准分子激光治疗性角膜切削术治疗角膜弥漫性火药伤

目的:探讨准分子激光治疗性角膜切削术在角膜浅层弥漫性火药伤中的应用,为角膜弥漫性火药伤提供一种新的有效的治疗方法。方法:收集1999年12月至2003年12月期间在我院就诊的25例(39只眼)角膜浅层弥漫性火药伤患者,采用准分子激光治疗性角膜切削术进行异物清除。术后观察视力、角膜上皮恢复时间、眼压、远视状态和Haze等状况。结果:该手术与常规手术相比,缩短了手术时间,一只眼激光手术过程在10min以内。一次手术即可完成绝大部分的异物剔除,手术损伤小,一般在1周内角膜上皮可以完全恢复。术后在角膜光学区基本不残留角膜斑翳,术后视力显著提高。术后10d平均视力为0.6。术后患者轻度远视38例,中度远视1例。该手术产生的并发症在术中和术后也能得到良好的控制,安全性和预测性较高。结论:准分子激光治疗性角膜切削术在角膜浅层弥漫性火药伤中是一种方便、效果好、费用低廉并值得推广的治疗方法。

Phototherapeutic Keratectomy of Diffuse Corneal Foreign Bodies Caused by Gunpowder Explosion

PURPOSE :To investigate the clinical effects of phototherapeutic keratectomy (PTK) on the treatment of diffuse corneal foreign bodies caused by gunpowder explosion. METHODS: From Dec, 1999 to Dec, 2003, 39 eyes of 25 patients with diffuse foreign bodies on cornea caused by gunpowder explosion were investigated in this study. All foreign bodies located in one third of superficial cornea and conjunctiva. Besides slit-lamp biomicroscope examination and cornea thickness measurement, ultra-sound B, VEP and ERG were used to exclude the possibility of damage of posterior ocular segments. Then the PTK was performed at every 100-150 pulse-interval. In case of damaging to deep cornea, the total pulse was less than 500 and corneal thickness was measured during the operation. After operation, vision acuity, recovery of corneal epithelium, haze, intraocular pressure and ametropia were checked and the patients were followed up for 6 months. RESULTS: Compared with traditional therapies used for diffused corneal foreign bodies, PTK generally took shorter time (10 minutes). It could erase most foreign bodies on cornea and had little injury to normal corneal tissue. Commonly, the corneal epithelial layer recovered completely within one week. The vision acuity after PKT was improved notablely. The mean value of vision acuity at 10th day of post-operation is 0.6 (vs < 0.3 in all patients before operation). There were 38 eyes with gentle hyperopia and 1 eye with moderate hyperopia. The complication of PTK can be controlled during operation or after operation by drugs. CONCLUSION: PTK is a facile, effective, hypo-cost method for the treatment of diffused foreign bodies on cornea damaged by gunpowder explosion.