飞秒激光小切口角膜基质透镜取出术(SMILE)术中黑斑的临床研究

Clinical observation of black spot in small incision lenticule extraction surgery

目的探讨飞秒激光小切口角膜基质透镜取出术(SMILE)术中黑斑的预防和处理。方法回顾性病例研究。连续选取2019年8月于潍坊眼科医院行SMILE手术的患者288例(557只眼)完善术前常规检查,行SMILE手术,术中记录黑斑的情况。术后随访3个月。结果288例(557只眼)均完成手术,术中及术后未见感染等并发症。术后1 d未矫正的远视力(UDVA)为-0.03±0.08(logMAR),残余等效球镜(SE)为(0.11±0.43)D。术后3个月UDVA为-0.06±0.05(logMAR),残余SE为(0.2±0.36)D。术后3个月UDVA和SE与术后1 d相比,差异均有统计学意义(P<0.05)。手术中5只眼出现黑斑,发生率为0.9%(5/557)。在黑斑的术眼中,3只眼通过仔细分离,完整取出透镜;1只眼大片状黑斑,暂停手术,1个月后再次应用SMILE程序扫描,完整取出透镜;1只眼因大片黑斑,术中更改为FS-LASIK。结论SMILE术中黑斑的发生率低,重视手术的细节可降低黑斑的发生。

Objective To investigate the prevention and treatment of black spots insmall incisionlenticule extraction(SMILE)surgery.Methods A retrospective case series study.557 eyes of 288 patients who underwent SMILE surgery in the Weifang Eye Hospital during August 2019 were selected.All patients completed the routine examination before operation.The black spots were recorded during the surgery.The follow-up period was three months.Results All 288 patients(557 eyes)completed the operation.No infection and other complications were observed during and after the operation.The uncorrected distance visual acuity(UDVA)at one day after the surgery was-0.03±0.08(logMAR),the residual spherical equivalent(SE)was 0.11±0.43 D.The UDVA at three months after operation was-0.06±0.05(logMAR),the residual SE was(0.2±0.36)D.There were significant differences in UDVA and SE between three months and one day after operation(P<0.05).Black spots appeared in 5 eyes,the incidence was 0.9%(5/557).Among the black spots eyes,the lenticules was removed completely through careful separation for three eyes.The surgery was suspended,and one month later,the SMILE surgery was performed in one eyes.One eye changed to femtosecond small LASIK(FS-LASIK)intraoperatively dued to large black spots.conclusions The incidence of black spots in SMILE is low,and paying attention to the details of the operation could reduce the occurrence of black spots.