飞秒激光小切口角膜基质透镜取出术术中并发症及处理  

Intraoperative complications and treatment in femtosecond laser small incision lenticule extraction

作　　者：马娇楠(综述) 王雁(审校)[1] Ma Jiaonan;Wang Yan(Clinical College of Ophthalmology of Tianjin Medical University,Tianjin Eye Hospital,Tianjin Key Laboratory of Ophthalmology and Visual Science,Tianjin 300020,China)

机构地区：[1]天津医科大学眼科临床学院天津市眼科医院天津市眼科与视觉科学重点实验室,300020

出　　处：《中华实验眼科杂志》2021年第12期1104-1108,共5页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金项目(81670884)。

摘　　要：飞秒激光小切口角膜基质透镜取出术(SMILE)作为一种相对新的角膜屈光手术方式,目前还处在不断探索的发展阶段。虽然临床研究显示其在矫治屈光不正方面具有较好的安全性、有效性、可预测性及稳定性,但是仍有相关术中并发症发生,导致临床效果不一。SMILE手术操作分为飞秒激光制作透镜以及分离、取出透镜,在每一步骤中均可能发生术中并发症。透镜的制作完全依赖飞秒激光,不可避免会发生飞秒激光相关的并发症,如负压脱失、不透明气泡层、黑区;透镜的分离、取出依赖术者的操作经验及手术技巧,因而可能在术中出现角膜帽撕裂、透镜取出困难、透镜组织残留、出血、透镜偏中心等。本文就SMILE术中经常出现的并发症种类、原因、处理原则以及对手术效果的影响等方面进行综述,旨在提高临床医生对手术过程中出现并发症的处理能力,以进一步提高手术的安全性。As a relatively new procedure,femtosecond laser small incision lenticule extraction(SMIIE)is still in its initial stage.Despite the safety,efficacy,predictability and stability it has showed in refractive error correction,there are still reports of intraoperative complications resulting in different clinical outcomes in SMILE.SMILE includes the production of lenticule by femtosecond laser,the separation and extraction of lenticule,and intraoperative complications may occur in every step.The production of the lenticule is completely dependent on the femtosecond laser,so complications related to femtosecond lasers are inevitable,such as suction loss,opaque bubble layer and black spots.Separation and extraction of the lenticule relies on the experience and surgical skills of surgeon,during which,torn corneal cap,difficult lenticule extraction,lenticule remnants,bleeding and lenticule decentration may occur.In this article,the categories,reasons,management and effects of intraoperative complications on outcome in SMILE were summarized to improve the ability of ophthalmologists to handle intraoperative incidents and enhance surgical safety.

关 键 词：准分子激光/治疗用法 角膜基质/手术 激光角膜手术/并发症 眼屈光 飞秒激光小切口角膜基质透镜取出术 

分 类 号：R779.6[医药卫生—眼科]