激光角膜原位磨镶术后外伤致角膜瓣皱褶的处理

目的探讨外伤致准分子激光原位角膜磨镶术（LASIK）后角膜瓣皱褶的处理方法。方法表麻下掀开已发生皱褶的角膜瓣，冲洗角膜床和角膜瓣床面，清除增生的上皮组织，展平角膜瓣的皱褶，使之覆贴于角膜床，边缘对齐。10例（10眼）手术处理后观察6个月。结果（1）视力术后1d10眼中9眼裸眼视力≥0．6；术后6个月，裸眼视力0．6～1．2（0．8±0．16）；另1例合并黄斑出血，视力0．2。（2）裂隙灯检查：术后1d，2例角膜瓣破损挫伤处，角膜瓣基质水肿，对位良好。3例边缘部有上皮植入，上皮轻度水肿，再次手术处理上皮植入后，角膜瓣对位良好。术后6个月，所有患眼角膜瓣皱褶均展平。结论LASIK术后外伤致角膜瓣的损伤和皱褶，通过及时妥善的处理，可以展平角膜瓣皱褶，不会对视力造成严重影响。

Treatment of traumatic corneal flap fold after LASIK

Objective To investigate the treatment of traumatic corneal flap fold after laser in situ keratomileusis(LASIK). Methods We opened the corneal flap which had folds by topical anesthesia. Corneal bed and corneal flap bed were rinsed and proliferative epithelial tissue was remored. We expanded and paved the corneal flap folds to make it stick to the corneal bed with dear margins. Ten patients (10 eyes)with traumatic corneal flap fold were analyzed with following-up for 6 months after surgery. Results 1. UNVA In the second day after surgery ,9 patients' uncorrected visual acuites(UNVA) were not less than 0. 6 ;In the 6 months after surgery, 9 patients' UNVA were 0. 6 ～ 1.2(0. 8 ±0. 16) ,1 patient' uncorrected visual acuity was 0. 2 with macular hemorrhage. 2. Slit lamp biomicroscopic examination. There was stromal edema around the corneal flap contusion with good contraposition in 2 cases at 1 day postoperatively. 3 cases had epithelial ingrowth around the margin with slightly swollen epithelia. The corneal flaps could restore right position after the surgical treatment for epithelial ingrowth. The corneal flap folds in all cases become flattened at 6 months postoperatively. Conclusion Traumatic corneal flap fold after LASIK can be eliminated by the timely and proper treatment. There is no serious impact on vision.