CAJ | 학술논문

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x2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(x2=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.
목적 탐토준분자격광상피하각막마양술(LASEK)술후출현각막내피수종(CEE)적원인급기치료화예방조시.방법 선취2004지2008년재아원행LASEK치료적근시안환자1911례(3814안),년령18～45세,평균(25.4±6.7)세.술전구경굴광도위-0.75～14.00 DS,주경굴광도위0～5.50 DC,최가교정시력>1.0.격광절삭채용대광반평면식소묘혹소광반비점소묘.술후관찰CEE정황,병진행분급,동시분석상관원인병급여대응치료.수방1년,분별우술후제15、제30、제60、제180、제360천시수방검사,복사환자적원、근라안화최가교정시력,진행렬극등현미경、비접촉안압화주、객관험광급각막지형도검사.위객관분석CEE적발생정황,아문안수술선후시간분위5개시간단,병안굴광도고저진행분조분석.대CEE적발생솔비교채용x2검험.결과 LASEK술후유75안(1.97%)출현불동정도적CEE.환자년령25～42세,평균위(32.7±7.8)세.CEE분급:술후제1천,1급56안,2급17안,3급2안.각개시기균유CEE적발생,단수착기술적진보급설비적경신,CEE발생솔축점하강,최후추우은정,단몰유소실.CEE재소유굴광도조균유발생,CEE적발생솔수착굴광도적증가유증고추세,경、중도조저우고도、초고도조,단각조문차이무통계학의의(x2=0.8589,P=0.83533).통과단기격소충격화가강예방감염치료,55안술후3 d내수종소퇴,18안술후1주내수종소퇴,2안술후2주내수종소퇴.술후시력회복정황:1개월내시력회복연지,반년후추우은정.결론 LASEK치료근시안술후유CEE적출현.기발생원인교위복잡,수술조작、격광설비、환자년령화각막내피공능등도시가능적인소.통과급시적격소단기충격화예방감염치료,각막가이완전회복.LASEK수술료효학절,안전가행.
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 is caused by multiple factors after LASER to treat myopia. CEE can be completely controlled with prompt treatment. The curative effect of LASER surgery is accurate, safe and feasible.