准分子激光上皮下角膜磨镶术后角膜上皮下雾状混浊的临床观察及防治

目的探讨准分子激光上皮瓣下角膜磨镶术(LASEK)后角膜上皮下雾状混浊(Haze)的形成原因及防治措施。方法 2004年2月-2011年12月期间采用LASEK治疗近视患者345例669只眼,屈光度3.50～13.5 D,平均(6.87±2.92)D;散光0.50～4.00 D,平均(1.83±1.32)D。根据患者术前屈光等效球镜度数分为:中度近视组(3.50～5.75 D)120只眼,高度近视组(6.00～8.75 D)288只眼,超高度近视组(9.00～13.50 D)261只眼。应用综合措施防治Haze,术中用日夜配戴的高亲水性绷带型角膜接触镜覆盖保护角膜上皮瓣,术毕频点激素眼液4次,术后使用激素类联合非甾体类抗炎眼液及降眼压药、抗生素眼液;随访6～12个月,观察术后Haze的发生率,并按Fantes(1990)标准分级,分析相关原因。结果 LASEK术后6个月时0.5级Haze发生率14.65%(98只眼),无1级Haze。各组0.5级Haze发生率分别为中度近视组2.5%(3只眼),高度近视组11.11%(32只眼),超高度近视组24.14%(63只眼)。结论 LASEK术后Haze的发生与术眼的屈光度呈正比,与角膜上皮瓣的活性和完整性,术后紫外线照射等有关。术后采用激素类联合非甾体类抗炎眼液及降眼压药等综合防治措施,可减少、减轻Haze的发生,使LASEK技术更安全有效。

Clinical Observation and Treatment of Haze a er Laser Epithelial Keratomileusis

Objective To observe the forming of subepithelial Haze after laser epithelial keratomileusis(LASEK),and to explore the related pathogenesis.Methods Between February 2004 and December 2011,345 patients(669 eyes) underwent LASEK.The mean spherical equivalent was(6.87±2.92) D(ranged from 3.50 to 13.50 D), and the mean astigmatism was(1.83±1.32) D(ranged from 0.50 to 4.00 D).There were 120 eyes in the middling myopia group(ranged from 3.50 to 5.75 D),288 eyes in the high myopia group(ranged from 6.00 to 8.75 D),and 261 eyes in the super high myopia group(ranged from 9.00 to 13.50 D).A bandage contact lens that can be worn day and night was placed intrao-peratively to protect the corneal epithelial-flap.After the operation,dexamethasone eyedrop was dropped 4 times immediately.And the postoperative regimen consisted of topical steroid,nonsteroidal antiinflammatory agents(NSAIDS),antibiotic and intraocular pressure lower medications.The patients were followed up for 6-12 months to observe the incidence and degree of Haze and analyze the related pathogenesis.Results At the sixth month after LASEK,the incidence of 0.5 degree Haze was 14.80%(99 eyes).Among them it was 2.5% in the middling myopia group(3 eyes),11.11% in the high myopia group(32 eyes),and 4.14% in the superhigh myopia group(63 eyes). Conclusions The related pathogenesis of Haze includes: the diopter,the activity and integrality of the epithelial-flap, and the postoperative ultraviolet radiation.It can relieve the Haze by taking the synthetical measures consisted of topical steroid,nonsteroidal anti-inflammatory agents,and antibiotic and intraocular pressure lower medications,which makes LASEK safer and more feasible.