病例24　45歲女性，常規復查，無不適主訴（準分子激光原位角膜磨鑲術后1個月）

CASE 24　A 45-year-old female had regular examination without complaints (one month post LASIK)

見圖1-40。See Fig. 1-40.

鑒別診斷

Differential Diagnosis

◎ LASIK術后角膜上皮植入：為LASIK術后角膜瓣下出現油滴樣或珍珠樣點片狀的上皮細胞增生。一般發生于術后1周以上。

◎ Epithelial ingrowth post-LASIK: Oil drop like or pearl like plaques under the corneal f lap due to accumulation of proliferative corneal epithelial cells. It usually occurs more than 1 week post operation.

◎ 角膜瓣下異物：為角膜瓣下出現異物殘存，可以是油脂、碎屑等。

◎ Cornea subf lap foreign body: It is the remnant of foreign body under the corneal f lap, such as oil, debris and so on.

◎ 感染性角膜炎：患者出現眼紅、眼疼、畏光等炎癥表現。不同的微生物感染具有各自的特征。（可參照本書感染性角膜疾病的鑒別）

◎ Infectious keratitis: The patients present inf lam m a t ion such as redness, pain and photophobia. Different microbial infections have their own characteristics. (Please see the differentiation of infectious keratitis in this book)

病史詢問

Asking History

◎ 詢問是否有視力下降、異物感、畏光、眼痛、眼部刺激感等不適及發生時間。

◎ Asking the complaints such as vision decreased, foreign body sensation, photophobia, pain, irritation, and the onset of symptoms.

◎ 是否有屈光手術病史及手術時間。

◎ Asking the history of refractive surgery in detail such as complication and the time of operation.

檢查

Examination

◎ 視力、眼壓、驗光。

◎ Vision, IOP, refraction.

◎ 裂隙燈檢查：角膜熒光素染色確認上皮的完整性。

◎ Slit lamp examination to identify the size, loca t ion of the lesion: Fluorescein staining to conf irm epithelium integrity.

◎ 角膜地形圖檢查角膜的不規則性。

◎ Corneal irregularity was detected by corneal topo g r aphy.

診斷

Diagnosis

LASIK術后角膜上皮植入。

Epithelial ingrowth post-LASIK.

治療

Management

◎ 較小的局限的上皮植入可以密切觀察。

◎ Small and localized epithelial ingrowth can be closely observed.

◎ 進行性的較大范圍的上皮植入，造成不規則散光并導致視力下降或基質融解的患者，須掀開角膜瓣刮除基質床及瓣基質面的增生上皮，徹底沖洗層間，將角膜瓣仔細復位。

◎ Progressive large-scale epithelial implantation which induces irregular astigmatism or visual acuity decrease or stromal dissolution need to open the corneal f lap to scrape offthe proliferative epithelium of the stroma bed, also the stroma surface of the f lap, wash the interlayer thoroughly and reposition the corneal f lap carefully.

◎ 或者上皮刮除聯合準分子激光治療性角膜切削術(PTK)。

◎ Other techniques for removal include scraping of epithelial ingrowth combined with PTK.

◎ 術中聯合應用冷凍療法、Nd:YAG激光、絲裂霉素C以及縫合可降低復發率。

◎ Adjuncts, such as cryotherapy, Nd: YAG laser, mitomycin C and sutures, may lead to a decreased incidence of recurrence.

◎ LASIK術后予抗生素及糖皮質激素局部點眼，配戴角膜繃帶鏡緩解不適感和預防復發。

◎ Topical antibiotics and steroids are given postop e ratively as per routine after LASIK surgery. A band a g e contact lens may be placed to improve comfort.

患者教育和預后

Patient Education & Prognosis

◎ LASIK術后發生角膜瓣下上皮植入的概率約為0.5%~2.0%。發生的時間一般在術后1周以上。如果不進行治療，可能會導致視力喪失。

◎ The probability of epithelial ingrowth post-LASIK is about 0.5% to 2.0%. It generally occurs more than 1 week after operation. It can cause vision lost without treatment.

◎ 角膜上皮植入可不伴隨任何不適癥狀，所以常規定期復查是關鍵。

◎ There can be no discomfort with corneal epithelial implantation patients, so a regular follow-up is neces s ary.