| Purpose1. To observe the clinical complication after Laser subepithelial keratomileusis (LASEK), including subepithelial Haze, high intraocular pressure, and filamentary keratitis, discuss the related pathogenesis.2. To research the prevention and treatment of the clinical complication, improve the surgical technique, take synthetical measure to relieve them. Methods1.345patients(669eyes) were treated with LASEK. There were120eyes in the middling myopia group(range from-3.50to-5.75D),288eyes in the high myopia group(range from-6.00to-8.75D), and261eyes in the superhigh myopia group(range from-9.00to-13.5D). A bandage contact lens that can be wear day and night (Bsush&Lomb) was palced intraoperatively to protect the corneal epithelial-flap. After the operation Dexamethasone eyedrop was dropped4times immediately. And the postoperative regimen consisted of topical steroid, nonsteroidal anti-inflammatory agents(NSAIDS), antibiotic and intraocular pressure lower medications. To observe the incidence and degree of Haze, analyse the related pathogenesis.2.345eyes after LASEK were divided to165eyes with0.5%loteprednol etabonate in the experimental group and180eyes with0.1%fluorometholone in the control group. To observe and compare the incidences of Haze, high intraocular pressure(IOP), and filamentary keratitis in postoperative6months. 3. All669eyes were divided to232eyes in the contact-lens group and437eyes in the non-contact-lens group. To observe and compare the incidence of the postoperative filamentary keratitis. After its onset we treat it with the Vidisic Gel in quantities immediately,sum up the effect, and analyse the clinical feature, related pathogenesis, prevention and treatment.Results1. At the sixth month after LASEK the incidences of0.5degree Haze is14.65%(98eyes).Among them it was2.5%in the middling myopia group(3eyes),11.11%in the high myopia group(32eyes),24.14%in the superhigh myopia group(63eyes). And there are significantly different.2. The incidences of high IOP are significantly different(χ2=5.386,P=0.020) between the0.5%loteprednol group (3.64%) and0.1%fluorometholone group (10.00%), so are those of Haze(χ2=4.143, P=0.042)between the0.5%loteprednol group (9.70%) and the0.1%fluorometholone group(17.22%).3. The incidences of filamentary keratitis are significantly different(χ2=5.413, P=0.020) between the contact-lens group (6.47%) and the non-contact-lens group(2.75%), so are those(χ2=8.477, P=0.004) between LASIK group (2.16%) and LASEK group(4.04%). The healing time with the Vidisic Gel is1.21±0.52days, and there were no recur in the following6months.Conclutions1. The related pathogenesis of Haze include:the diopter, the ablation depth, the activity and integrality of the epithelial-flap, the postoperative ultraviolet radiation. It can relieve the Haze by taking the synthetical measures consisted of topical steroid, nonsteroidal anti-inflammatory agents(NSAIDS), antibiotic and intraocular pressure lower medications, and it make LASEK safer and more feasible.2. Compared with traditional steroid suspension,0.5%loteprednol etabonate ophthalmic suspension can significantly reduce occurrence of high IOP and Haze. It was safe and effective after LASEK.3. The related pathogenesis of filamentary keratitis after excimer laser corneal refractive surgery include:the secondary affection with contact lens (dry eye and inflammation of the anterior eye segment), the intraoperative damage to corneal, the repair of corneal epithelium and the aftertreatment. It has a short healing time and predominance effect to treat the postoperative filamentary keratitis with the Vidisic Gel. |
