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目的探讨准分子激光治疗近视引起角膜的严重并发症———角膜上皮植入的原因并提出相应的预防和治疗措施。方法本院1997~2001年间采用相同的微型角膜刀(Hansotone)共行1万多只眼手术,随诊的6000例中12例(14眼)发生角膜上皮植入,其中资料完整的10例(11眼)。观察年龄、术前及术后屈光状态、术中及术后并发症。结果年龄19~59岁,7例8眼为高度近视,3例3眼为中度近视;2眼术中发现角膜瓣薄;11眼术后均有不同程度的层间弥漫性角膜炎(diffuselamellar keratitis,DLK);6眼上皮植入明显,伴有较大的不规则散光;2眼上皮植入局限但伴角膜瓣局部溶解。结论角膜上皮植入可能与角膜上皮是否完整、手术器械的质量和医生的操作技巧、术后伤口反应轻重、及病人的全身情况有关。
Objective To investigate the causes of corneal serious complications of excimer laser treatment of myopia --- corneal epithelial implantation and put forward corresponding preventive and therapeutic measures. Methods The hospital from 1997 to 2001 with the same microkeratome (Hansotone) more than 10,000 common eye surgery, follow-up of 6000 cases in 12 cases (14 eyes) corneal epithelial implantation occurred, of which 10 cases of complete data ( 11 eyes). Observation of age, preoperative and postoperative refractive status, intraoperative and postoperative complications. Results The age ranged from 19 to 59 years. Seven of the 8 eyes were high myopia, 3 of 3 eyes were moderate myopia. The corneal flap was found thinly in 2 eyes. Diffused lamellar keratitis (diffuse lamellar keratitis, DLK); 6 eyes were implanted into the epithelium obviously, accompanied by a large irregular astigmatism; 2 eyes with epithelial implantation limitations but with partial dissolution of the corneal flap. Conclusion Corneal epithelial implantation may be related to corneal epithelial integrity, the quality of surgical instruments and doctors’ operation skills, the severity of postoperative wound reactions, and the general condition of the patient.