飞秒激光辅助白内障手术早期学习曲线探索

Early experience with the femtosecond laser-assisted cataract surgery

目的探索飞秒激光辅助白内障手术早期的学习曲线情况。方法连续收集2014年10月至2015年10月于温州医科大学附属眼视光医院行飞秒激光辅助白内障手术的白内障患者86例（114只眼）。分两组，第1-50只眼为1组，第51～114只眼为2组。飞秒激光（LenSx，Alcon，Foaworth，TX）辅助白内障手术均由同一位经验丰富的白内障手术医师完成（兼具丰富角膜屈光手术经验）。飞秒激光操作包括撕囊，劈核和透明角膜切口制作。记录术中异常及并发症情况。结果两组平均年龄分别为（60．4±14．9）岁和（60．9±16．2）岁，差异无统计学意义（P〉0．05）。Docking次数在两组中分别为（1．14±0．50）和（1．19±0．53），结膜下出血的发生率分别为22．0％（11只眼）和34．4％（22只眼），两者之间均未见统计学差异（P〉0．05）。手工辅助切口发生率在两组分别为26％（13只眼）和17．2％（11只眼）；瞳孔缩小发生率分别为2％（1只眼）和1．6％（1只眼）；前囊膜tag发生率分别为4％（2只眼）和3．1％（2只眼）；前囊膜撕裂发生率分别为4％（2只眼）和3．1％（2只眼）；后囊膜撕裂发生率分别为2％（1只眼）和0；以上所列的并发症发生率在两组之间均无统计学差异（P=0．252～0．801）。结论对于一位经验丰富的白内障手术医生，尤其是具有丰富角膜屈光手术经验的手术医生来说，FLACS是非常安全的，学习曲线对术中异常情况和并发症发生率并无显著影响。

Objective To describe the early experience with the femtosecond Laser-assisted cata- ract surgery. Methods This study involved 85 continuous patients （114 eyes） who planned to have femtosecond laser-assisted cataract surgeries. All eyes were divided into 2 groups： Group 1 （first 50 eyes） and Group 2 （eyes 51 through 114）. All femtosecond laser-assisted （LenSx, Alton, Fort Worth, TX） cataract surgeries were performed by the same experienced cataract surgeon （also experienced with corneal refractive surgeries）. Femtosecond laser procedures included anterior capsulotomy, lens segmentation, and clear corneal incision creation. All abnormalities and complications during the sur- geries were recorded. Results The mean age of patients in 2 groups was 60.4~14.9 years and 60.9~ 16.2 years, respectively. There was no significant difference was found between the 2 groups. The numbers of docking attempts and occurrence rates of subconjunctival hemorrhage of 2 groups were 1.14~0.50 and 1.19~0.53, 22.0% （11 eyes） and 34,4% （22 eyes）, respectively. However, both of them showed no significant differences between the 2 groups. The occurrence rates of corneal inci- sion creation assisted with keratome in 2 groups were 26% （13 eyes） and 17.2% （11 eyes）, miosis after the laser procedure were 2% （1 eye） and 1.6% （1 eye）, anterior capsular tags were 4% （2 eyes） and 3.1% （2 eye）, anterior capsular tear were 4% （2 eyes） and 3.1% （2 eyes）, posterior capsu- lar tear were 2% （1 eye） and 0; No significant differences were found in those complication occur-rence rates between the 2 groups （P ranged from 0.252 to 0.801）. Conclusions FLACS is proved to be very safe for the experienced cataract surgeon, especially for those who also possess rich experiences in corneal refractive surgeries. The learning curve has no significant effect on the abnormalities and complications occurrence during the surgery.