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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 related factors of corneal flap complications during LASIK and the intraoperative treatment methods and to explore the timing of the second surgery. Design retrospective case series. Thirteen eyes with corneal flap complications were included in 12313 patients (24015 eyes) who underwent LASIK. Methods Thirteen eyes with corneal flap complications during LASIK were terminated by laser surgery immediately. The corneal flap was reset and the flap was washed under flap. On the 1st, 3rd, 7th and 30th days, the slit lamp examination was performed, and the obvious optometry and corneal topography examination were performed before the operation again. According to the severity of patients with corneal flap complications and corneal recovery, the first surgery 12 to 30 days after the second surgery. Postoperative slit lamp examination and visual acuity. The main indicators of refraction, corneal topography and visual acuity. Results Complications of 13 cases of incomplete valve 9 (broken valve 1), a small flap, buttonhole 3 eyes. After receiving the second surgery, the visual acuity was converted to visual angle analysis. There was no significant difference between the uncorrected visual acuity (median 0.67) and the best corrected visual acuity (median, 0.83) 30 days after surgery P = 0.403). In the pupil area, the position of the button flap, the broken flap and the valve insufficiency all decreased. The mean (1.06 ± 0.52) D and 3 astigmatic axis changed clockwise (10 °, 20 °, 30 °) 4 eyes showed an increase of astigmatism (-0.25-0.50D), of which 3 eyes were buttoned flaps. The corneal K value decreased (952 ± 0.13D) compared with that before the first operation after the flap was completely healed (P = 0.000). The corneal K values of the remaining 10 eyes did not change compared with those before the first surgery (P = 0.105). Conclusions The corneal flap complications during LASIK should not rush to treatment. The timing of the second operation should be determined according to the type and severity of complications. (Ophthalmology, 2007,16: 340-343)