LASIK术后皮质类固醇性高眼压临床分型  

Classification of steroids induced high intraocular pressure after laser in situ keratomileusis

作　　者：庞辰久[1] 王丽娅[1] 宋晓虹[1] 张黎[1] 

机构地区：[1]河南省眼科研究所,河南省眼科中心,河南省郑州市450003

出　　处：《眼科新进展》2007年第11期847-849,共3页Recent Advances in Ophthalmology

摘　　要：目的探讨准分子激光角膜原位磨镶术(laser in situ keratomileusis,LASIK)后皮质类固醇性高眼压的临床特点,并根据其特点分型,为临床诊疗提供帮助。方法回顾性分析我中心2002年以来LASIK术后皮质类固醇性高眼压患者的病历(包括外院病例),对其临床特点进行总结。LASIK术后继发皮质类固醇性青光眼的患者34例64眼,男18例,女16例,年龄18~35岁,手术前等值球镜为-3.50^-14.00D,发病时间为术后6~28d。结果根据其临床特点分为普通型、上皮水肿型、层间积液型、弥漫性板层角膜炎型、角膜扩张型。其中普通型46眼,其临床仅表现为高眼压;上皮水肿型4眼,除高眼压外,裂隙灯检查可见全角膜上皮水肿;层间积液型2眼,裂隙灯下可见角膜层间有积液,角膜中央测出为低眼压,但从周边测可发现眼压升高;弥漫性板层角膜炎型4眼,其特点为高眼压,裂隙灯检查可见类似弥漫性板层角膜炎表现,皮质类固醇治疗加重病情,降眼压治疗有效;角膜扩张型8眼,临床表现为高眼压,角膜地形图可发现角膜扩张。结论LASIK术后继发皮质类固醇性青光眼有不同的临床特点,临床医师应加以重视,以免误诊漏诊。　Objective To discuss the clinical characteristics of steroids induced high intraocular pressure（IOP） after laser in situ keratomileusis（LASIK）,and make a help for clinical identification according to their features.Methods High IOP after LASIK cases were retrospective studied from 2002 in Henan Institute of Ophthalmology,and their clinical characteristics were summarized.Sixty-four eyes in 34 cases （including cases from other hospitals） of steroids induced high IOP were recognized.There were 18 male cases and 16 female cases,the age of the patients ranged from 18～35 years old.The spherical equivalent refraction were -3.50 D～-14.00 D.It occurred from 6～28 days after LASIK.Results It was divided into five types according to its clinical features.（1）General type;（2）Epithelial edema type;（3） Interlamellar liquid type;（4） Interlamellar stromal keratitis type;（5） Keratectasia type.There were 46 eyes in general type.It had no other clinical characteristics except high IOP.The epithelial edema type was in 4 eyes.Except high IOP,the whole corneal epithelial edema was easy recognized with slit lamp examination.Interlamellar liquid type was in 2 eyes.There was liquid accumulated in the interlamellar.The IOP was lower when measured from the central cornea but was high from the peripheral cornea.The interlamellar stromal keratitis type was found in 4 eyes which had the similar features with diffused lamellar keratitis,but it would get worse when administered with steroids.Keratectasia type was in 8 eyes.It has high IOP.The cornea topography indicated keratectasia.Conclusion There were special features in steroids induced high intraocular pressure after LASIK.The clinician should pay more attention to these cases to avoid misdiagnosis.

关 键 词：高眼压 皮质类固醇 准分子激光角膜原位磨镶术 

分 类 号：R772[医药卫生—眼科]