LASIK术中不完全瓣临床处理.docVIP

LASIK术中不完全瓣临床处理摘要：目的观察LASEK处理LASIK术中的并发症――不完全瓣的术后效果。方法对LASIK术中出现的6例（6眼）不完全瓣的患眼和对侧健康眼2眼施行LASEK。结果6例不完全瓣患者术中成功制作完整的角膜上皮瓣，术后第1 d患者主诉无疼痛稍有眼部异物感，裸眼视力1～3个月已基本稳定，在1.0～1.2之间。全部8眼3个月时角膜haze 0级5眼，0.5级3眼。结论LASIK术中出现不完全瓣时用LASEK矫正是安全有效的。 关键词：准分子激光原位角膜磨镶术；并发症；不完全瓣；近视矫正 中图分类号：R772.2文献标识码：B文章编号：1672-979X(2007)01-0036-03 Clinical Processing of Imperfect Corneal Flap in LASIK WANG Jun, CHEN Hui-ying (Department of Ophthalmology, Jiang Yin Affiliated Hospital of Southeast University Medical School, Jiangyin 214400, China) Abstract：Objective To observe results of LASEK to process the complications - imperfect corneal flap in LASIK. Methods Six eyes with imperfect corneal flaps and two healthy eyes of the other part in LASIK were processed with LASEK. Results Complete flaps of the corneal top skin were made successfully in LASEK for six eyes with imperfect corneal flaps. The patients presented no ache with slight foreign body feeling in the eyes at the 1st day after operation, and the naked visions were stabilized in 1.0～1.2 from the 1st to 3rd month. Five eyes were 0 classes and three ones were 0.5 classes in corneal haze at the 3rd month after operation. Conclusion LASEK is safe and effective in the clinical processing of imperfect corneal flap in LASIK. Key words：eximer laser in-situ keratomileusis; complication; imperfect corneal flap; myopia 准分子激光屈光性原位角膜磨镶术（laser in-situ keratomileusis，LASIK）仍是目前矫治近视的主流角膜屈光手术，它是将准分子激光和显微板层角膜成形系统相结合的一种治疗方法，首先制作一个约厚110 ～160μｍ左右带蒂的角膜瓣后行激光切削。随着准分子激光系统和微型角膜刀的不断更新完善，手术医师临床经验的丰富和技术的提高，LASIK术中与显微角膜板层刀相关的角膜瓣并发症已相对减少，但不完全瓣仍然是最常见的角膜瓣并发症之一[1]，术中一旦出现不完全瓣，一般需将瓣复位终止激光治疗，等待3～6个月后重新施行LASIK或准分子激光屈光性上皮下角膜切削术（laser epithelial keratomileusis，LASEK）。我们用LASEK尝试当场处理LASIK术中的并发症不完全瓣，术后效果满意，现报告如下。 1一般资料 对自2004年5月至2006年3月间行LASIK术的960例（1 905只眼），用法国Moria-M2显微角膜板层刀在术中制作角膜瓣时出现的6例（6眼）不完全瓣的患眼和对侧健康眼2眼施行LASEK，患者年龄18～39岁，6眼不完全瓣眼的近视屈光度为-1.50～-6.50Ｄ，散光-0.50～-1.75Ｄ，角膜中央厚度505～569μｍ，角膜曲率39.87～47.37 D，6眼不完全角膜瓣中有3眼为“纽扣”瓣。角膜不完全瓣发生的原因：2眼由于角膜曲率高（47.0 D）引起，1眼是术中负压不足