丝裂霉素C在LASIK术后外伤致角膜上皮植入患者手术治疗中的应用

目的探讨丝裂霉素C（MMC）在准分子激光原位角膜磨镶术（LASIK）术后外伤致角膜上皮植入患者的手术治疗中应用的临床疗效。方法在LASIK术后外伤致角膜上皮植入21例（21眼）手术治疗中应用0．02％MMC,观察术后裸眼视力及角膜瓣愈合情况。结果术后裸眼视力平均为0．82±0．26,较术前明显提高（P〈0．05）。绝大部分患眼角膜瓣愈合良好,3眼角膜瓣边缘部分融解,但中心视力无明显影响。结论在LASIK术后外伤致角膜上皮植入手术治疗中应用0．02％MMC可以取得良好的临床疗效。     

不同时期准分子激光原位角膜磨镶术后角膜上皮内生的处理

目的探讨准分子激光原位角膜磨镶术（laser in situ keratomileusis,LASIK）后角膜上皮内生的理想处理方法。方法1999年1月至2008年12月处理20例（22眼）LASIK术后角膜上皮内生患者．经历3个认识和处理时期。第一时期从1999年1月至2000年12月,处理3例（3眼）,均按术后炎症反应处理．无明确角膜上皮内生概念及相关处理方法。第二时期为2001年1月至2004年12月,处理8例（9眼）．角膜上皮内生与角膜上皮植入未严格区分,按角膜上皮植入原则处理。第三时期为2005年1月至2008年12月,处理9例（10眼）,均为不同情况下引起的角膜上皮内生,其中2例（2眼）为单纯角膜上皮内生,5例（6眼）为皱褶瓣处理后产生的上皮内生,2例（2眼）为角膜划伤后上皮内生。处理要点：①内生上皮处理净后用拖拽法将角膜瓣边晾干边原位复位。②角膜瓣复好位后晾干约5～8min。③处理后不戴角膜接触镜。结果第一时期处理3眼中,2眼角膜瓣被剪除,处理后1个月裸眼视力均为5．0：1眼角膜瓣颞上缘部分溶解,未波及光学区。裸眼视力为4．9。第二时期处理9眼中,6眼1次处理成功：3眼角膜上皮内生复发,处理2d后行再次冲洗处理。处理后1个月裸眼视力：2眼为4．9．6眼为5．0,1眼为5．1。第三时期所处理9例（10眼）均1次处理成功,角膜瓣均平整。2例（2眼）单纯角膜上皮内生患者术后第1个月的裸眼视力均为5．0;5例（6眼）皱褶瓣处理后又产生上皮内生患者．再处理后角膜上皮愈合时间分别为3眼2d、2眼3d、1眼4d,1个月后裸眼视力：2眼为4．8,1眼为4．9,3眼为5．0：2例（2眼）角膜划伤后上皮内生者,处理2d后上皮愈合．7d后角膜炎症消退．1个月后裸眼视力均为4．8。所处理的22眼中．3眼矫正视力下降1行,其余矫正视力均无下降。术后随访3个月以上．所有患者未再见有角膜?     

LASIK和SBK术后外伤性角膜瓣移位的处理

目的:探讨准分子激光角膜原位磨镶术(laser in situ keratomileusis,LASIK)和准分子激光角膜前弹力层下磨镶术(Sub-Bowman’s keratomileusis,SBK)术后外伤性角膜瓣移位的处理。方法:对14例14眼LASIK和SBK术后因外伤导致角膜瓣移位的患者,经及时手术处理,合理用药,视力恢复良好。结果:选取的14例中13例治疗术后1wk视力均达到0.8以上,角膜透明,无1例患者角膜出现角膜瓣皱褶、上皮植入、角膜瓣溶解。1例患者因角膜瓣全部移位,治疗术后1wk视力0.1,角膜全层水肿,角膜瓣下皱褶不明显,下方瓣缘裂伤处有1～2mm宽的上皮植入。术后6mo,视力达到1.0,角膜完全透明。结论:及时正确处理LASIK和SBK术后外伤性角膜瓣移位均能获得良好视力。     

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。     

LASIK术后外伤性角膜瓣移位的治疗

目的 观察LASIK术后外伤性角膜瓣移位复位术的疗效情况.方法 对12例（12眼）LASIK术后因外伤导致角膜瓣移位及时进行角膜瓣复位术,同时佩戴亲水性角膜接触镜,观察术后视力、角膜瓣恢复情况以及眼部症状.结果 术后1周内9例视力提高至0.8～1.0,2例视力提高至0.6,1例视力提高至0.3;角膜瓣均无皱褶、移位、上皮植入或角膜融解;眼部疼痛、畏光、流泪症状较术前明显改善.随访3个月其中视力0.3的1例提高至0.5,其余患者视力无波动;全部患者角膜瓣亦均恢复良好,未再发生皱褶、移位或上皮植入.结论 LASIK术后发生角膜瓣移位及时行角膜瓣复位手术对视力及角膜瓣恢复具有良好的疗效.     

激光原位角膜磨镶术后外伤致角膜瓣并发症的治疗

目的 探讨眼外伤致准分子激光原位角膜磨镶术(LASIK)术后角膜瓣移位、皱褶、丢失的治疗方法.方法 对15例(15眼)在我院行LASIK术后因外伤引起角膜瓣移位、皱褶、丢失的治疗情况进行分析.结果 15例均急诊行角膜瓣复位术,术后1 d所有角膜瓣对位良好,皱褶明显消失或减轻,大部分患眼上皮修复,9眼视力达到0.6 ～1.0(60.0％),视力恢复时间最快为术后2d,最长14 d,平均(7.5±0.4)d.角膜瓣丢失者术后3d上皮修复完整.术后1个月,所有病例角膜透明无细微皱褶,视力0.6 ～1.0,平均(1.02 ±0.45).与损伤前平均视力进行配对t检验,P＞0.05,无统计学差异.结论 LASIK术后外伤性角膜瓣移位、皱褶如果得到及时有效的处理,可以恢复良好视力.     

兔眼准分子激光原位角膜磨镶术后角膜层间上皮植入及处理的实验研究

目的利用兔眼准分子激光原位角膜磨镶术（LASIK）术后上皮植入的动物模型来探讨LASIK术后上皮植入的发病机制、自然转归、治疗及预防严重上皮植入的方法。方法对26只新西兰大白兔行LASIK治疗,人为地使角膜瓣轻度移位,做成上皮植入的动物模型。然后按Probst和Macha分级方法选取其中严重上皮植入（Ⅲ级）的20只兔（40只眼）随机分为A、B、C、D4组,每组10只眼,各组分别给予不同的处理方法,观察各种处理方法的效果。A组：作为观察组,不做处理,仅给以0.1%氟米龙滴眼液点眼;B组（单纯刮除组）：重新掀开角膜瓣,刮除角膜瓣基质面和基质床上植入的上皮,复位角膜瓣;C组（刮除＋50%酒精处理组）：刮除角膜瓣基质面和基质床上植入的上皮,50%酒精棉片贴敷1min,复位角膜瓣;D组（刮除＋角膜瓣边缘行准分子激光治疗性角膜切削术（PTK）＋角膜瓣边缘连续缝合组）,重新掀开角膜瓣,刮除角膜瓣基质面和基质床上植入的上皮,复位角膜瓣,然后用PTK以3mm直径光斑沿角膜瓣边缘切削,每处切削10个脉冲,共50～70脉冲,重点在角膜瓣的边缘与正常上皮交界处,最后以10-0尼龙线连续缝合角膜瓣边缘于基质床。各组随访3个月观察角膜水肿程度、上皮缺损和荧光素染色情况、角膜瓣融解情况,并行光镜检查。结果三种处理方法相比较B组和C组均有较高的复发率,与D组比较（P〈0.05）,差异有显著意义;术后1周荧光素染色D组和B、C两组比较（P〈0.01）,D组术后1周荧光素着色点较B、C组明显减少,差异有显著意义;术后1周角膜水肿情况,D组与B、C两组比较明显减轻（P〈0.01）,有显著意义;病理切片显示所有复发眼上皮植入均与角膜瓣周围的上皮层相连,并伴有角膜瓣边缘融解,处理成功者1周后可见,层间仍有微小的空隙,但瓣的边缘附着良好,层间镜下未见上皮细胞,3月后角膜恢复正常形态。结论对LASIK术后的严重角膜上皮植入,如果不及时、恰当的处理,很容易出现角膜瓣的融解,严重影响视力的恢复。故应于术前、术中积极预防,早期发现,及时处理,采取综合性治疗方法。刮除＋PTK＋角膜瓣边缘连续缝合是一种积极有效的处理严重上皮植入的方法,可以防止角膜瓣继续融解,能获得较好的手术效果。     

LASIK后角膜瓣皱褶和折叠的处理

目的 探讨准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)后早期角膜瓣皱褶和折叠的有效处理方法.方法 对LASIK术后11例角膜瓣皱褶的原因及处理进行回顾性分析.所有的患者需经手术重新复位,在显微镜下采用去离子水冲洗角膜瓣加戴角膜接触镜24 h.术后观察角膜瓣状况、屈光变化、裸眼视力和最佳矫正视力.结果 经过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 角膜瓣皱褶和折叠是LASIK术后较严重的并发症.早期诊断和正确快速的处理是获得最佳视力的关键.用去离子水重新复位角膜瓣并佩戴角膜接触镜治疗LASIK术后早期角膜瓣皱褶和折叠是安全简单有效的方法.     

LASIK术后角膜上皮植入的原因及分型

目的分析准分子激光原位角膜磨镶术（LASIK）后角膜上皮植入的原因及分型。设计回顾性病例系列。研究对象45例LASIK术后角膜上皮植入处理后随诊半年以上患者共49眼。方法分析北京协和医院门诊收治的外院转来时角膜上皮植入患者,上皮植入时间6～31天,最佳矫正视力为手动-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。按上皮植入距角膜中央的距离和范围分为周边型、旁中央型、中央型,分别为7眼、32眼、10眼。按照发展的速度分为进展性、稳定性、静止性,分别为31眼、4眼、4眼。主要指标LASIK术后角膜上皮植入手术史、视力、角膜瓣对合、伤口愈合情况。结果引起上皮植入的主要原因：（1）角膜上皮水肿、剥脱;（2）角膜瓣状况不良;（3）角膜瓣对合异常,分别为15眼、21眼、13眼。对视力影响程度由重到轻依次为中央型〉旁中央型〉周边型;进展的旁中央和中央型上皮植入超过1周者,92％可导致角膜瓣基质融解,严重影响视力。治疗方案：密切观察,原瓣掀开刮除植入上皮29眼,上皮刮除联合治疗性角膜屈光手术（PTK）14眼,非掀瓣保守观察治疗6眼。角膜瓣再次掀开者角膜伤口均一期愈合,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眼低于术前预期视力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者,1周左右可致角膜瓣融解,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。     

LASIK术后眼外伤致角膜瓣移位的治疗

目的探讨LASIK术眼眼外伤角膜瓣移位的治疗方法。方法对10例眼挫伤后角膜瓣移位的损伤情况及治疗效果进行分析。结果经冲洗及角膜瓣复位后，8例1周后视力提高至0．6～1．0，角膜瓣无皱褶及视物变形。2例角膜瓣复位好，视力未提高，因有视网膜挫伤。结论LASIK术后外伤所致角膜瓣移位要早发现、早治疗，将角膜瓣安全对位、平复，同时强调预防为主。     

LASIK后严重角膜上皮植入并角膜瓣融解的处理

目的：探讨ＬＡＳＩＫ术后严重角膜上皮内生所致角膜瓣融解缺损的治疗方法。病例和方法：ＬＡＳＩＫ术后经本院确诊为角膜上皮内生合并角膜瓣融解的１２例１３眼,根据角膜瓣厚度及角膜瓣融解的程度,９眼接受翻开角膜瓣清除层间上皮的治疗,３眼行异体角膜磨镶术,１眼去除角膜瓣。结果：翻开角膜瓣清除膜上皮的９眼中,２眼复发,但再次治疗后正常愈全。异体角膜磨镶术组的３眼角膜瓣均正常愈合。去除角膜瓣的１眼角膜上皮正常,但     

丝裂霉素C在LASIK术后角膜上皮植入手术治疗中的应用

目的:探讨丝裂霉素C(mitomycin C,MMC)在准分子激光原位角膜磨镶术(laserin situkeratomileusis,LASIK)术后角膜上皮植入手术治疗中应用的临床疗效。方法:在31例31眼LASIK术后角膜上皮植入患者手术治疗中应用0.2g/L MMC,观察术后裸眼视力及角膜瓣愈合情况。结果:术后6mo裸眼视力平均为0.82±0.19,较术前明显提高(P<0.05)。绝大部分患者角膜瓣愈合良好,4例患者角膜瓣边缘部分融解,但中心视力无明显影响。结论:在LASIK术后角膜上皮植入手术治疗中应用0.2g/LMMC可以取得良好的临床疗效。     

PRK for epithelial ingrowth in buttonhole after LASIK

PURPOSE: To evaluate the efficacy of photorefractive keratectomy (PRK) in progressive central epithelial ingrowth after buttonholes after laser in situ keratomileusis (LASIK). METHODS: Two eyes of two patients with progressive central epithelial ingrowth and fibrosis in flap buttonholes after LASIK underwent PRK 6 months following primary surgery. RESULTS: Epithelial ingrowth was treated successfully in both eyes. The uncorrected visual acuities were 20/20, and there was no evidence of recurrent epithelial ingrowth after 6 months. CONCLUSIONS: Photorefractive keratectomy is a useful modality in the treatment of central epithelial ingrowth in buttonholes following LASIK. As a single-step surgery, it offers both therapeutic and optical advantages by simultaneously clearing the corneal opacity and correcting the refractive error in selected cases.     

Late traumatic displacement of laser in situ keratomileusis flaps

PURPOSE: To report the occurrence, management, and outcome of late-onset traumatic dehiscence and dislocation of laser in situ keratomileusis (LASIK) flaps. METHODS: Two interventional case reports of patients with late-onset LASIK corneal flap dislocation after ocular trauma occurring at 7 and 26 months after surgery, respectively. RESULTS: The flaps were lifted, stretched, and repositioned after irrigation and scraping of the stromal bed and the underside of the flap. A bandage contact lens was placed, and topical antibiotic and corticosteroids were given postoperatively. The dislocated corneal flaps were successfully repositioned in both cases. The patient whose dislocated flap was repositioned 4 hours after the trauma recovered his uncorrected visual acuity (UCVA) of 20/20 1 week after the procedure and had a well-positioned flap with a clear interface. The patient who was managed 48 hours after the injury required repeat flap repositioning at 10 and 24 days after the initial procedure for treatment of persistent folds and striae in the visual axis. His uncorrected visual acuity 2 weeks after the third flap repositioning was 20/40 + 2. Diffuse lamellar keratitis developed in both patients that resolved with the use of topical corticosteroids. CONCLUSION: Laser in situ keratomileusis corneal flaps are vulnerable to traumatic dehiscence and dislocation, which can occur more than 2 years after the procedure.     

Partial dislocation of laser in situ keratomileusis flap by air bag injury

PURPOSE: A patient developed significant corneal complications from air bag deployment, 17 months after laser in situ keratomileusis (LASIK). METHODS: Case report, slit-lamp microscopy, and review of the medical literature. RESULTS: A 37-year-old woman underwent bilateral LASIK with resultant 20/20 uncorrected visual acuity. Seventeen months later, she sustained facial and ocular injuries from air bag deployment during a motor vehicle accident. Examination revealed bilateral corneal abrasions, partial dislocation of the right corneal LASIK flap, and a hyphema in the right eye. The LASIK flap was realigned, but recovery was complicated by a slowly healing epithelial defect and flap edema. One month following the injury, epithelial ingrowth beneath the LASIK flap was noted. Surgical elevation of the flap and removal of the epithelial ingrowth was performed. Eight months later, epithelial ingrowth was absent and the visual acuity was 20/40. Residual irregular astigmatism necessitated rigid gas permeable contact lens fitting to achieve 20/20 visual acuity. CONCLUSIONS: Air bags may cause significant ocular trauma. The wound healing response of LASIK allows corneal flap separation from its stromal bed for an indeterminate time after surgery. Discussion of the possible risk of corneal trauma as part of informed consent prior to LASIK may be appropriate.     

Corneal iron line following LASIK with epithelial ingrowth

PURPOSE: To report a new corneal iron line following keratorefractive surgery. METHODS: Case report and review of the literature. A 51-year-old man developed epithelial ingrowth after otherwise uneventful LASIK surgery. The patient, satisfied with an uncorrected visual acuity of 20/25 and otherwise asymptomatic, declined to have his flap relifted to treat the ingrowth. RESULTS: Six months postoperatively a corneal iron line was noted at the leading edge of the epithelial ingrowth. Vision remained stable. CONCLUSIONS:: Epithelial iron lines have been reported with a number of conditions, including post-refractive procedures. This is the first report of an iron line associated with epithelial ingrowth following LASIK.     

LASEK与LASIK治疗高度近视

目的:对比观察准分子激光上皮瓣下角膜磨削术(LASEK)与准分子激光原位角膜磨削术(LASIK)治疗高度近视的临床疗效。评估2种手术的安全性和有效性。方法:对行LASEK治疗的39例75只眼和同期行LASIK治疗的41例79只眼高度近视分别进行6个月以上的临床观察。结果:LASEK组术后1周至1个月达最佳矫正视力,术后3个月部分出现视力回退,术后6个月裸眼视力达术前矫正视力占95.83%,主要并发症有术后高眼压及Haze形成;LASIK组术后6个月裸眼视力达术前矫正视力占94.35%,主要并发症为屈光回退,角膜上皮内生或角膜瓣皱折等。结论:LASIK与LASEK均能安全、有效地矫正高度近视。     

Epithelial scraping for corneal epithelial ingrowth after laser in situ keratomileusis

BACKGROUND: Laser in situ keratomileusis (LASIK) is an effective method for correcting a wide range of myopia. However, complications sometimes occur. We report here a case treated with epithelial scraping two years and 4 months after surgery for epithelial ingrowth in the central cornea after LASIK. CASE: A 32 year-old woman who had undergone LASIK one year and 4 months before visited our hospital because of visual loss. At the first examination in our clinic, her best-corrected visual acuity was 20/60 in the right eye and 20/15 in the left eye. Epithelial ingrowth was observed in both eyes, but in the right eye, the epithelial ingrowth had reached the central cornea leading to the visual loss. The increased corneal stromal opacity decreased the visual acuity to 20/400. The patient decided to undergo epithelial scraping. The corneal flap was dissected again and epithelial scraping was performed on the stromal bed and back of the corneal flap. The visual acuity was improved from 20/400 to 20/40. However, the stromal opacity and the corneal astigmatism still remained. CONCLUSION: This case suggests that epithelial scraping should be performed immediately when ingrowing epithelium after LASIK begins to invade the central cornea.     

LASIK interface-captured foreign bodies after mild traumatic corneal scratch without flap displacement

A 38-year-old woman developed diffusely distributed opacities with crystalline materials in the laser in situ keratomileusis (LASIK) interface of her eye after she was scratched by a sprig during mountain climbing. No sign of flap displacement was noted. Despite two days of topical and systemic antibiotics therapy, the corneal infiltration with interface opacities persisted. The following day, the distribution of the crystalline materials had rotated in a counterclockwise direction. Flap lifting and foreign body removal using sufficient irrigation were performed. One month after surgery, the patient's postoperative uncorrected visual acuity was 0.8 with cleared interface. No signs of epithelial ingrowth or flap striae were noted. Mild traumatic corneal scratching without flap displacement may threaten the integrity of the LASIK interface. If foreign bodies are suspected to be the cause of inflammation, early flap lifting with irrigation is imperative for successful treatment.