角膜屈光术不同制瓣方式术后丝状角膜炎研究  

Filamentary keratitis occurring in different flap preparation styles of corneal refractive surgery

作　　者：黎新[1] 王骞[1] 董诺[1] 郑林[1] 

机构地区：[1]厦门大学附属厦门眼科中心视光部,厦门361001

出　　处：《中国实用眼科杂志》2011年第7期663-665,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的观察角膜屈光手术不同制瓣方式术后丝状角膜炎的发病情况，探讨其发病的相关因素及防治方法。方法回顾性临床病例对照研究。对2004年7月至2010年7月在厦门大学附属厦门眼科中心就诊的14360例28702只眼近视伴散光者行角膜屈光手术，其中11542例（23082只眼）行微型自动旋转式角膜板层刀（LASIK组）制瓣，516例（1030只眼）行飞秒激光Femt0-second laser（FS组）制瓣，2302例（4590只眼）行LASEK治疗，观察三组术后丝状角膜炎的发生情况，比较其发病率，发病者均予以及时去除丝状物及配戴日抛型角膜接触镜治疗。结果LASIK组、Fs组及LASEK组丝状角膜炎发病率分别为0．16％、0％、1．35％，三者差异有统计学意义（X^2=152．642，P〈0．05）。所有丝状角膜炎患者经过1-4d的治疗，均得到痊愈，无1例复发。结论飞秒激光制瓣比常规角膜板层刀及乙醇制瓣术后丝状角膜炎发病率低，采用去除丝状物、应用人工泪液联合配戴日抛型角膜接触镜等方法，可有效治疗术后丝状角膜炎。Objective To compare the incidence, underlying pathophysiology, and clinical features of filamentary keratitis in different flap preparation styles of excimer laser surgery. Methods It was a retrospective case-control study. All 28702 eyes were divided into group A including 23082 eyes treated with laser-assisted in situ keratomileusis in Xiamen Eye Center of Xiamen University between July 2004 and July 2010 with 90 m microkeratome flap preparation, group B of 1030 eyes treated with laser-assisted in situ keratomileusis with 100 m femoto-second laser flap preparation and group C of 4590 eyes treated with laser epithelial keratomileusis. The incidences of the postoperative filamentary keratitis were observed and compared. In cases suffered with filamentary keratitis changes in comeal signs by slitlamp evaluation, appropriate artificial tears therapy and therapeutic lens treatment were required. Results The incidences were significantly different （P 〈0.05） between group A, group B and group C with 0.16%, 0 and 1.35% respectively, and all cases suffered with filamentary keratitis had complete healing. No additional complications were reported. Conclusions The incidence of filamentary keratitis after excimer laser corneal refractive surgery is affected by the different flap preparation styles. The removement of filaments and the use of artificial tears and soft contact lenses for therapeutic purposes are safe, effective and practical.

关 键 词：飞秒激光 准分子激光角膜原位磨镶术 准分子激光上皮瓣下角膜磨镶术 丝状角膜炎 

分 类 号：R772.210.5[医药卫生—眼科]