病例24 45岁女性，常规复查，无不适主诉（准分子激光原位角膜磨镶术后1个月）
CASE 24 A 45-year-old female had regular examination without complaints (one month post LASIK)
见图1-40。See Fig. 1-40.
图1-40 角膜瓣下可见局限的白色油滴样不规则混浊（两个红色箭头所示）Fig. 1-40 Inferior non-central white restricted droplet plaques (red, up arrows) can be seen at the f lapstromal interface
鉴别诊断
Differential Diagnosis
◎ LASIK术后角膜上皮植入：为LASIK术后角膜瓣下出现油滴样或珍珠样点片状的上皮细胞增生。一般发生于术后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.
◎ 角膜瓣下异物：为角膜瓣下出现异物残存，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：患者出现眼红、眼疼、畏光等炎症表现。不同的微生物感染具有各自的特征。（可参照本书感染性角膜疾病的鉴别）
◎ 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)
病史询问
Asking History
◎ 询问是否有视力下降、异物感、畏光、眼痛、眼部刺激感等不适及发生时间。
◎ Asking the complaints such as vision decreased, foreign body sensation, photophobia, pain, irritation, and the onset of symptoms.
◎ 是否有屈光手术病史及手术时间。
◎ Asking the history of refractive surgery in detail such as complication and the time of operation.
检查
Examination
◎ 视力、眼压、验光。
◎ Vision, IOP, refraction.
◎ 裂隙灯检查：角膜荧光素染色确认上皮的完整性。
◎ Slit lamp examination to identify the size, loca t ion of the lesion: Fluorescein staining to conf irm epithelium integrity.
◎ 角膜地形图检查角膜的不规则性。
◎ Corneal irregularity was detected by corneal topo g r aphy.
诊断
Diagnosis
LASIK术后角膜上皮植入。
Epithelial ingrowth post-LASIK.
治疗
Management
◎ 较小的局限的上皮植入可以密切观察。
◎ Small and localized epithelial ingrowth can be closely observed.
◎ 进行性的较大范围的上皮植入，造成不规则散光并导致视力下降或基质融解的患者，须掀开角膜瓣刮除基质床及瓣基质面的增生上皮，彻底冲洗层间，将角膜瓣仔细复位。
◎ 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.
◎ 或者上皮刮除联合准分子激光治疗性角膜切削术(PTK)。
◎ Other techniques for removal include scraping of epithelial ingrowth combined with PTK.
◎ 术中联合应用冷冻疗法、Nd:YAG激光、丝裂霉素C以及缝合可降低复发率。
◎ Adjuncts, such as cryotherapy, Nd: YAG laser, mitomycin C and sutures, may lead to a decreased incidence of recurrence.
◎ LASIK术后予抗生素及糖皮质激素局部点眼，配戴角膜绷带镜缓解不适感和预防复发。
◎ 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.
患者教育和预后
Patient Education & Prognosis
◎ LASIK术后发生角膜瓣下上皮植入的概率约为0.5%~2.0%。发生的时间一般在术后1周以上。如果不进行治疗，可能会导致视力丧失。
◎ 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随任何不适症状，所以常规定期复查是关键。
◎ There can be no discomfort with corneal epithelial implantation patients, so a regular follow-up is neces s ary.