准分子激光上皮下角膜磨镶术后角膜内皮水肿原因分析及处理  

Cause analysis and treatment of corneal endothelium edema after LASEK

作　　者：胡学斌[1] 方芳[1] 江萍[1] 莫纯坚[1] 王红俊[1] 陈丽华[1] 

机构地区：[1]三峡大学第一临床医学院,湖北省宜昌市中心人民医院眼视光学专科,湖北宜昌443003

出　　处：《中华眼视光学与视觉科学杂志》2010年第2期146-149,共4页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的 探讨准分子激光上皮下角膜磨镶术（LASEK）术后出现角膜内皮水肿（CEE）的原因及其治疗和预防措施.方法 选取2004至2008年在我院行LASEK治疗的近视眼患者1911例（3814眼）,年龄18～45岁,平均（25.4±6.7）岁.术前球镜屈光度为-0.75～14.00 DS,柱镜屈光度为0～5.50 DC,最佳矫正视力〉1.0.激光切削采用大光斑平面式扫描或小光斑飞点扫描.术后观察CEE情况,并进行分级,同时分析相关原因并给予对应治疗.随访1年,分别于术后第15、第30、第60、第180、第360天时随访检查,复查患者的远、近裸眼和最佳矫正视力,进行裂隙灯显微镜、非接触眼压和主、客观验光及角膜地形图检查.为客观分析CEE的发生情况,我们按手术先后时间分为5个时间段,并按屈光度高低进行分组分析.对CEE的发生率比较采用χ^2检验.结果 LASEK术后有75眼（1.97%）出现不同程度的CEE.患者年龄25～42岁,平均为（32.7±7.8）岁.CEE分级：术后第1天,1级56眼,2级17眼,3级2眼.各个时期均有CEE的发生,但随着技术的进步及设备的更新,CEE发生率逐渐下降,最后趋于稳定,但没有消失.CEE在所有屈光度组均有发生,CEE的发生率随着屈光度的增加有增高趋势,轻、中度组低于高度、超高度组,但各组问差异无统计学意义（χ^2=0.8589,P=0.83533）.通过短期激素冲击和加强预防感染治疗,55眼术后3 d内水肿消退,18眼术后1周内水肿消退,2眼术后2周内水肿消退.术后视力恢复情况：1个月内视力恢复延迟,半年后趋于稳定.结论 LASEK治疗近视眼术后有CEE的出现.其发生原因较为复杂,手术操作、激光设备、患者年龄和角膜内皮功能等都是可能的因素.通过及时的激素短期冲击和预防感染治疗,角膜可以完全恢复.LASEK手术疗效确切,安全可行.Objective To study the cause, treatment and prevention of the appearance of corneal endothelium edema （CEE） after LASEK to treat myopia. Methods LASEK was performed to treat myopia on 1911 patients （3814 eyes） with an age range of 18～45 years, average （25.4±6.7）years. Preoperative sphere was between -0.75 and -14.00 D and the cylinder was 0 to -5.50 D. Corrected visual acuity was better than 1.0. Large facula plane formula scan or Small facula flying-spot scan was used for the LASEK incision. After surgery, measurements were recorded for near and distant vision, best corrected visual acuity, slit lamp slave microscope examination, non-contact intraocular pressure, subjective and objective optometric tests and corneal topography at two weeks, one month, three months, six months and one year. CEE cases were identified, graded according to the time period and analyzed for further study to correlate the cause and method of treatment. Results After surgery, CCE appeared in varying degrees in 75 eyes （1.97%）. Patient age ranged from 25 to 42 years, average （32.7±7.8）years. CEE occurred in every follow-up period but gradually declined with the use of more recent technology and renewed equipment available for treatment. The trends remain unchanged. The CEE cases were graded as follows one day after surgery： level 1, 56 eyes; level 2, 17 eyes; and level 3, 2 eyes. Intensive corticosteroid therapy was used for treatment plus treatment to prevent infection in the short term. CEE disappeared with treatment： there were 56 eyes at 3 days, 18 eyes at 1 week, and 2 eyes at 2 weeks. Visual acuity slowly recovered within a month and the change in vision tended to stabilize by six months. CEE occurred in each group and increased with the severity of myopia. CEE had a lower incidence in the mild and moderate groups compared to the high and very high groups. But statistical analysis with SPSS 10.0 software showed no significant difference between the groups （P〉0.05）. Conclusion The appearance of CEE

关 键 词：角膜切削术 上皮下 激光 近视 角膜内皮水肿 

分 类 号：R779.63[医药卫生—眼科]