Kuo Irene C, O'Brien Terrence P, Haller Julia A, Jabbur Nada S
Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Cataract Refract Surg. 2006 Dec;32(12):2146-8. doi: 10.1016/j.jcrs.2006.05.038.
We describe 2 complications of sequential keratorefractive and vitreoretinal surgery not previously reported. Epithelial ingrowth occurred in 1 patient who experienced laser in situ keratomileusis flap dehiscence and replacement during vitreoretinal surgery. In the second patient, a flap could not be created with a microkeratome or a femtosecond laser because of anatomical changes from previous vitreoretinal surgery. Anatomic repair of the vitreoretinal pathology and completion of keratorefractive surgery with good visual outcomes were achieved in both patients. Flap stability should be an important operative consideration for vitreoretinal surgeons; patients may have to be informed of the risk for and possible subsequent complications of iatrogenic flap dehiscence. Refractive surgeons operating on patients after vitreoretinal surgery may encounter difficulty creating a LASIK flap even with a femtosecond laser and may need to consider other keratorefractive options.
我们描述了两种先前未报道过的角膜屈光与玻璃体视网膜联合手术并发症。1例患者在玻璃体视网膜手术期间发生准分子原位角膜磨镶术（LASIK）瓣裂开并进行了更换，随后出现了上皮内生。在第2例患者中，由于既往玻璃体视网膜手术导致的解剖结构改变，无法使用微型角膜刀或飞秒激光制作角膜瓣。两名患者均实现了玻璃体视网膜病变的解剖修复，并完成了角膜屈光手术，视觉效果良好。对于玻璃体视网膜外科医生而言，瓣的稳定性应是手术中的重要考量因素；可能需要告知患者医源性瓣裂开的风险及随后可能出现的并发症。即使使用飞秒激光，为玻璃体视网膜手术后的患者实施手术的屈光外科医生在制作LASIK瓣时也可能会遇到困难，可能需要考虑其他角膜屈光手术方案。
