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角膜屈光手术并发症案例图解
$65.06
角膜屈光手术量逐年提高,开展手术的医院逐渐增多,操作以及术后处理的不规范导致了大量的并发症,如感染、角膜瓣损伤等,严重影响视觉质量,目前国内尚无屈光手术并发症相关专著,本书填补这一空白。主编北京协和医院眼科李莹教授是角膜病学组副组长,多年来接诊了大量术后并发症的患者,且本人手术患者并发症出现率极低,积累了大量病例和经验。本书适合角膜屈光手术医师阅读,帮助其及时处理并发症,并规范操作,减少并发症的发生。部分屈光手术并发症患者会于眼...
角膜屈光手术量逐年提高,开展手术的医院逐渐增多,操作以及术后处理的不规范导致了大量的并发症,如感染、角膜瓣损伤等,严重影响视觉质量,目前国内尚无屈光手术并发症相关专著,本书填补这一空白。主编北京协和医院眼科李莹教授是角膜病学组副组长,多年来接诊了大量术后并发症的患者,且本人手术患者并发症出现率极低,积累了大量病例和经验。本书适合角膜屈光手术医师阅读,帮助其及时处理并发症,并规范操作,减少并发症的发生。部分屈光手术并发症患者会于眼表专业就诊,因此本书同样适合眼表医师阅读。本书主体为案例,按照表层角膜屈光手术和基质角膜屈光手术分类,每种手术方法的案例按照上皮、角膜瓣、层间、感染分类,介绍角膜屈光手术后并发症的表现、处理、随访,以及本案例带来的警示,以及手术操作中如何避免并发症发生,配大量图片,文字简洁,适合屈光手术医师,以及眼表专业医师阅读。
第一章 概论/ 1第二章 表层类角膜屈光手术相关并发症/ 3第一节 表层类角膜屈光手术相关并发症概述 / 3第二节 角膜上皮愈合迟缓 / 4典型病例1:TPRK 术后角膜上皮延迟愈合 / 4典型病例2:TPRK 术后角膜上皮延迟愈合 / 6第三节 角膜上皮下雾状混浊 / 7典型病例1:TPRK 术后角膜上皮下雾状混浊(haze) / 7典型病例2:LASEK 术后角膜上皮下雾状混浊(haze) / 11第四节 角膜感染 / 14典型病例1:TPRK 术后细菌性角膜炎 / 14典型病例2:LASEK 术后真菌性角膜炎 / 18第五节 干眼 / 21典型病例:TPRK 术后干眼 / 21第三章 LASIK 和FS-LASIK 手术相关并发症 / 25第一节 LASIK 和FS-LASIK 手术相关并发症概述 / 25第二节 角膜上皮植入 / 25典型病例1:LASIK 术后角膜上皮植入 / 26典型病例2:FS-LASIK 术后角膜上皮植入 / 31第三节 LASIK 术后角膜穿孔 / 33典型病例:LASIK 术后角膜穿孔 / 33第四节 角膜瓣异常 / 35典型病例:FS-LASIK 术后角膜瓣异常 / 36第五节 感染 / 37典型病例:LASIK 术后感染性角膜炎 / 37第六节 免疫性角膜炎 / 40典型病例1:LASIK 术后免疫性角膜炎 / 40典型病例2:FS-LASIK 术后边缘角膜炎 / 44第七节 屈光回退处理 / 46典型病例:LASIK 术后屈光回退 / 47第八节 角膜游离瓣 / 50典型病例:LASIK 术后角膜游离瓣 / 50第九节 弥漫性层间角膜炎 / 53典型病例:FS-LASIK 术后弥漫性层间角膜炎 / 53第十节 角膜瓣位置异常 / 55典型病例:LASIK 术后角膜瓣位置异常 / 55第十一节 角膜扩张 / 58典型病例1:FS-LASIK 术后角膜扩张 / 58典型病例2:LASIK 术后角膜扩张 / 61第十二节 干眼 / 64典型病例:FS-LASIK 术后干眼 / 64第四章 SMILE 手术相关并发症 / 68第一节 SMILE 手术相关并发症概述 / 68第二节 脱负压吸引 / 68典型病例:SMILE 术后失吸处理 / 68第三节 透镜分离困难 / 71典型病例:SMILE 术中透镜分离困难 / 71第四节 透镜残留 / 73典型病例:SMILE 透镜残留 / 73第五节 黑斑/ 不透明气泡层处理 / 75典型病例1:SMILE 不透明气泡层 / 76典型病例2:SMILE 术中黑斑 / 77典型病例3:SMILE 术中黑斑 / 79第六节 上皮植入 / 81典型病例:SMILE 术后上皮植入 / 81第七节 感染 / 84典型病例1:SMILE 术后感染 / 84典型病例2:SMILE 术后细菌性角膜炎 / 86第八节 角膜扩张 / 90典型病例:SMILE 术后角膜扩张联合微角膜透镜植入联合角膜胶原交联 / 91第九节 弥漫性层间角膜炎 / 97典型病例:SMILE 术后DLK / 97第十节 光敏综合征 / 99典型病例:SMILE 术后光敏综合征 / 100第十一节 角膜层间积液综合征 / 102典型病例1:SMILE 术后层间积液综合征 / 102典型病例2:SMILE 术后层间积液综合征 / 104第十二节 免疫性角膜炎 / 110典型病例:SMILE 术后免疫性角膜炎 / 110第五章 角膜屈光术后二次手术/ 114第一节 角膜屈光术后二次手术概述 / 114第二节 偏中心切削 / 114典型病例1:SMILE 术后二次手术 / 115典型病例2:LASIK 术后二次手术 / 121第三节 角膜不规则 / 125典型病例:FS-LASIK 术后角膜不规则 / 125第四节 术后残留远视/ 近视/ 散光 / 128典型病例:FS-LASIK 术后残留屈光不正 / 129第五节 角膜营养不良处理 / 133典型病例1:LASIK 术后角膜营养不良 / 133典型病例2:角膜颗粒状营养不良激光屈光手术后角膜混浊 / 136第六章 激光角膜屈光手术后外伤相关并发症/ 140第一节 激光角膜屈光手术后外伤相关并发症概述 / 140第二节 FS-LASIK 术后角膜外伤 / 142典型病例:FS-LASIK 术后外伤性角膜瓣皱褶 / 143第三节 FS-LASIK 术后角膜外伤 / 145典型病例:FS-LASIK 术后外伤性角膜瓣裂伤伴上皮植入 / 145第四节 LASIK 术后角膜外伤 / 147典型病例1:LASIK 术后外伤性角膜水肿伴上皮植入 / 147典型病例2:LASIK 术后外伤性角膜瓣移位 / 150第五节 LASEK 术后角膜上皮外伤 / 155典型病例:LASEK 术后外伤性角膜上皮剥脱 / 155参文献考/ 159索引/ 161后序/ 163
自从1993 年3 月我国首先开展准分子激光矫治屈光不正至今已经有30 年,激光角膜屈光手术已逐渐成为屈光不正患者视力矫正的主要方式。多年来,无论是手术种类、手术操作精准度、手术安全性都有大幅度变化,向着越来越有效、安全、稳定与个性化的方向发展,因此越来越多的人接受手术。尤其近年来近视发生率逐年提高,很多人为了工作、入伍、升学等职业需求或者为了生活与运动方便,以及美容需求等来做手术。角膜处在人眼球的最前端,具有透明、坚韧、折光的生物学特性,在正常角膜上做激光手术,要求具有更高的精准度和安全性。角膜屈光手术,无论是表层类手术,如准分子激光角膜切削术(photorefractive keratectomy, PRK)、准分子激光上皮下角膜磨镶术(laser assistedsubepithelial keratomileusis, LASEK)、表层经上皮准分子激光角膜切削术(trans-epitheliumphotorefractive keratectomy, TPRK),还是基质类手术,如准分子激光原位角膜磨镶术(laserin situ keratomileusis,LASIK)、飞秒激光辅助制瓣准分子激光原位角膜磨镶术(femtosecondlaser assisted laser in-situ keratomileusis, FS-LASIK)、飞秒激光小切口角膜基质透镜取出术(femtosecond laser small incision lenticule extraction,SMILE),医生可以根据患者情况量身定制,术后都可以获得良好的视觉效果,97% 以上的患者可以达到预期的最佳矫正视力,30%的患者可以超过预期最佳矫正视力。任何手术都不可避免术后并发症的发生,角膜屈光手术也是如此,尽管其术后并发症发生概率较低,一旦发生会影响患者视力矫正和视觉质量,如果不及时诊断处理,个别并发症的后果严重。再者,由于表层和基质两大类手术在手术操作、解剖学原理、组织恢复等方面有较大不同,因此术后发生在不同时间段的术后反应和并发症的情况也各不相同。为了临床医生能够及时准确地诊治术后并发症,我们收集了一系列临床术后并发症病例,主要包括表层类的角膜上皮延迟愈合、角膜上皮下雾状混浊(haze)、欠矫或过矫、感染和角膜扩张,以及基质类的黑斑或不透明气泡层、角膜瓣皱褶及瓣移位、角膜上皮植入、偏中心、弥漫性板层角膜炎、切口边缘撕裂、透镜残留等,希望借此提醒临床医生在关注手术效果的同时,更要关注并发症的诊断、治疗和预防,进一步提高处理并发症的能力。近三十年来,我们不仅拥有了良好的设备、精湛的手术技能,更重要的是还建立了严格的手术质量控制以及并发症处理的措施。因为手术的质量控制对手术的成功、降低并发症的发生率至关重要,所以严格的手术适应证把控、个性化的手术选择、科学的围手术期用药方案,有助于手术质量的提高,从而保证整体手术的长久安全。本书编者主要来自中国医学科学院北京协和医院、山东第一医科大学附属眼科医院(山东省眼科研究所)、首都医科大学附属北京同仁医院、天津医科大学眼科医院、四川大学华西医院、北京茗视光眼科、沈阳爱尔眼科医院、重庆白继眼科、西安交通大学第一附属医院和大同朝聚安康眼科医院。各位参编专家在忙碌的医教研工作中,精心收集汇总病例资料,为本书的出版付出了辛勤的劳动。本书以丰富的病例图片及图解为基础,图文并茂,使读者能够更直观地了解病例中所展现的术后并发症的诊断、治疗及转归详情。在本书出版之际,再次对所有的编者表示衷心的感谢!特别感谢谢立信院士多年来对角膜屈光手术安全与有效性的悉心指导,并为本书撰写序言!非常感谢孙旭光教授多年来在角膜感染等重症屈光手术并发症诊治方面给予的无私指导和帮助!感谢北京协和医院姜洋、阳珊两医生对本书资料、照片的整理!真诚地感谢所有参与诊治的医务人员,以及配合治疗的患者!对于本书中可能存在的不足之处,敬请同行多加指正。李 莹2023 年8 月于北京
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