飞秒激光小切口微透镜取出术并发症分析

Complications of femtosecond laser corneal small incision lenticule extraction

目的:回顾分析本院飞秒激光小切口透镜取出术(small incision lenticule extraction,SMILE)患者临床资料,探讨术中及术后出现的并发症及如何有效预防与处理。方法:对2015-01/12本院实施的799眼SMILE手术进行统计,回顾性分析其术中术后出现的各类并发症。结果:选取患者中798眼均顺利完成手术,术后视力恢复好,仅1眼术中扫描出现严重黑斑,改行飞秒激光LASIK,手术过程中5例5眼(0.6%)患者发生失吸,11例17眼(2.1%)患者发生了不透明气泡层(OBL),术后BCVA无下降。术后的角膜上皮下雾状混浊及弥漫性板层角膜炎(DLK)的发生率低,分别为0.3%和0.4%,未出现其他严重的并发症,角膜愈合良好。仅6例9眼(1.1%)于6mo后复查出现不同程度的屈光回退,其余患者SMILE术后3mo均获得1.0以上UCVA,达到术前BCVA。结论:SMILE手术具有较好的安全性,预防并及时正确处理各类并发症是术后获得良好视力的关键。

AIM： To investigate the safety and complications of femtosecond laser corneal small incision lenticule extraction （SMILE） procedure and discuss the prevention and treatment. METHODS ： We retrospectively studied the complications of 403 patients（799 eyes） with myopia and myopic astigmatism treated by SMILE. RESULTS： All the patients underwent the operation successfully. Only 1 case（1 eye）suffered from dark spot and changed to femtosecond laser-assisted LASIK （FS- LASIK）, 5 cases （5 eyes, 0. 6%） suffered from the suction loss, 11 cases （17 eyes, 2. 1%） developed opaque bubble layer. All patients gained perfect uncorrected visual acuity（UCVA） （20/20）. The best corrected visual acuity（BCVA） did not decrease after operations. The incidence of haze and diffuse lamellar keratitiswas low （0.3% and 0.4%, respectively） and no other complications were observed. There was 9 eyes in 6 patients （1. 1%） found regression of refraction at 6mo after surgery, while the UCVA of rest patients reached 1.0 at 3mo after surgery. CONCLUSION ： The SMILE procedure has high safety for myopia and myopic astigmatism. Effective prevention and management of the complications is the key to achieve the satisfactory visual acuity.