FEMTOLDVFS-LASIK角膜瓣发生并发症的原因及处理办法

Causes and Management Methods of Complications in the Production of FS-LASIK Corneal Flap with FEMTO LDV

目的分析FEMTO LDV飞秒激光辅助制作角膜瓣的准分子激光原位角膜磨镶术(FS-LASIK)角膜瓣相关并发症的发生原因,并探讨其处理方法。方法回顾性病例研究。选取2012年7月至2022年6月于医院接受FS-LASIK的10600例(20480眼)近视散光患者,术中均使用FEMTO LDV飞秒激光辅助制作角膜瓣,观察角膜瓣的制作情况。结果本研究共出现角膜瓣相关并发症5566眼(27.18%),其中术中并发症5516眼,占99.1%,术后并发症50眼,占0.9%。术中并发症:直径超小瓣2眼(0.10‰),游离瓣9眼(0.44‰),不全瓣、碎瓣、纽扣瓣15眼(0.73‰),角膜瓣掀开困难94眼(4.59‰),角膜基质床线状条纹96眼(4.69‰),角膜基质床颗粒状107眼(5.22‰),角膜基质微小气泡15眼(0.73‰),前房气泡13眼(0.63‰),角膜上皮脱落12眼(0.59‰),术中负压丢失2眼(0.10‰),角膜瓣蒂位置反向3眼(0.15‰),眼底出血1眼(0.05‰),角膜瓣边缘出血2078眼(10.15%),球结膜下出血1043眼(5.09%),角膜瓣偏中心2039眼(9.96%)。术后并发症:角膜瓣皱褶50眼(2.44‰)。结论FEMTO LDV飞秒激光辅助制作角膜瓣虽有并发症发生,但均不影响手术效果,全面了解设备的性能,合理设计切削参数,提高医生的操作技巧才能制作完美的角膜瓣。

Objective To analyze the causes of complications in the production of femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)corneal flap with FEMTO LDV,and discuss the treatment method.Methods This was a retrospective case study.A total of 10600 patients(20480 eyes)with myopia and/or astigmatism who accepted FS-LASIK in the hospital from July 2012 to June 2022 were selected.During the surgery,FEMTO LDV femtosecond laser was used to assist in the fabrication of corneal flaps,and the progress of corneal flap fabrication was observed.Results In this study,a total of 5566 eyes(27.18%)had corneal flap related complications,of which 5516 eyes had intraoperative complications,accounting for 99.1%,and 50 eyes had postoperative complications,accounting for 0.9%.Intraoperative complications,2 eyes(0.10‰)super small diameter of corneal flap,9 eyes(0.44‰)free corneal flaps,15 eyes(0.73‰)incomplete flaps,broken flaps,button hole flaps,94 eyes(4.59‰)difficult flap lift,96 eyes(4.69‰)striae of flap,107 eyes(5.22‰)granular flap,15 eyes(0.73‰)opaque bubble layer,13 eyes(0.63‰)bubbles in the anterior chamber,12 eyes(0.59‰)corneal epithelium shedding,2 eyes(0.10‰)loss of suction,3 eyes(0.15‰)reverse of corneal flap hinge position,1 eyes(0.05‰)fundus bleeding,2078 eyes(10.15%)bleeding of corneal flap edge,1043 eyes(5.09%)subconjunctival hemorrhage,2039 eyes(9.96%)corneal flap offset.Postoperative complications,50 eyes(2.44‰)creases of flap.Conclusion Although there are complications after FEMTO LDV femtosecond laser in situ keratomileusis for myopia,but it does not affect the operation effect,making perfect corneal flap requires a comprehensive understanding of the performance of the equipment,the reasonable design of cutting parameters and operation skills of surgeon.