摘要
目的探讨准分子激光原位角膜磨镶术(LASIK)后角膜融解的发病原因、临床表现及相关因素,为临床预防和治疗提供依据.方法对LASIK术后角膜融解患者11例(12只眼)进行临床分析,观察并记录临床表现;进行全身系统检查,尤其免疫学检查,明确诊断;采用局部给药配合全身疾病治疗方案,并观察疗效和转归.结果10例患者单眼发病,仅1例患者双眼发病.角膜融解部位为角膜瓣边缘,以下方和鼻侧多见;8只眼(67%)术中角膜上皮剥脱、角膜瓣过薄或术后角膜上皮水肿、角膜上皮植入.6例(55%)患者合并全身疾患,其中甲状腺炎1例(1只眼),系统性红斑狼疮2例(2只眼),干燥综合征2例(2只眼),类风湿性关节炎1例(1只眼);有浅层巩膜炎病史1例(1只眼),皮肤出现湿疹、红斑1例(1只眼),角膜瓣下异物1例(1只眼);无其他疾病者2例(3只眼).经眼局部使用环孢霉素A、糖皮质激素、抗生素及角膜保护剂配合全身疾病治疗,患者全部治愈;病程23～45d,平均30.3d;角膜病灶处残留不同程度薄翳或斑翳;角膜散光度数≥1.00D4只眼(1.00～5.50D),实际矫正视力低于预期矫正视力2行5只眼,1行2只眼,无下降5只眼.结论角膜融解是一种与全身性疾病有关的非感染性角膜疾病,LASIK可能为诱发因素.LASIK术前详细的全身系统性检查和术中规范的手术操作对减少角膜融解的发生至关重要.发病后在治疗眼部病变的同时配以全身病治疗,可获得满意效果.(中华眼科杂志,2005,41:330-334)
Objective To study the characteristics of corneal melting after laser in situ keratomileusis and to investigate the risk factors for corneal melting. Methods Twelve eyes of 11 patients with corneal melting after LASIK were studied. The patients consisted of 6 men and 5 women, ranging in age from 26 to 41 years. Each eye was routinely examined with slit lamp microscope and confocal microscope. All patients were conducted with systemic examination, especially immunologic index such as rheumatoid factor, anti-SSA and anti-SSB antibodies. The patients with systemic diseases were treated for the systemic diseases as well as for the ocular disorders. Results Corneal melting occurred unilaterally in all cases; 8 in the left eye and 4 in the right eye. The intervals between onset of corneal melting and LASIK ranged from 2 to 5 weeks. Corneal melting tended to begin from the rim of corneal flaps, especially in the inferior and nasal rims. Eight cases(67%)either had corneal epithelium denudation or thinner corneal flaps during operation or had corneal epithelium edema or epithelium implantation post operatively. 6 cases(55%)were combined with systemic diseases, 1 with thyroiditis, 2 with systemic lupus erythematous, 2 with Sjgren syndrome and 1 with rheumatoid arthritis. One patient once had superficial scleritis, one patient was combined with eczema and erythema of the skin; one patient had foreign body beneath the corneal flap; other patients had no accompanying disorders (3 eyes). All of the cases were cured with treatment by cyclosporine A, topical steroids and protective agents for the cornea. The course of corneal melting ranged from 23 days to 45 days (mean 30.3 days). Corneal nebula or macula of different degrees remained. Four cases had astigmatism with sphere changes above 1.0 diopters. The actual corrected visual acuity of 5 eyes was 2 lines lower than the expected corrected visual acuity, 2 eyes 1 line lower, 5 eyes unchanged. Conclusion Corneal melting is a non-infectious corneal disorder and may accompany with systemic diseases. LASIK may be an inductive factor for corneal melting. A thorough inquiry and examination for systemic diseases are of great importance for the prevention of corneal melting. The treatment for corneal melting should be combined with diagnosis and treatment for the accompanying systemic diseases.
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2005年第4期330-334,共5页
Chinese Journal of Ophthalmology
