LASIK术中角膜瓣相关并发症的再手术处理  

Management and reoperation of LASIK intraoperative flap complications

作　　者：高旭[1] 周跃华[1] 齐颖[1] 翟长斌[1] 王钢[1] 牛波[1] 郭宁[1] 

机构地区：[1]首都医科大学附属北京同仁医院眼科中心,100730

出　　处：《眼科》2007年第5期340-343,共4页Ophthalmology in China

摘　　要：目的分析LASIK术中角膜瓣并发症的相关因素,术中处理方法,并探讨二次手术的时机。设计回顾性病例系列。研究对象12313例(24015眼)接受LASIK的患者中发生角膜瓣并发症的13眼。方法对LASIK术中发生角膜瓣并发症的13眼,均立即终止激光手术治疗,复位角膜瓣,冲洗瓣下。术后第1、3、7、30天行裂隙灯检查,再次手术前行显然验光及角膜地形图检查。根据患者角膜瓣并发症的严重程度以及角膜恢复的情况,于第一次手术后12～30天行第二次手术。术后行裂隙灯检查并观察视力。主要指标屈光度、角膜地形图及视力。结果发生并发症的13眼中瓣不全9眼(碎瓣1眼)、小瓣1眼、纽扣瓣3眼。在接受二次手术后,将视力数值转换为视角后分析,术后30天裸眼视力视角(中位数0.67)与术前最佳矫正视力视角(中位数0.83)比较差异无统计学意义(P=0.403)。纽扣瓣、碎瓣及瓣不全的位置在瞳孔区内的患者,球镜度均降低,平均(1.06±0.52) D,3眼散光轴发生顺时针改变(10°、20°、30°),4眼散光增加(-0.25～-0.50D),其中3眼为纽扣瓣,其角膜K值在瓣愈合完整后与首次手术前角膜K值相比降低(2 95D±0.13D),差异有统计学意义(P=0.000),其余10眼的角膜K值与首次手术前角膜K值相比未发生改变(P=0.105)。结论LASIK术中发生角膜瓣并发症时不要急于处理,应根据并发症的类型、严重程度确定二次手术时机。(眼科,2007,16:340-343)Objective To analyze the factors that affect the intraoperative flap complications of LASIK and the management, for determining the better time to take reoperation. Design Retrospective case series. Participants Among 12313 patients （24015 eyes） accepted laser treatment, 13 eyes failed to accomplish operation because of flap complications were enrolled in this study. Method The laser treatment on 13 eyes was canceled. Routine management was carefully performed, including replacing flap and rinsing. Topography and refraction were taken and all the patients accepted reoperations later on 12 to 30 days. Main Outcome Measures The uncorrected visual acuity （UCVA）, refraction and cornea topography after first session and reoperation. Result The types of the complication in 13 eyes included 9 incomplete flaps, 3 button hole flaps and I small flap. The visual acuity data were converted into visual angle data, and nonparametric test Mann-Whitney showed no significant difference （U=69.000, P=0.403）between the eyes with complication （median of visual angle=0.67） and the predicted result （median of visual angle=0.83）. In the patients with button hole and incomplete flap with the cutting across the pupil area, the refraction changed with decreasing on spherical power （1.06±0.52）D and the variety of cylinder as well the axis. Among the eyes with flap complications, the axes of 3 eyes rotated clockwisely （10°, 20 °, 30°and the cylinders of 4 eyes raised -0.25D to -0.50D. The cylinders of all the 3 button hole eyes increased. Topography changed in the patients with button hole. K value decreased significantly （t=1 1.595,P=0.000）, average 2.95±0.13 D, after the reheating of cornea, while eyes with other complications had no significant change （t=-1.7000, P=0.105）. Conclusions To avoid sequelae of intraoperative complications, proper management is highly important, and no laser treatment should be done in the procedure. The time to take reoperation depended on the type and severity of the fla

关 键 词：近视/外科学 激光手术 手术中并发症 再手术 

分 类 号：R779.63[医药卫生—眼科]