目的：针对急需眼内手术合并角膜带状变性的低龄患儿，探讨同次全身麻醉下行经角膜上皮准分子激光治疗性角膜切削术(trans-PTK)序贯眼内抢救手术的可行性。

方法：本研究为回顾性研究，纳入了2024年8月至2025年8月期间于上海交通大学医学院附属新华医院接受同次全身麻醉下trans-PTK序贯眼内手术的患儿临床资料。纳入患儿均患有复杂眼内疾病合并视轴区角膜带状变性，屈光间质混浊影响眼内手术操作。在全身麻醉诱导并平稳后，术中对患眼进行trans-PTK切削，以消融角膜上皮及钙化斑块。完成后在维持全身麻醉的状态序贯展开特定的眼内治疗操作。角膜带状变性的范围和可视化由量表评估。记录并分析手术参数、术后角膜透明度变化、眼内可视化变化以及术中特殊的眼表干预措施。

结果：本研究纳入患儿13例13眼，年龄6.15±3.10岁，男9例，女4例。抢救手术的原因包括视网膜脱离6眼，硅油乳化、异位或取出4眼，前房消失或房角关闭3眼。所有患儿均在同次全身麻醉下顺利完成联合手术，术中角膜平均最大切削深度为97.08±15.60 μm，平均激光治疗时间为57.85±14.80 s。所有患眼的角膜透明度均获得不同程度改善，其中完全改善9眼，部分改善4眼。眼内可视化显著性改善\〖3(2.5，3.5)vs 0(0，0)分，P<0.05\〗。患儿术后最后一次随访时BCVA较术前无变化。在序贯进行的眼内手术操作中，未使用黏弹剂的患眼角膜脱水速度加快，角膜润湿间隔平均缩短至11.66±4.10 s。其中5眼因屈光不规则或严重脱水影响术野，于术中预防性覆盖透明质酸钠黏弹剂，有效维持了角膜湿润及术中视野的清晰。术中、术后所有患儿均无不良事件发生。

结论：对于患严重眼内疾病合并角膜带状变性的低龄患儿，在同次全身麻醉下可行trans-PTK使眼内可视化快速提升，使序贯眼内手术得到顺利实施。

METHODS: A retrospective study was performed. Clinical data were collected from pediatric patients who received sequential trans-PTK between August 2024 and August 2025. All patients had complex intraocular diseases combined with visual axis-involving band keratopathy, and opacified refractive media impeded intraocular surgical procedures. Under stable general anesthesia, trans-PTK was performed on the affected eye to remove corneal epithelium and calcific plaques. Upon completion, specific intraocular therapeutic procedures were sequentially performed while maintaining general anesthesia. The extent of band keratopathy and visualization were evaluated using a grading scale. Intraoperative parameters, postoperative corneal clarity, improvement of intraocular visualization and any adjunctive ocular surface measures were documented and evaluated.

RESULTS:A total of 13 eyes from 13 enrolled pediatric patients were included. The mean age was 6.15±3.10 y, with 9 males and 4 females. The indications for salvage surgery included rhegmatogenous retinal detachment(6 eyes), silicone oil emulsification, dislocation, or extraction(4 eyes), and anterior chamber shallowing or angle-closure(3 eyes). All patients completed the combined procedure under the same general anesthesia. Mean maximum corneal ablation depth was 97.08±15.60 μm, and mean laser treatment time was 57.85±14.80 s. Postoperatively, corneal transparency improved in all eyes, including completed improvement in 9 eyes and partial improvement in 4 eyes. Intraocular visualization score was significantly improved \〖3(2.5,3.5)vs 0(0,0),P<0.05\〗. Best-corrected visual acuity did not differ significantly from preoperative levels. During sequential intraocular surgery, corneal dehydration accelerated in eyes not treated with viscoelastic agents, and the mean corneal wetting interval was shortened to 11.66±4.10 s. Viscoelastic agents were applied in 5 eyes to reduce irregular refraction and severe dehydration, maintaining corneal hydration and surgical field clarity. No adverse events occurred in any pediatric patient during the intraoperative or postoperative periods.

CONCLUSION: For young pediatric patients with severe intraocular diseases complicated by band keratopathy, Trans-PTK performed under the same session of general anesthesia allows for a rapid enhancement of intraocular visualization, facilitating the successful implementation of sequential intraocular procedures.