Ting Darren Shu Jeng, Srinivasan Sathish, Danjoux Jean-Pierre
Sunderland Eye Infirmary, Sunderland, UK.
Department of Ophthalmology, University Hospital Ayr, Ayr, UK.
BMJ Open Ophthalmol. 2018 Mar 29;3(1):e000133. doi: 10.1136/bmjophth-2017-000133. eCollection 2018.
The number of laser in situ keratomileusis (LASIK) procedures is continuing to rise. Since its first application for correcting simple refractive errors over 25 years ago, the role of LASIK has extended to treat other conditions, including postkeratoplasty astigmatism/ametropia, postcataract surgery refractive error and presbyopia, among others. The long-term effectiveness, predictability and safety have been well established by many large studies. However, due to the creation of a potential interface between the flap and the underlying stroma, interface complications such as infectious keratitis, diffuse lamellar keratitis and epithelial ingrowth may occur. Post-LASIK epithelial ingrowth (PLEI) is an uncommon complication that usually arises during the early postoperative period. The reported incidence of PLEI ranged from 0%-3.9% in primary treatment to 10%-20% in retreatment cases. It can cause a wide spectrum of clinical presentations, ranging from asymptomatic interface changes to severe visual impairment and flap melt requiring keratoplasty. PLEI can usually be treated with mechanical debridement of the affected interface; however, additional interventions, such as alcohol, mitomycin C, fibrin glue, ocular hydrogel sealant, neodymium:yttriumaluminum garnet laser and amniotic membrane graft, may be required for recurrent or refractory cases. The aims of this review are to determine the prevalence and risk factors of PLEI; to describe its pathogenesis and clinical features and to summarise the therapeutic armamentarium and the visual outcome of PLEI.
准分子原位角膜磨镶术（LASIK）手术的数量持续上升。自25多年前首次应用于矫正单纯屈光不正以来，LASIK的作用已扩展至治疗其他病症，包括角膜移植术后散光/屈光不正、白内障手术后屈光不正和老花眼等。许多大型研究已充分证实了其长期有效性、可预测性和安全性。然而，由于在瓣片与下方基质之间形成了潜在界面，可能会发生诸如感染性角膜炎、弥漫性层间角膜炎和上皮植入等界面并发症。LASIK术后上皮植入（PLEI）是一种不常见的并发症，通常发生在术后早期。报道的PLEI发生率在初次治疗中为0% - 3.9%，再次治疗病例中为10% - 20%。它可导致广泛的临床表现，从无症状的界面改变到严重视力损害以及需要角膜移植的瓣片溶解。PLEI通常可通过对受影响界面进行机械清创来治疗；然而，对于复发或难治性病例，可能需要额外的干预措施，如酒精、丝裂霉素C、纤维蛋白胶、眼用水凝胶密封剂、钕:钇铝石榴石激光和羊膜移植。本综述的目的是确定PLEI的患病率和危险因素；描述其发病机制和临床特征，并总结PLEI的治疗手段和视觉结果。
