Tehrani M, Dick H B
Universitäts-Augenklinik, Langenbeckstrasse 1, 55131 Mainz.
Ophthalmologe. 2002 Aug;99(8):645-50. doi: 10.1007/s003470100552.
Laser in situ keratomileusis (LASIK) has become the leading refractive option to correct myopia, hyperopia and astigmatism. In addition to the relative rapid visual recovery and the lack of postoperative pain, new flap-related complications are being added. The formation of striae can lead to a significant loss of corrected visual acuity if the central pupil zone is affected. Awareness of possible complications is important not only for the surgeon, but also for the ophthalmologist in practice for a rapid diagnosis and prompt management.
Striae have a variety of appearances and are caused by misalignment/displacement of the corneal flap after replacement or are results of a slippage effect of the flap over the stromal bed after LASIK. Symptomatic striae ideally are treated on the first or second day after surgery by refloating the flap, irrigation with balanced salt solution or hypotonic saline solution, stroking and stretching the surface with moist and dry sponges. In more severe cases scraping away the epithelium and antitorque or interrupted sutures can be performed to treat persistent striae.
Symptomatic deep striae should be diagnosed early and managed promptly within the first days. Any later intervention decreases the chance of successful elimination and visual outcome. Hints to prevent the development of striae formation are provided.
准分子原位角膜磨镶术（LASIK）已成为矫正近视、远视和散光的主要屈光手术方式。除了视力恢复相对较快和术后无痛外，新的与角膜瓣相关的并发症也不断出现。如果中央瞳孔区受到影响，角膜瓣皱襞的形成可导致矫正视力显著下降。认识到可能出现的并发症不仅对外科医生很重要，对于在临床实践中进行快速诊断和及时处理的眼科医生也很重要。
角膜瓣皱襞有多种表现形式，是由于角膜瓣复位后错位/移位，或LASIK术后角膜瓣在基质床上滑动所致。有症状的角膜瓣皱襞理想情况下应在术后第一天或第二天通过重新漂浮角膜瓣、用平衡盐溶液或低渗盐溶液冲洗、用湿海绵和干海绵轻抚和拉伸表面来治疗。在更严重的情况下，可以刮除上皮并进行抗扭转或间断缝合以治疗持续性角膜瓣皱襞。
有症状的深层角膜瓣皱襞应尽早诊断，并在术后头几天内及时处理。任何延迟干预都会降低成功消除并发症和获得良好视力预后的机会。文中还提供了预防角膜瓣皱襞形成的提示。
