目的:探讨准分子激光屈光性角膜切削术中使用0.2g/L丝裂霉素(MMC)预防术后角膜上皮下混浊(haze)的安全性、有效性。方法:对120例(240眼)屈光不正的患者进行准分子激光屈光性角膜切削术,术中使用0.2g/L丝裂霉素,作用时间为20~90s,观察术后角膜上皮愈合时间、观察术后1,3,6,12mo时裸眼视力、矫正视力、屈光状态、haze形成情况及并发症、角膜内皮细胞计数等。结果:角膜上皮愈合时间为3.01±0.72d;手术前后角膜内皮细胞计数统计学上无显著性差异(P=0.62);术后1,3,6,12mo时裸眼视力、矫正视力、屈光状态统计学上无显著性差异;术后6mo0~0.5级haze218眼(90.8%),1级haze21眼(8.75%),2级haze1眼(0.83%),术后12mo1级haze12眼(5%);术后未见丝裂霉素毒性反应及并发症。结论:使用0.2g/L丝裂霉素预防准分子激光屈光性角膜切削术后角膜上皮下混浊安全、有效。     

准分子激光原位角膜磨镶术后角膜瓣皱褶的原因及处理

目的探讨准分子激光原位角膜磨镶术（laser in situ keratomileusis，LASIK）后角膜瓣皱褶的原因及处理。方法对LASIK术后19例角膜瓣皱褶的原因及处理进行回顾性分析。结果术后第1d发现的角膜瓣皱褶可能与术前配戴角膜接触镜及术中过度冲洗等操作不当有关，处理上采用重新复瓣加戴角膜接触镜。术后第10d发现的角膜瓣皱褶原因不明，10d后发生的角膜瓣皱褶与外伤有关，处理上采用去上皮水化角膜瓣加戴角膜接触镜，经以上处理的所有患者裸眼视力均达到或超过术前最佳矫正视力，角膜透明，未见明显皱褶，角膜瓣位置正常，无上皮植入。结论术后LASIK早期角膜瓣皱褶可能与过度冲洗及术前配戴角膜接触镜有关，晚期角膜瓣皱褶与外伤有关。术后第1d角膜瓣皱褶仅需采用重新复瓣加戴角膜接触镜法。术后10d后角膜瓣皱褶需采用去上皮水化角膜瓣加戴角膜接触镜法。     

准分子激光角膜屈光术后反复角膜上皮脱落的多因素分析

目的研究准分子激光角膜屈光术后出现反复性角膜上皮脱落的各种可能的影响因素。方法 2006年1月至2008年12月在我院屈光手术中心接受角膜屈光手术(LASEK、LASIK)治疗的3091例(6085只眼)患者均随访6个月以上。将其中发生反复性角膜上皮脱落的57例(110只眼)的患者的资料进行分析总结,并将其与随机抽取的同期手术的患者60例(120只眼)进行比较。结果反复性角膜上皮脱落皆发生在准分子激光原位角膜磨镶术(LASIK)术后患者,准分子激光上皮下角膜磨镶术(LASEK)术后患者无一例发病;在角膜上皮脱落组男性为12例,女性为45例;在对照组男性24例,在女性为36例;行χ2检验,χ2=4.926,P<0.05,提示两组差异有统计学意义;在所有发病的57例患者中,有38例(66.7%)有术前配戴角膜接触镜史,其中配戴3年以上者有27例,占71.1%;术前配戴角膜接触镜时间在角膜上皮脱落组为0~20年,平均(4.84±4.32)年,在对照组为0~10年,平均(2.57±2.14)年,行成组t检验,t=3.629,P<0.05,提示两组差异有统计学意义;于术后1个月内发病者52例(91.2%),术后3个月之后发病者55例(96.5%);双眼发病者51例(89.5%)。结论反复性角膜上皮脱落多发于LASIK术后患者,多术后早期、双眼发病,女性、术前长期配戴角膜接触镜为其高危因素。     

全自动直线式角膜上皮刀制作角膜上皮瓣的有效性和安全性

目的评估在机械法-准分子激光角膜上皮瓣下磨镶术(epipolos-laser in situ keratomileusis,epi-LASIK)中直线式角膜上皮刀制作角膜上皮瓣的有效性和安全性。方法接受epi-LASIK手术的患者共有26例(51眼),应用直线式KN-5000B角膜上皮刀制作角膜上皮瓣,测量角膜前弹力层床面垂直径、瞳孔中心到上皮瓣蒂部垂直距离以及蒂部宽度,观察角膜上皮瓣成形异常情况。在术后配戴角膜接触镜的第5天,观察术后刺激症状和角膜愈合情况。结果所有患者均预期完成手术。角膜前弹力层床面垂直径为8.5～9.3mm,平均为(9.00±0.17)mm;角膜上皮瓣蒂部宽度为4.3～5.4mm,平均为(4.91±0.25)mm;瞳孔中心距上皮瓣蒂部垂直距离为3.5～4.8mm,平均为(4.45±0.24)mm。上皮瓣相关并发症包括游离瓣1眼,局限边缘瓣缺损1眼,偏心瓣1眼,边缘齿轮状2眼,瓣下金属碎屑4眼,出血2眼。无基质残留瓣、纽扣瓣和破碎瓣。术后检查除游离瓣1眼外所有角膜瓣对合良好,无移位。术后第5天所有患者刺激症状消失,术后第10天所有患者角膜上皮恢复透明。结论直线式角膜上皮刀制作epi-LASIK角膜上皮瓣是安全、理想的。     

PRK术后应用亲水性软性角膜接触镜的临床观察

目的　观察亲水性软性角膜接触镜在准分子激光屈光性角膜切削术 (PRK)后的临床效果。 方法　将双眼屈光状态基本相同,屈光度为-1 00~-6 00D,进行近视PRK矫正的患者 148例,分为术后戴角膜接触镜 3d与不戴两组。观察记录术后 3d的角膜上皮愈合情况、疼痛程度、角膜上皮下混浊程度。术后平均随访半年。 结果　戴镜组术后2d内角膜上皮完全愈合率为 68%,对照组为 24% (P<0 05 )。戴镜组疼痛 0 5级、1级、2级的发生率分别为 58%、20%、22%,对照组为 0、54%、45% (P<0 05)。戴镜组术后 1、3、6个月的角膜haze发生率分别为 50%、32%、14%,对照组为 83%、70%、35% (P<0 05)。 结论　亲水性软性角膜接触镜可明显减轻PRK术后疼痛等刺激症状,促进角膜上皮愈合,使角膜haze发生减少和程度减轻,表明PRK术后角膜创面覆盖及上皮快速愈合是减轻haze发生的重要条件之一。     

近视对青少年及儿童角膜内皮细胞的影响

资料显示 ,准分子激光屈光性角膜手术和长期配戴角膜接触镜对角膜内皮细胞均有一定影响[1 3] 。我们于 2 0 0 0年 6月至 2 0 0 1年 12月观察并分析了 16 6例患有近视的青少年或儿童患者的角膜内皮细胞各项检查的结果 ,以期为青少年配戴角膜接触镜及行屈光性角膜手术的安全性提供依据 ,现将结果报告如下。一、资料和方法1 一般资料及分组 :选择 2 0 0 0年 6月至 2 0 0 1年 12月于我院眼科门诊进行屈光检查的青少年及儿童近视患者 16 6例 ( 332只眼 )作为近视组 ,其中男性 90例 ( 180只眼 ) ,女性76例 ( 15 2只眼 )。年龄 4～ 30岁 ,平均 ( 16…     

不同基弧软性角膜接触镜对LASEK的影响

目的：探讨不同基弧软性角膜接触镜对准分子激光上皮下角膜磨镶术(LASEK)的影响。

方法：对186例372眼近视患者施行LASEK手术,随机分为观察组和对照组,激光切削后分别配戴-1.0D基弧为8.7,8.5mm的软性角膜接触镜。术后1,3,5d比较两组术后角膜刺激症状,术后5d比较角膜上皮愈合时间、裸眼视力,术后1mo比较两组裸眼视力,术后3mo比较角膜上皮下雾状混浊(haze)程度。

结果：术后1,3,5d观察组角膜刺激症状明显好于对照组,差异有统计学意义(P<0.05)。术后5d角膜上皮愈合时间、裸眼视力观察组明显好于对照组,差异有统计学意义(P<0.05)。术后1mo两组裸眼视力无明显差别,差异无统计学意义(P>0.05)。术后3mo两组haze比较差异无统计学意义(P>0.05)。

结论：LASEK术后应适当增加需配戴的软性角膜接触镜的基弧,可以减轻角膜刺激症状,促进角膜上皮愈合和视力恢复。     

Laser epithelial keratomileusis for myopia

PURPOSE: To describe a new technique for excimer laser corneal surgery: laser epithelial keratomileusis (LASEK). METHODS: We report 76 eyes with spherical equivalent refractive myopia ranging from -8.00 to -22.00 D (mean -11.00 +/- 3.00 D). Using ethanol applied over an 8.5-mm-diameter area for 20 seconds, the epithelium was detached and photorefractive keratectomy (PRK) was performed. The epithelium was reapplied to the ocular surface and covered with a therapeutic soft contact lens. Treatments were carried out with the Nidek EC-5000 excimer laser. RESULTS: At a mean of 803 days after LASEK, mean spherical equivalent refraction was -1.80 +/- 2.40 D (range -9.27 to +2.00 D). Stability was reached in approximately 60 days. Fifty-nine percent of the epithelial flaps were easy to detach intact during surgery and 62.7% of patients reported no postoperative pain. Eighty-four percent of eyes had the therapeutic bandage lens removed by the fourth postoperative day. Twelve percent of eyes had incomplete epithelial flap removal. Epithelium can fall off the cornea during the healing phase. No significant subepithelial haze was seen in 95% of eyes. CONCLUSION: With LASEK, it may be possible to treat a larger diameter ablation zone in thinner corneas without the problems of a LASIK stromal flap and with less postoperative pain than PRK, with minimal subepithelial haze.     

Accidental self-removal of a flap--a rare complication of laser in situ keratomileusis surgery.

PURPOSE: To report a rare complication in which the patient accidentally removed the laser in situ keratomileusis corneal flap. METHODS: Interventional case report. A 35-year-old woman underwent uncomplicated laser in situ keratomileusis surgery. Ten days after surgery, she inserted a soft contact lens into the right eye to improve her vision. She tried to remove the contact lens, but had pain and bleeding. She was referred 10 days later with a diagnosis of loss of flap. RESULTS: On examination, she had a best-corrected visual acuity of 20/70 in the right eye. The right eye examination revealed no corneal flap, mild corneal edema, and significant haze. A central epithelial defect was found. CONCLUSION: Accidental corneal flap removal can rarely follow laser in situ keratomileusis surgery. This complication provides insight into the weak adhesion of the flap onto the stromal bed after laser in situ keratomileusis surgery and, hence, the inherent risk of traumatic flap dislocation or amputation, which needs to be explained to the patient.     

去上皮瓣的Epi-LASIK临床观察

目的:探讨去除上皮瓣和常规的机械法准分子激光角膜上皮瓣下磨镶术(Epi-LASIK)治疗近视的临床疗效。方法:对30例(60眼)近视患者施行EPi-LASIK,采用法国MORIA角膜上皮分离器完成手术眼上皮分离,30例患者均左眼(30眼)保留角膜上皮瓣蒂于鼻侧,右眼(30眼)直接去除角膜上皮,采用Zeiss-Mel-80型准分子激光治疗仪进行激光切削后,去除组直接置入亲水性角膜接触镜,保留组待上皮复位后置入接触镜。术后第1,3,6d;1mo随访。分析比较两组术后疼痛程度、角膜上皮愈合时间、视力、角膜上皮下雾状混浊程度(Haze)。结果:术后疼痛:去瓣组明显轻于常规组,比较有统计学意义。角膜上皮愈合时间:去瓣组平均3.30±0.55d,留瓣组4.90±0.49d,两者比较差异有统计学意义。裸眼视力:术后第6,30d两组比较差异无统计学意义。术后1moHaze程度:去瓣组0级30眼,常规组0级30眼,两组无差异。结论:两组术后患者,去瓣组Epi-LASIK疼痛程度轻、上皮愈合和视力恢复较快、视觉质量更好,总体临床疗效优于常规Epi-LASIK。     

角膜屈光术不同制瓣方式术后丝状角膜炎研究

目的 观察角膜屈光手术不同制瓣方式术后丝状角膜炎的发病情况,探讨其发病的相关因素及防治方法.方法 回顾性临床病例对照研究.对2004年7月至2010年7月在厦门大学附属厦门眼科中心就诊的14 360例28 702只眼近视伴散光者行角膜屈光手术,其中11 542例(23 082只眼)行微型自动旋转式角膜板层刀(LASIK组)制瓣,516例(1 030只眼)行飞秒激光Femto-second laser(FS组)制瓣,2 302例(4 590只眼)行LASEK治疗,观察三组术后丝状角膜炎的发生情况,比较其发病率,发病者均予以及时去除丝状物及配戴日抛型角膜接触镜治疗.结果 LASIK组、FS组及LASEK组丝状角膜炎发病率分别为0.16%、0%、1.35%,三者差异有统计学意义(X2=-152.642,P＜0.05).所有丝状角膜炎患者经过1-4 d的治疗,均得到痊愈,无1例复发.结论 飞秒激光制瓣比常规角膜板层刀及乙醇制瓣术后丝状角膜炎发病率低,采用去除丝状物、应用人工泪液联合配戴日抛型角膜接触镜等方法,可有效治疗术后丝状角膜炎.

Abstract：

Objective To compare the incidence, underlying pathophysiology, and clinical features of filamentary keratitis in different flap preparation styles of excimer laser surgery. Methods It was a retrospective case-control study. All 28702 eyes were divided into group A including 23082eyes treated with laser-assisted in situ keratomileusis in Xiamen Eye Center of Xiamen University between July 2004 and July 2010 with 90 m microkeratome flap preparation, group B of 1030 eyes treated with laser-assisted in situ keratomileusis with 100 m femoto-second laser flap preparation and group C of 4590 eyes treated with laser epithelial keratomileusis. The incidences of the postoperative filamentary keratitis were observed and compared. In cases suffered with filamentary keratitis changes in corneal signs by slitlamp evaluation, appropriate artificial tears therapy and therapeutic lens treatment were required. Results The incidences were significantly different (P ＜0.05) between group A, group B and group C with 0.16%, 0 and 1.35% respectively, and all cases suffered with filamentary keratitis had complete healing. No additional complications were reported. Conclusions The incidence of filamentary keratitis after excimer laser corneal refractive surgery is affected by the different flap preparation styles. The removement of filaments and the use of artificial tears and soft contact lenses for therapeutic purposes are safe, effective and practical.     

长期配戴软性角膜接触镜者角膜上皮的病理改变

目的研究软性角膜接触镜对角膜上皮组织的基底细胞数目、上皮厚度、基底细胞形态、增殖细胞核抗原（PCNA）等的影响。方法前瞻性病例对照研究。选择配戴软性角膜接触镜超过3年的患者33例（66眼,角膜接触镜组）和从未配戴软性角膜接触镜患者33例（66眼,对照组）,对所选患者,在去瓣准分子激光上皮下角膜磨镶术（Flap—freeEpi．LASIK）手术中,用Epi-K角膜上皮刀取下角膜上皮瓣。2组中各取30例（60眼）采用超声进行离体角膜上皮瓣厚度的测量和采用显微镜进行基底细胞计数,各取3例（6眼）进行石蜡切片及免疫组化染色,观察角膜上皮瓣基底细胞形态的变化和进行PCNA的测定。数据采用独立样本t检验进行分析。结果角膜接触镜组角膜上皮层厚度为（55．33±4．56）μm;对照组角膜上皮层厚度为（57．19±3．82）μm,二者之间差异有统计学意义（t=-2．422,P〈0．05）。角膜接触镜组基底上皮细胞数目减少,为（3872．6±153．2）eells／mm^2;对照组基底上皮细胞数目为（3989．2±289．6）cells／mm^2,二者之间差异有统计学意义（t=-2．757,P〈0．01）。角膜接触镜组较对照组角膜基底细胞排列疏松,细胞形态欠规整,基底膜较厚,相对粗糙。角膜接触镜组角膜上皮基底细胞可发现PCNA阳性细胞,而对照组无阳性细胞。结论长期配戴软性角膜接触镜可导致角膜上皮损伤：使角膜上皮层变薄;单位面积内的的角膜上皮基底细胞数量减少;角膜上皮的组织结构发生病理学改变,细胞形态发生改变。细胞之间的连接和基底膜遭到破坏,PCNA阳性细胞存在。     

LASIK术后角膜瓣移位皱折的处理

目的:探讨LASIK术后角膜瓣移位、皱折的治疗方法。方法:在手术显微镜下去除角膜基质裸露区新生的角膜上皮组织,刮除角膜瓣皱折处上皮,BSS液瓣下冲洗,使角膜瓣展平,覆盖透氧角膜接触镜。结果:经治疗的19例患者角膜瓣复位良好,视力较LASIK术后无下降。结论:及时正确地治疗,可以避免严重的并发症并获得良好的视觉结果。     

First clinical results with the femtosecond neodynium-glass laser in refractive surgery

PURPOSE: We evaluated four femtosecond laser intrastromal cutting procedures: creation of a corneal flap for laser in situ keratomileusis (LASIK), tunnel and entry cut for intracorneal ring, corneal flap and removable lens for keratomileusis, and intrastromal ablation for myopia and hyperopia. METHODS: A clinical trial using a femtosecond surgical laser (IntraLase Corporation) was performed in partially sighted eyes. Femto-LASIK treatment was performed on 46 eyes up to -14.00 D; 16 patients received intracorneal ring segments (Femto-ICRS); 5 patients each with one highly myopic eye had femtosecond laser keratomileusis (FLK), and 13 patients each with one myopic or hyperopic eye had intrastromal ablation (ISPRK). In Femto-LASIK, excimer laser ablation was done under the flap. In Femto-ICRS, ring segments were introduced into the laser-created channels. In femtosecond laser keratomileusis, a lens-shaped block of stroma was removed manually from under the flap. RESULTS: No difference was found between the results obtained with Femto-LASIK and a standard microkeratome. No refractive effects occurred when the created flap was not elevated. In cases of Femto-ICRS and conventional ICRS produced the same refractive results. With Femto-ICRS, no intraoperative complications occurred and visual acuity improved immediately after surgery. In femtosecond laser keratomileusis, high myopia was corrected without using excimer laser ablation; centralization of the treatment area was excellent. In intrastromal ablation, 1 to 2 hours after surgery the corneas were highly transparent; refractive results were stable. CONCLUSIONS: Femtosecond lasers can produce precise intrastromal cutting, offering significant safety and other advantages (no razor blades, corneal trauma, partial resections, or sterilization issues) over current techniques.     

LASIK术后角膜瓣下上皮植入的处理

目的:探讨LASIK术后角膜瓣下上皮植入的发生及处理。方法:回顾分析2633例5134眼LASIK术后角膜瓣下上皮植入的19例32眼的处理及预后情况,对上皮植入范围超过2mm,角膜瓣边缘荧光素染色阳性的9例15眼,在手术显微镜下去除角膜瓣边缘1mm范围的上皮,清除瓣下植入上皮,BSS液瓣下冲洗,展平角膜瓣,覆盖透氧角膜接触镜。结果:手术处理的15眼角膜瓣复位良好,患者视力较LASIK术后无下降。结论:及时正确地治疗,可以避免严重的并发症并获得良好的视觉结果。     

Soft contact lenses for irregular astigmatism after laser in situ keratomileusis.

PURPOSE: To investigate soft contact lenses for managing irregular astigmatism after laser in situ keratomileusis (LASIK). The prevailing notion has been that soft contacts conform to corneal surface irregularities and have a limited role for managing LASIK-induced irregular astigmatism. METHODS: A 41-year-old man with bilateral central steep islands following LASIK had best spectacle-corrected visual acuity of 20/40(+1) in the right eye and 20/70+2 in the left eye, despite 20/20 acuity in each eye with rigid contact lenses. Three soft lenses made of etafilcon A (58% H2O) in different center thicknesses were placed sequentially on each eye. All lenses were -2.00 D sphere, in the flatter of the two available base curves. With each lens, corneal topography, spherical over-refraction, and the resulting visual acuity were recorded. RESULTS: In all instances, corneal topography showed reduced surface irregularity although at least some irregularity still transmitted through the lenses. Each spherical over-refraction gave better visual acuity than the corresponding best spectacle-corrected visual acuity. The right eye achieved 20/20 with the thickest lens and spherical over-refraction. The left eye achieved 20/25 with the lens of intermediate thickness and spherical overrefraction. The patient reported functional vision and good comfort with these lenses. CONCLUSIONS: Disposable soft contact lenses can modestly mask irregular astigmatism caused by excimer laser ablation.     

Traumatic epithelial flap detachment after laser subepithelial keratomileusis

PURPOSE: To report a case of corneal epithelial flap detachment 20 days after laser subepithelial keratomileusis (LASEK). METHODS: A 30-year-old man underwent LASEK for correction of myopia. On postoperative day 8, he was comfortable and the corneal epithelium healed completely with uncorrected visual acuity (UCVA) of 20/20. On postoperative day 20, the corneal epithelial flap on the right eye detached and was lost during pressure patching after puncture of the hordeolum. RESULTS: The corneal defect was treated with a bandage contact lens, levofloxacin, and hyaluronic acid eye drops. Ten days after detachment, UCVA had improved to 20/20 and the epithelium had closed completely. CONCLUSIONS: Mild trauma can cause epithelial flap detachment during the early postoperative period of LASEK.