【摘要】 目的利用兔眼准分子激光原位角膜磨镶术(LASIK)术后上皮植入的动物模型来探讨LASIK术后上皮植入的发病机制、自然转归、治疗及预防严重上皮植入的方法。方法对26只新西兰大白兔行LASIK治疗,人为地使角膜瓣轻度移位,做成上皮植入的动物模型。然后按Probst和Macha分级方法选取其中严重上皮植入(Ⅲ级)的20只兔(40只眼)随机分为A、B、C、D4组,每组10只眼,各组分别给予不同的处理方法,观察各种处理方法的效果。A组:作为观察组,不做处理,仅给以0.1%氟米龙滴眼液点眼;B组(单纯刮除组):重新掀开角膜瓣,刮除角膜瓣基质面和基质床上植入的上皮,复位角膜瓣;C组(刮除+50%酒精处理组):刮除角膜瓣基质面和基质床上植入的上皮,50%酒精棉片贴敷1min,复位角膜瓣;D组(刮除+角膜瓣边缘行准分子激光治疗性角膜切削术(PTK)+角膜瓣边缘连续缝合组),重新掀开角膜瓣,刮除角膜瓣基质面和基质床上植入的上皮,复位角膜瓣,然后用PTK以3mm直径光斑沿角膜瓣边缘切削,每处切削10个脉冲,共50～70脉冲,重点在角膜瓣的边缘与正常上皮交界处,最后以10-0尼龙线连续缝合角膜瓣边缘于基质床。各组随访3个月观察角膜水肿程度、上皮缺损和荧光素染色情况、角膜瓣融解情况,并行光镜检查。结果三种处理方法相比较B组和C组均有较高的复发率,与D组比较(P<0.05),差异有显著意义;术后1周荧光素染色D组和B、C两组比较(P<0.01),D组术后1周荧光素着色点较B、C组明显减少,差异有显著意义;术后1周角膜水肿情况,D组与B、C两组比较明显减轻(P<0.01),有显著意义;病理切片显示所有复发眼上皮植入均与角膜瓣周围的上皮层相连,并伴有角膜瓣边缘融解,处理成功者1周后可见,层间仍有微小的空隙,但瓣的边缘附着良好,层间镜下未见上皮细胞,3月后角膜恢复正常形态。结论对LASIK术后的严重角膜上皮植入,如果不及时、恰当的处理,很容易出现角膜瓣的融解,严重影响视力的恢复。故应于术前、术中积极预防,早期发现,及时处理,采取综合性治疗方法。刮除+PTK+角膜瓣边缘连续缝合是一种积极有效的处理严重上皮植入的方法,可以防止角膜瓣继续融解,能获得较好的手术效果。更多还原

【Abstract】 Objective To investigate the occurrence,progression,management and prevention methods by animal model of severe corneal epithelial ingrowth after laser in situ keratomileusis in rabbit eyes.Methods 26 experimental rabbits were used to establish animal model of epithelial ingrowth by moving slightly the place of the corneal flap.Acording to the standard of Probst and Macha’s,40 eyes with severe epithelial ingrowth(Ⅲ grade) were enrolled,and divided into 4 groups randomly and equally.The control group of A were free of management.Group B were treated by lifting the flap and scraping the epithlium in the interface.Group C were treated by scraping at first,and then contacted the stroma bed with tampon dipped in 50% alcohol for about 1 minute.In Group D,the flap was lifted,and the in-growing epithelium was removed and the flap edge area treated with PTK and the edge sutured with 10-0 nylon suture.The fluorescein staining,corneal edema,flap melt,recrudescence and pathology were observed during the follow-up of 3 months.Results The recrudescence was higher in B and C than A(P<0.05).The fluorescein staining and corneal oedema of A group was obviously different from B or C(P<0.01)at 1 week postoperation.Pathological examination showed the in-growing epithelium be joind with normal epithelium and the normal configuration in flap edge disappeared.Conclusion Corneal epithelial ingrowth is a severe complication after LASIK.However,with proper treatment,vision can be saved in most cases.We believe that scraping assosiate with PTK and suture is a available method.更多还原