飞秒激光微切口角膜基质透镜取出术术后并发症分析及处理

Analysis on incidence and management of complications after femtosecond laser-assisted small incision lenticule extraction

摘要:

目的：分析飞秒激光微切口角膜基质透镜取出术(small incision lenticule extraction， SMILE)术后并发症，探讨其发生的原因、处理对策及对预后的影响。

方法：回顾性分析我院2016-06/2017-05进行的SMILE患者1 127例2 236眼的临床资料，随访时间为6mo。

结果：术后并发症总体发生率为8.05%，包括弥漫性层间角膜炎74眼(3.31%)、视力恢复延迟58眼(2.59%)、角膜层间异物残留14眼(0.63%)、视物重影34眼(1.52%)。1眼存在严重偏中心切削者术后3mo视力尚未恢复，行角膜地形图引导的准分子激光上皮下角膜磨镶术(laser-assisted subepithelial keratomileusis，LASEK)。所有患者并发症经适当处理后结果良好，术后裸眼视力均达到或超过术前最佳矫正视力。

结论：尽管SMILE存在一定比例术后并发症，但手术总体是安全的。术中注意手术技巧，调整手术参数，术后合理用药可以减少并发症的发生。

Abstract:

AIM: To evaluate the safety and postoperative complications of femtosecond laser-assisted small incision lenticule extraction(SMILE).

METHODS: Retrospective case series. A total of 1127 patients(2 236 eyes)who were treated with SMILE for myopia or myopia astigmatism between June 2016 and May 2017 were enrolled in this study. Eyes that developed postoperative complications were noted and identified. The incidence, risk factors, management and prognosis were analyzed. The follow-up was 6mo.

RESULTS: The rate of postoperative complications was 8.05%, included diffuse lamellar keratitis(3.31%), delayed visual acuity(2.59%), minor interface residue(0.63%), and ghost images(1.52%). These complications had an impact on best corrected visual acuity(BCVA)at 3mo in only 1 eye with decentered ablation and was re-treated with topography-guided laser-assisted subepithelial keratomileusis(LASEK). Good visual outcomes were achieved in all eyes finally.

CONCLUSION: Although few eyes suffered postoperative complications, SMILE is an acceptable safe surgery. Careful surgical skill, appropriate surgical parameter, and rational postoperative medication can decrease the risk of complication.