飞秒激光辅助白内障超声乳化术中激光相关并发症的发生率及其原因

Incidence of laser-related complications during femtosecond laser-assisted cataract surgeryand its factors

目的调查飞秒激光辅助白内障超声乳化术中激光相关并发症的发生率及其原因。方法调查2017年6月至2019年9月在南通大学附属医院眼科行飞秒激光辅助白内障超声乳化术的老年性白内障患者498例(678眼)。术中使用Alcon LenSx飞秒激光行晶状体前囊膜切开、预劈核、透明角膜切口以及部分弧形角膜松解切口,随后按标准方法完成白内障超声乳化联合人工晶状体植入术。记录术中与激光相关的并发症并用Adobe Photoshop CC 2017进行量化分析,同时探讨上述并发症发生的原因。结果激光相关的并发症的发生率前囊膜切开不完整为6.34%、前囊膜撕裂为2.65%、劈核不完整为1.03%、角膜切口分离不全为6.49%、角膜切口靠内为25.81%、角膜切口倾斜为2.21%、弧形角膜松解切口偏中心为4.92%、负压环脱失为0.59%、结膜下出血为31.12%及瞳孔缩小为7.23%。以上对应并发症发生的最主要原因分别为眼位偏斜占41.86%、前囊膜切开不完整占55.56%、Ⅳ度硬核白内障占42.86%、老年环占45.45%、眼位偏斜占50.28%、眼位偏斜占53.33%、眼位偏斜占44.44%、患者配合不佳占100.00%、高负压占100.00%及前囊膜切口与虹膜太接近占63.27%。结论飞秒激光辅助白内障超声乳化术虽然精准、微创,但仍然有部分患眼因各种原因而出现激光相关的并发症,眼科手术医师应关注这些并发症的防治。

Objective To investigate the incidence and causes of laser-related complications of femtosecond laser-assisted cataract surgery.Methods This study comprised 498 continuous patients(678 eyes)who underwent femtosecond laser-assisted cataract surgery in the department of Ophthalmology,the Affiliated Hospital of Nantong University from June 2017 to September 2019.Anterior capsular capsulotomy,lens fragmentation,corneal incisions,and arcuate keratotomy were performed using Alcon LenSx femtosecond laser.The rest of the procedure was completed by phacoemulsification and insertion of intraocular lenses.The laser-related complications during surgery were recorded and analyzed with Adobe Photoshop CC 2017,and the causes of the above complications were discussed.Results The laser-related complications were as follows incomplete capsulotomy(6.34%),anterior tears(2.65%),incomplete lens fragmentation(1.03%),incompletely corneal incision(6.49%),inside of corneal incision(25.81%),tilt of corneal incision(2.21%),arcuate keratotomy located off-center(4.92%),suction breaks(0.59%),subconjunctival hemorrhage(31.12%),and miosis(7.23%).The main causes of the above complications were as follows tilt of eye position(41.86%),incomplete capsulotomy(55.56%),Ⅳgrade hard nucleus cataract(42.86%),arcus senilis(45.45%),tilt of eye position(50.29%),tilt of eye position(53.33%),tilt of eye position(44.44%),patients with poor cooperation(100.00%),high negative pressure(100.00%),and anterior capsule incision being too close to the iris(63.27%).Conclusion Although femtosecond laser-assisted cataract surgery provides precise and minimally invasive outcomes,there still may be intraoperatively laser-related complications due to various reasons.It is worthwhile for surgeons to pay attention to the prevention and treatment of these complications.