Intralase飞秒激光术中掀瓣困难的原因及处理

Causes of flap-lifting difficulties in Intralase Femto-LASIK and relevant solutions

目的探讨Intralase飞秒激光制作角膜瓣联合基质面行准分子激光切削（Femto—LASIK）术中掀瓣困难的相关因素及处理方法。方法选取我院行Intralase飞秒激光的患者442例（874眼），其中男208例（414眼），女234例（460眼）；年龄18～42（24．9±4．1）岁；术前等效球镜度数为（-5．37±1．87）D。术前最佳矫正视力均在1．0以上。术前均进行常规检查，如裸眼视力、最佳矫正视力、综合验光、自动眼压、Pentacam三维眼前节分析系统等。手术均由同一医师完成，数码摄像机记录手术过程。结果442例（874眼）患者中46眼出现掀瓣困难，占5．26％。其中由于角膜基质微化空泡引起32眼，占掀瓣困难总眼数的69．6％；由于压平镜与角膜间存在杂质或水渍，引起局部掀瓣困难5眼，占10．9％；由于压平镜与角膜接触面积小引起假吸导致启边困难9眼，占19．6％。结论Intralase飞秒激光术中引起掀瓣困难基本都与角膜基质微化空泡形成和术者的操作密切相关。

Objective Relevant factors of flap-lifting difficulties in Intralase fem- tosecond laser assisted in-situ keratomileus （Femto-LASIK） and corresponding solu- tions. Methods Four hundread and forty-two patients（874 eyes） aged from 18 to 42 years old who had received Intralase Femto-LASIK in our hospital were selected, of which 208 （414 eyes） were males, 234 （450 eyes） were females. The mean age was （24.9 ±4.1 ）years old. Pre-operative spherical equivalent（SE） was（ - 5.37±1.87 ） D. Pre-operative best corrected visual acuity（BCVA） of all eyes were higher than 1.0. Pre- operative routine examinations were carried out, including uncorrected visual acuity （ UCVA）, BCVA, comprehensive optometry, automatic intraocular pressure （ IOP）, penta- cam, mydriatic optometry. All operations were performed by the same surgeon;The sur- gical procedures were recorded using digital camera. Results Flap-lifting difficulties occurred in 45 eyes（5.25% ） ,of which flap-lifting difficulties in 32 eyes（59.6% ） werecaused by opaque bubble layer（OBL） ;Local flap-lifting difficulties in 5 eyes（ 10.9% ） were caused by impurities and water- logging between corneas and planishing glasses;Edge-opening difficulties in 9 eyes（ 19.5% ） were caused by pseudoadsorp- tion induced by small contact areas between corneas and planishing glasses. Conclusion Flap-lifting difficulties in In- tralase Femto-LASIK are nearly all closely associated with opaque bubble layer or operate misses.