Mirshahi Alireza, Bühren Jens, Kohnen Thomas
Department of Ophthalmology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
J Cataract Refract Surg. 2004 Aug;30(8):1636-41. doi: 10.1016/j.jcrs.2004.02.052.
To report the clinical outcome of laser in situ keratomileusis (LASIK) cases complicated by severe central intraoperative epithelial defects (EDs) caused by the microkeratome cut.
Department of Ophthalmology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.
In a retrospective study of 1650 LASIK cases at 1 center, the preoperative data, surgical procedures, and postoperative course in 22 eyes of 14 patients who experienced severe central EDs during the LASIK procedure (1.3%) were reviewed. The surgery was performed using a Technolas C-LASIK 217 excimer laser (Bausch & Lomb) and a Hansatome microkeratome (Bausch & Lomb). A follow-up of at least 12 months was available in all but 1 case. The median follow-up was 13.5 months (range 12 to 25 months). In the postoperative period, the following parameters were reviewed: course of refraction, best spectacle-corrected visual acuity (BSCVA), slitlamp findings, and corneal topography.
The mean patient age was 42 years (range 27 to 61 years). Eight patients were affected bilaterally. Fifteen eyes (68%) had moderate to severe dry-eye symptoms preoperatively. Almost all eyes lost BSCVA in the postoperative period, and visual acuity improved slowly. By the last follow-up visit, no eye had lost more than 1 line of BSCVA. Diffuse lamellar keratitis (DLK) was observed in 20 eyes (91%), irregular astigmatism in 17 (77%), and microfolds in 12 (55%). In unilaterally affected patients, the refractive outcome was better in the nonaffected eye.
A large central ED is a severe intraoperative complication of LASIK that may lead to DLK, irregular astigmatism, flap microfolds, clearly prolonged visual rehabilitation, and temporary loss of BSCVA. The improvement in BSCVA may take several months.
报告准分子原位角膜磨镶术（LASIK）术中因微型角膜刀切割导致严重中央上皮缺损（EDs）的病例的临床结果。
德国美因河畔法兰克福约翰·沃尔夫冈·歌德大学眼科。
在对1个中心的1650例LASIK病例进行的回顾性研究中，回顾了14例患者22只眼在LASIK手术过程中出现严重中央EDs（1.3%）的术前数据、手术过程和术后病程。手术使用Technolas C-LASIK 217准分子激光（博士伦）和Hansatome微型角膜刀（博士伦）进行。除1例患者外，所有患者均进行了至少12个月的随访。中位随访时间为13.5个月（范围12至25个月）。在术后阶段，对以下参数进行了评估：屈光过程、最佳矫正视力（BSCVA）、裂隙灯检查结果和角膜地形图。
患者平均年龄为42岁（范围27至61岁）。8例患者双眼受累。15只眼（68%）术前有中度至重度干眼症状。几乎所有眼睛在术后均丧失了BSCVA，视力恢复缓慢。到最后一次随访时，没有一只眼睛的BSCVA下降超过1行。20只眼（91%）观察到弥漫性板层角膜炎（DLK），17只眼（77%）出现不规则散光，12只眼（55%）出现微褶皱。在单侧受累患者中，未受累眼的屈光结果更好。
大面积中央ED是LASIK术中的严重并发症，可能导致DLK、不规则散光、瓣微褶皱、明显延长的视力恢复时间以及BSCVA的暂时丧失。BSCVA的改善可能需要数月时间。
