LASIK术后角膜上皮植入及内生的治疗

目的:观察准分子激光角膜原位角膜磨镶术(LASIK)后角膜上皮植入及内生发生的情况,分析发生的原因和治疗方法。方法:我院自2006-09/2011-11行LASIK术2666例5212眼,其中发生角膜上皮植入及内生10例16眼,分析其发生的原因,采用不同的处理方法,并观察其疗效。结果:患者2666例5212眼中发生角膜上皮植入及内生的10例16眼,发生率为0.31%,按照发生的原因、时间、范围的大小及位置,采取不同的处理措施。其中4例5眼给予百力特眼液点眼,并辅予局部预防性降眼压药物点眼,角膜上皮植入及内生消失;6例11眼药物治疗联合手术掀瓣刮除层间上皮,并常规配戴绷带型角膜接触镜1～2d,术后予百力特眼液点眼,并辅予局部预防性降眼压药物点眼,所有患者随访6mo～4a无1例复发,视力恢复好。结论:LASIK术后角膜上皮植入及内生是术后所特有的并发症。术前要严格排除手术禁忌证,术中行规范手术操作、术后及早发现角膜上皮植入及内生并给予积极治疗是对LASIK术后并发症的有效治疗手段。     

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。     

准分子激光原位角膜磨镶术后上皮植入的研究进展

准分子激光原位角膜磨镶术(LASIK)具有众多优点，但术后可发生瓣游离、角膜感染、瓣下异物、上皮植入等并发症。本着重介绍了LASIK术后上皮植入的危害、临床表现、发生原因、发病机制及处理措施的国内外研究现状，以为预防其发生提供依据。     

准分子激光原位角膜磨镶术后上皮植入的研究进展

准分子激光原位角膜磨镶术 (LASIK)具有众多优点 ,但术后可发生瓣游离、角膜感染、瓣下异物、上皮植入等并发症。本文着重介绍了LASIK术后上皮植入的危害、临床表现、发生原因、发病机制及处理措施的国内外研究现状 ,以为预防其发生提供依据。     

LASIK术后角膜上皮内生的处理

目的：分析准分子激光原位角膜磨镶术(LASIK)后角膜上皮植入及内生发生的原因,总结治疗经验。

方法：回顾性分析2008-01/2012-12于我院行LASIK患者1 256例2 256眼,术后发生角膜上皮植入及内生18例30眼的临床资料。对所有患眼进行治疗后,对治疗前后患者整体视觉质量评分进行分析。

结果：行LASIK术后角膜上皮植入及内生18例30眼,发生率为1.3%。18例30眼患者中12眼为术后外伤致角膜瓣移位上皮内生,12眼为术中多次角膜瓣下冲洗,2眼为术中制作角膜瓣出现不规则瓣,4眼术中无特殊。30眼角膜上皮内生的程度：Ⅰ级11例18眼,Ⅱ级4例8 眼,Ⅲ级3例4眼。Ⅰ～Ⅱ级者予妥布霉素地塞米松滴眼液点眼并辅予降眼压药物治疗为主,Ⅲ级者先予药物治疗,若情况无好转,则予手术治疗。治疗后11例18眼Ⅰ级者中8例13眼内生均消失,3例5眼植入上皮灶缩小; 4例8眼Ⅱ级者中2例4眼上皮植入消失,2例4眼上皮植入程度减轻至Ⅰ级; 3例4眼Ⅲ级者中2 例2 眼角膜缘1mm处瓣缘有0.5～1mm宽瓣下浅灰白色带,视力0.8 ～1.2,1例2眼患者予刮除植入角膜上皮及内生上皮,随访无复发。治疗后18例角膜上皮内生患者整体视觉质量评分低于治疗前(Hc=10.511,P<0.01)。

结论：规范手术操作、术后及早发现并予积极治疗是对预防和治疗LASIK 术后并发症有重要意义。     

LASlK术后角膜上皮内生的处理

目的：分析准分子激光原位角膜磨镶术( LASIK)后角膜上皮植入及内生发生的原因,总结治疗经验。
　　方法：回顾性分析2008-01/2012-12于我院行LASIK患者1256例2256眼,术后发生角膜上皮植入及内生18例30眼的临床资料。对所有患眼进行治疗后,对治疗前后患者整体视觉质量评分进行分析。
　　结果：行LASIK术后角膜上皮植入及内生18例30眼,发生率为1.3%。18例30眼患者中12眼为术后外伤致角膜瓣移位上皮内生,12眼为术中多次角膜瓣下冲洗,2眼为术中制作角膜瓣出现不规则瓣,4眼术中无特殊。30眼角膜上皮内生的程度：I级11例18眼,Ⅱ级4例8眼,Ⅲ级3例4眼。 I~Ⅱ级者予妥布霉素地塞米松滴眼液点眼并辅予降眼压药物治疗为主,Ⅲ级者先予药物治疗,若情况无好转,则予手术治疗。治疗后11例18眼I级者中8例13眼内生均消失,3例5眼植入上皮灶缩小;4例8眼Ⅱ级者中2例4眼上皮植入消失,2例4眼上皮植入程度减轻至I级;3例4眼Ⅲ级者中2例2眼角膜缘1 mm处瓣缘有0.5~1mm宽瓣下浅灰白色带,视力0.8~1.2,1例2眼患者予刮除植入角膜上皮及内生上皮,随访无复发。治疗后18例角膜上皮内生患者整体视觉质量评分低于治疗前(Hc=10.511,P<0.01)。
　　结论：规范手术操作、术后及早发现并予积极治疗是对预防和治疗LASIK 术后并发症有重要意义。     

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。     

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。     

LASIK术中术后并发症的观察分析

目的观察准分子激光原位角膜磨镶术(excimerlaserinsitukeratomileusis,LASIK)的术中术后并发症,探讨其发生的种类,原因,处理方法及预防措施。方法对523例(1011眼)LASIK术中术后并发症的发生、发展及影响进行了6个月的观察。结果LASIK术中并发症有角角膜血管翳出血,角膜瓣不规则游离,角膜瓣偏位,角膜瓣形成不全和角膜层间异物;术后出现多种并发症如切削区明显偏位,中心岛形成,瓣下中央区感染,不规则散光,角膜瓣皱褶,角膜瓣下上皮植入,屈光过矫,欠矫,屈光回退,眩光,激素性高眼压和干眼症。多数并发症经治疗和处理后,未对视功能产生明显影响。结论LASIK治疗近视安全、有效,但存在许多并发症,应引起重视。手术技巧的提高、手术设计的完善和手术设备的改进以及有效及时处理各种并发症是保证手术成功的关键。     

LASIK术后角膜上皮植入的发生及处理

目的探讨LASIK术后角膜上皮植入的发生、影响因素、处理方法和效果.方法回顾性分析由同一位医生所行LASIK术后随访6个月以上并有完整记录的所有病例.结果共633例病人1 240只眼,其中61眼曾行二次LASIK手术.有10人10眼(0.81%)发生角膜上皮植入.其中,1眼为二次手术后发生(1.6%);6眼有戴接触镜史;5眼术中发生瓣或上皮异常游离瓣1眼、上皮缺损2眼、上皮松解2眼;6眼术后1天时发现荧光素染色阳性(5眼)或角膜瓣皱折(1眼);9眼上皮植入发生于角膜瓣的边缘,4眼见于原上皮缺损或易脱落方向.除1眼待术外,其余9眼(5眼药物治疗,4眼手术治疗)的最终裸眼视力为0.72±0.32(0.02～1.0),最佳矫正视力为0.93二0.1(0.8～1.0),球镜为-0.31±0.97D(-2.25～1.5D),柱镜为0.61±0.50D(0～1.25D),无异物感、眩光、荧光素着染等,上皮植入消失5眼,变小1眼,静止3眼.结论术者应通过提高手术操作技能和完善各手术步骤尽可能地减少此并发症的发生.发现后恰当处理,可获得很好效果.     

有晶状体眼后房型人工晶状体植入和准分子激光原位角膜磨削术矫正超高度近视的临床评价

目的:比较和评价有晶状体眼后房型人工晶状体(Phakic Posterior Chamber Intraocular Lens,PPCI-OL)植入和准分子激光原位角膜磨削术(Laser in situ Keratomileusis,Lasik)矫正高度近视的有效性、安全性和稳定性。方法:高度近视患者43例,随机分为PPCIOL组和Lasik组,分别行可植入接触镜(Implantable Con-tact Lens,ICL)植入术和Laisk,随访并比较两组有效性和安全性指数,两年屈光度回退≤2 D的生存率,低对比度视力和眩光视力的改变。结果:PPCIOL组术前平均等效球面屈光度(-16.77±3.37)D(-11.75--25.75 D);Lasik组术前平均等效球镜度(-13.8±2.71)D(-9.37--23.75 D)。术后1个月两组有效性无统计学差异,PPCIOL组安全性指数高于Lasik组(P<0.001),2 a时屈光度回退率分别为0、32.56％(P<0.001),术后3个月低对比视力和眩光视力PPCIOL组较术前提高比Lasik组明显(P<0.001)。PPCIOL组有1例2眼术后6个月时有晶状体前囊混浊,两组未见其他并发症。结论:有晶状体眼后房型人工晶状体植入矫正超高度近视有效,安全性和稳定性较Lasik更好,并能获得良好的视觉质量。     

In vivo Confocal Microscopy Report after Lasik with Sequential Accelerated Corneal Collagen Cross-Linking Treatment

We report the first pilot qualitative confocal microscopic analysis of a laser in situ keratomileusis (Lasik) treatment combined with sequential high-fluence accelerated corneal collagen cross-linking, denominated Lasik XTra, by means of HRT II laser scanning in vivo confocal microscopy after a 6-month follow-up. After obtaining approval from the Siena University Hospital Institutional Review Board, a 33-year-old female patient underwent a Lasik XTra procedure in her left eye. Confocal analysis demonstrated induced slight corneal microstructural changes by the interaction between UV-A, riboflavin and corneal stromal collagen, beyond the interface to a depth of 160 µm, without adverse events at the interface and endothelial levels. This application may be considered a prophylactic biomechanical treatment, stiffening the intermediate corneal stroma to prevent corneal ectasia and stabilizing the clinical results of refractive surgery. According to our preliminary experiences, this combined approach may be useful in higher-risk Lasik patients for hyperopic treatments, high myopia and lower corneal thicknesses.Key words: Laser in situ keratomileusis, Accelerated corneal collagen cross-linking, Confocal microscopy     

Histopathological study of corneal lamella excised after complications of myopia treatment with LASIK

BACKGROUND: Several complications may occur after Lasik surgery, some of which can lead to corneal scarring and irreversible visual loss. We report such a case, with a clinicopathologic correlation. HISTORY AND SIGNS: A forty-seven-year-old patient with a - 6 D myopia had a Lasik performed with a 160 micron Moria microkeratome. This was complicated by the occurrence of a free cap which was sutured 3 times and of an epithelial ingrowth which was scraped. THERAPY AND OUTCOME: A superficial lamellar graft was performed 1S year later because of persistent photophobia and discomfort. Three weeks later the patient had a clear graft and was symptom free. Light microscopy showed an epithelial ingrowth, peripheral breaks and folds of Bowman's membrane, peripheral folds of superficial stroma with fibrosis and compensatory corneal epithelium acanthosis. There is keratolysis of the central stroma. By electron microscopy, the disrupted stroma showed activated fibroblasts, and the superficial epithelium is immature. Pathogenesis of these complications is discussed. CONCLUSIONS: The patient's clinical symptoms are to a certain extent explained by the histopathological findings. Epithelial ingrowth must be treated in time to avoid keratolysis.     

準分子激光兔角膜原位磨鑲術后視網膜酶組織化學和組織學研究

目的觀察兔眼準分子激光原位角膜磨鑲術(Laserin situ kratomileusis,Lasik)后視網膜糖代謝有關酶的活性及組織學變化.方法 36只兔接受不同深度的Lasik手術角膜切削,分别于手術后不同時間處死,制成冰凍切片和石蠟切片,觀察視網膜琥珀酸脱氫酶(SDH)、乳酸脱氫酶(LDH)、還原型輔酶Ⅰ(NADH)活性變化及組織學改變.結果不同切削量各手術組與對照組比較,術后不同時間各手術組比較,視網膜三種酶活性均無顯著性差异(p＞0.05).視網膜組織學觀察亦無明顯區别.結論臨床Lasik手術切削兔角膜后,視網膜SDH、LDH、NADH活性無明顯改變,組織學結構正常.     

Excimer surface photoablation versus Lasik for correction of mild myopia

INTRODUCTION: Above -6 diopters, Lasik procedure has shown its superiority in term of predictibility, efficacy and stability. In the adverse, in the field of low myopia, Lasik and surface excimer photoablation (PRK) are very controversial. We compare quantitative and qualitative outcome achieved in series of 25 PRK operated patients and 25 Lasik. MATERIAL AND METHOD: 2 homogeneous groups were constituted: group A for Excimer patients and group B for Lasik. Initial ametropia had to be ranged between -2 and -6 diopters (D), eventually associated to a myopic astigmatism that needed to be under -1,75 D. Excimer laser model was a Visx (Visx 20/20 or Star S2). In case of Lasik, flap was performed with an Automated corneal shaper microkératom (Baush & Lomb) or with a Flap Maker (Ioltech). Evaluation of refraction and visual results was associated to measurements of contrast and glare sensitivities and collection of functional complaints. RESULTS: A retrospective analysis is performed with a 2 years follow-up. At that term, rate of eyes, that achieved 20/20 or better is comparable in the two groups (62% in group A and 64% in group B). However, profile of visual recovery goes faster after Lasik. Best corrected visual acuity is favorably preserved in two groups, but is altered with glare in Lasik group. Cycloplegic refraction shows a tendency to regression more important in case of surface ablation (10% versus 4%), especially above -4 D (28%). No significant difference is noted concerning contrast sensitivity, correctly unchanged in the two groups. No case of severe complication is mentioned after both surgical methods. DISCUSSION-CONCLUSION: In the field of low myopia, PRK and Lasik appear to guarantee same predictibility and safety, in conditions of preliminary learning curve. Stability and visual recovery are earlier achieved after Lasik, in addition to postoperative indolence. However, application of this technique to all degrees of myopia requires its perfect control and an adjustment of ablation nomograms.     

重复使用的LASIK角膜板层切削刀扫描电镜观察

目的：观察准分子激光角膜板层显微切削刀在应用不同手术次数后,与未使用过的新切削刀对比所发生的变化,从而为临床提供客观资料。方法：共收集12只CHIRON显微切削刀,其中2只为未用于手术的新刀（0眼术后）,其余为3眼、4眼、5眼、6眼、8眼术后各2只。这些刀片在术后立即收集到原盒中保存以防进一步的损伤。所有切削刀均用HITACHIS－3200扫描电镜观察。结果：本文通过对12只重复使用的板层切削刀进行扫描电镜观察,且与未使用过的新刀相对比,发现未使用过的切削刀质地细腻,刀缘连续性好,随着使用次数的增多,刀质粗糙,出现裂隙和孔洞。结论：角膜板层切削刀随着使用次数增加,刀质的损害程度加重,提示使用此刀的抛弃型尚安全可靠。     

准分子激光原位角膜镶磨术(lasik)后高度近视的视力及屈光的变化

目的探讨原位角膜磨镶术治疗高度近视的疗效。方法对34例67眼高度近视患者进行Lasik手术，分别在术后1周、1月、3月、6月检查视力和屈光度，比较术前、术后的变化。结果术后第1周视力就有十分明显的提高；6月裸眼视力>0．5占83．58％，残留屈光度在1．00D以内者占35．82％。结论Lasik手术治疗高度近视十分有效，绝大多数患者术后不用眼镜能胜任日常工作和生活。     

自然复瓣法在LASIK手术中的应用

目的观察准分子激光原位角膜磨镶(Lasik)手术中自然复瓣法的应用效果。方法对自然复瓣法在1836眼Lasik手术中的应用效果进行回顾性研究。结果与棉签复瓣组相比,自然复瓣组术后角膜瓣的透明性增加,而角膜瓣移位的发生率明显降低,且未见严重的并发症发生。结论自然复瓣法是一种安全、有效的Lasik手术角膜瓣复位方法。     

Nd: YAG laser treatment of anterior chamber implantation cysts

The development of an epithelial implantation cyst is a severe complication of anterior segment surgery and trauma. Two patients with anterior chamber implantation cysts were treated with Nd: YAG laser. One required surgical correction as the cyst reformed after each of 6 laser treatment sessions. In the other patient, the cyst reformed once, and has not recurred for 18 months since the second laser treatment. Collapse of anterior chamber implantation cysts can be achieved with Nd: YAG laser, though multiple treatment sessions may be required due to the cyst's tendency to reform.     

Quantification of corneal aberrations with an aberration coefficient

BACKGROUND: Abnormal corneal surfaces in keratoconus, contact lens induced corneal distorsion or after refractive surgery are thoroughly described by Zernike polynoms. This study investigated such deviations from the healthy eye by a newly introduced aberration coefficient. PATIENTS AND METHODS: 300 healthy eyes were measured with videokeratometry. Corneal Zernike coefficients (grade 1. - 8. degrees ) were used to calculate the aberration coefficient. This number was also determined for 113 eyes with keratoconus (videokeratometric stage 1 to 3 - 4), 326 eyes of contact lens wearers (200 soft and 126 hard lenses) and 119 eyes after Lasik surgery. RESULTS: In the keratoconus group the aberration coefficient was outside normal limits in 99.2 % and correlated well with the illness stage. Corneal distorsions of low extent appeared in 5 % of soft lens wearers without a difference between yearly or disposable replacement mode. The percentage of hard lens-induced distorsions was 39 % (low extent) and 5 % (considerable extent), respectively. Only 16.8 % of eyes after Lasik had a completely normal aberration coefficient; the rest lied between 1.0 - 1.5 (62.2 %), 1.6 - 2.0 (19.3 %) and > 2.0 (1.7 %). CONCLUSIONS: The aberration coefficient is a helpful tool for keratoconus classification, quality control of contact lens fitting and quantification of corneal aberrations after refractive surgery. Optical aberrations of the cornea after Lasik surgery are more widespread than presumed so far and reach a considerable extent in a fifth of the operated persons.