CAJ | 학술논문

目的探讨准分子激光角膜原位磨镶术后迟发性弥漫性层间角膜炎产生原因、临床特点、预防办法、处理原则及预后.方法 2008年9月收治准分子激光术后5周,停用糖皮质激素眼药水3～7d后出现弥漫性层间角膜炎5例(10只眼),炎症反应持续时间1～9周(平均2.6周).经局部使用激素、抗生素等眼药水对症治疗,观察临床经过及治疗效果.结果经治疗刺激症状迅速减轻,弥漫性层间角膜炎逐步消退,仅1眼因反应严重而迁延9周痊愈,视力均恢复良好.结论 ①本组病例发生弥漫性层间角膜炎的原因推测为角膜板层刀所致,选择品牌刀片、做好刀具的消毒、清洗等工作,可减少或有效预防此类反应的发生.②临床表现以角膜刺激症状为主,伴层间沙漠样改变以下方层间为重.③对激素类眼药反应敏感.④反应期间和反应消失后对视力均无明显影响,预后良好.
목적 탐토준분자격광각막원위마양술후지발성미만성층간각막염산생원인、림상특점、예방판법、처리원칙급예후.방법 2008년9월수치준분자격광술후5주,정용당피질격소안약수3～7d후출현미만성층간각막염5례(10지안),염증반응지속시간1～9주(평균2.6주).경국부사용격소、항생소등안약수대증치료,관찰림상경과급치료효과.결과 경치료자격증상신속감경,미만성층간각막염축보소퇴,부1안인반응엄중이천연9주전유,시력균회복량호.결론 ①본조병례발생미만성층간각막염적원인추측위각막판층도소치,선택품패도편、주호도구적소독、청세등공작,가감소혹유효예방차류반응적발생.②림상표현이각막자격증상위주,반층간사막양개변이하방층간위중.③대격소류안약반응민감.④반응기간화반응소실후대시력균무명현영향,예후량호.
Objective To Discussion on the reasons, the clinical features, prevention methods, principles and prognosis of the delayed diffuse lamellar Keratitis after LASIK.Methods Five cases (10 eyes) admitted into the hospital 5 weeks after received LASIK in September 2008 due to the delayed diffuse lamellar Keratitis appeared 3 to 7 days after stopping the use of the glucocorticoid eye drops and the duration of the reaction lasted 1 to 9 weeks (averaged 2.6 weeks).By the partial use of hormones, antibiotics and symptomatic treatment of eye-drops, the irritating symptoms were rapidly alleviated, and the delayed diffuse lamellar Keratitis gradually faded.Only one eye did not fully recovered until 9 weeks later, and the restoration of the vision was good.Results The common clinical features of this group were as the follows: 1.Reaction appeared within 1 week after stopping the use of glucocorticoid eye drops after LASIK; 2.Clear corneal irritation; 3.Severity of symptoms associated with the sequence of eye surgery; 4.Corneal irritation occurred prior to the reaction layer; 5.Layer reaction alleviated from the bottom to the top; 6.Sensitive to hormone eye drops; 7.No or minor effect on vision happened during the reaction, three cases (5 eyes) out of 5 remained unchanged (1.2), 2 eyes dropped 1 line, 2 dropped 2 lines and 1 eye showed a drop of 5 lines, with the disappearance of the reaction, the vision reached to a pre-operation level.Conclusions 1.The occurrence of the diffuse lamellar Keratitis is speculated to the use of corneal iamellar knife.Such factors as the selection of brand razor blades, a good job in disinfection and cleaning of the razor blades can reduce or effectively prevent the occurrence of such reactions; 2.Clinical manifestations are mainly corneal irritation with the desert-like layer changes mainly shown in the lower floor; 3.Sensitive to the hormone-typed eye drops; 4.Response during and after the reaction has no significant effect on the sight, and the prognosis is good.