[上皮下准分子激光原位角膜磨镶术术中意外基质层分离的危险因素及处理]

[Risk factors and management for inadvertent stromal dissection of Epi-LASIK].

作者信息

Zhang Yu, Xia Ying-jie, Chen Yue-guo

机构信息

Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China.

出版信息

Zhonghua Yan Ke Za Zhi. 2013 Apr;49(4):315-9.

PMID:23900090

Abstract

OBJECTIVE

To investigate the risk factors of inadvertent cornea stromal dissection during mechanical epikeratome separation of the corneal epithelium using a Moria Epi-keratome and to explore the best procedure for the treatment of this complication.

METHODS

We retrospectively reviewed inadvertent stromal dissections in central or peri-central areas of the cornea during mechanical epi-keratome separation of the corneal epithelium from a series of 708 eyes (355 patients) who received myopic Epi-laser-assisted in situ keratomileusis (Epi-LASIK) procedures during the past five years. The best spectacle corrected visual acuities (BCVA) and topographies at the final follow-up after the last procedures were compared.

RESULTS

From the total of treated eyes, 4 eyes of 4 patients (0.56%) suffered inadvertent stromal dissection. In two of them, an excimer laser ablation under the flaps was performed immediately. One patient was treated with LASIK 6 month after the first procedure and another one received an excimer laser photo-therapeutic keratectomy (PTK) removing the corneal epithelium and photorefractive keratectomy (PRK) for refractive correction 1 month after Epi-LASIK. Postoperatively, BCVA lost one line in one eye which received immediate excimer laser ablation under complicated flap. Topography demonstrated irregularity corresponding to the site of stromal dissection. Two eyes (one received immediate excimer laser ablation and another received LASIK 6 month after stromal dissection) recovered to the pre-Epi-LASIK BCVA. One eye that received PTK and PRK 1 month after Epi-LASIK obtained an increase of one line in BCVA. Topography in all three eyes showed regular patterns in the middle of the cornea.

CONCLUSIONS

Stromal dissection during mechanical separation of the corneal epithelium with Moria Epi-K epikeratome is a potential complication of Epi-LASIK. One month postoperative PTK and PRK turned out to be the option of proper management for good recovery without severe visual impairment.

摘要

目的

探讨使用Moria角膜上皮刀进行角膜上皮机械分离过程中发生意外角膜基质层分离的危险因素，并探索治疗该并发症的最佳方法。

方法

我们回顾性分析了过去五年中接受近视性上皮瓣下准分子激光原位角膜磨镶术（Epi-LASIK）的708只眼（355例患者）在角膜上皮机械分离过程中角膜中央或周边区域发生的意外基质层分离情况。比较了最后一次手术后最终随访时的最佳矫正视力（BCVA）和角膜地形图。

结果

在所有接受治疗的眼中，4例患者的4只眼（0.56%）发生了意外基质层分离。其中2只眼立即在瓣下进行了准分子激光消融。1例患者在首次手术后6个月接受了LASIK治疗，另1例患者在Epi-LASIK术后1个月接受了准分子激光光治疗性角膜切削术（PTK）以去除角膜上皮，并进行了屈光性角膜切削术（PRK）以矫正屈光不正。术后，1只在复杂瓣下立即接受准分子激光消融的眼的BCVA下降了一行。角膜地形图显示与基质层分离部位相对应的不规则性。2只眼（1只立即接受准分子激光消融，另1只在基质层分离后6个月接受LASIK）恢复到了Epi-LASIK术前的BCVA。1只在Epi-LASIK术后1个月接受PTK和PRK的眼的BCVA提高了一行。所有3只眼的角膜地形图在角膜中部均显示规则形态。