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?

Treatment of corneal epithelia ingrowth at different time periods after LASIK

Objective To investigate the ideal treatment for corneal epithelial ingrowth after laser in situ keratomileusis （LASIK）. Methods Twenty patients （22 eyes） with corneal epithelial ingrowth were analyzed from January 1999 to December 2008. The patients were divided into three different time periods. Three patients were treated during the first period by adopting a therapeutic approach for postoperative inflammatory reaction. There was no knowledge in our clinic for defining a clear concept of cornea epithelial ingrowth and its management. In the second period, from January 2001 to December 2004, the therapeutic principle of corneal epithelium implants was applied to treat 8 patients （9 eyes）. In the third period, between January 2005 to the present time, 9 patients （10 eyes） were treated. Of these 9 patients, corneal epithelial ingrowth was found after handling the reductus flap in 5 patients （6 eyes）. Treatment highlights： ①After cleaning the endogenetic epithelium, the corneal flap was dried in the open air and was repositioned at the same time; ②The corneal flap was dried in the open air for 5-8 minutes after repositioning the flap; ③No contact lens was used after the treatment. Results In the first period, corneal flaps were removed in two patients, and their uncorrected visual acuity ＇after one month was 5.0; one patient＇s uncorrected visual acuity was 4.9 because the corneal flap had partially dissolved. In the second period, 3 eyes were flushed twice, and after one month their uncorrected visual acuity was 4.9（2 eyes）, 5.0（6 .eyes） and 5.1（1 eye）. In the third period, of the 9 patients （10 eyes）, 2 patients （2 eyes） had a visual acuity of 5.0; and corneal epithelial ingrowth had reappeared in 5 patients （6 eyes）. Corneal healing times were 2 clays （3 eyes）, 3 days （2 eyes） and 4 days （1 eye） after reprocessing and their visual acuities were 4.8（2 eyes）, 4.9（1 eye） and 5.0（3 eyes）. In the 22 eyes, corrected visual acuity became wo