tailieunhanh - Fundamentals, Surgical Techniques, and Complications - part 10

Trong thực tế, bề mặt cắt bỏ excimer laser là một trong các phương thức được sử dụng để điều trị bệnh nhân với hội chứng xói mòn tái phát (111-115). 1. Quản lý Intraoperative Nếu một khiếm khuyết biểu mô được chú ý trong cuộc phẫu thuật, | 454 Roque et al. sions especially with LASIK and would probably be better PRK candidates. In fact surface excimer laser ablation is one of the modalities used to treat patients with recurrent erosion syndrome 111-115 . 1. Intraoperative Management If an epithelial defect is noted intraoperatively a higher index of suspicion for epithelial ingrowth should be maintained Figs. and . An attempt at repositioning the loose epithelium should be performed Table 7 . Carefully piecing the loose edges together may sometimes prove to be very challenging. Alternatively the epithelium can be gently Table 7 Management of Epithelial Tears Defects Edema Types Acute intervention Follow-up Long-term management Outcomes Epithelial tear Reposition the epithelium if possible Observe for epithelial ingrowth and infection Aggressive topical steroids for DLK prophylaxis Lubrication Good Epithelial defect Replace all adherent and loose epithelium and place a bandage contact lens Lubrication Prophylaxis for infection with antibiotics Treatment of pain with BCL topical NSAID Aggressive topical steroids for DLK prophylaxis Remove BCL after adequate lubrication Good Stromal edema Gentle pressure on the flap with a microsponge or blunt spatula Aggressive topical steroids for DLK prophylaxis Slight haze if persistent stromal edema Good Stretched flap Gentle replacement of epithelium and eliminate redundant epithelium is rarely required Bandage contact lens if necessary Lubrication Routine Good Shrinked contracted flap Distend the flap with care Lift and rehydrate the flap Suturing as needed Lubrication Routine Good Prevention 1. Consider PRK in patients with anterior membrane dystrophy and symptoms consistent with recurrent corneal erosion syndrome. 2. Avoid excessive use of topical anesthetic as it may loosen the epithelium use a glycerin-based preparation such as Proparacaine. 3. Place minimal fiducial marks and avoid the central mm of cornea. Copyright Marcel Dekker Inc. All .