重视角膜屈光手术操作规范及并发症防治

doi:10.6040/j.issn.1673-3770.0.2021.347

摘要/Abstract

摘要： 当今各种治疗近视眼技术的手段很多,激光角膜屈光手术是矫正屈光不正的重要方式之一。屈光手术中任何环节的质量控制对手术成功与否、减少并发症至关重要。严格的手术适应证把控、个性化的手术方式选择、规范的围手术期处方用药等等都有助于手术质量提高,保证整体手术安全。

关键词: 角膜, 屈光手术, 并发症, 近视, 安全, 规范化

Abstract: With the increasing varieties of treatment techniques, laser corneal refractive surgery has become an important method of correcting ametropia. Quality control of all steps of the surgical procedure is crucial for the success of the operation and for complications reduction. Strict control of surgical indications, personalized surgical management, and standardization of perioperative medication regimens are helpful in improving the quality and ensuring the overall safety of surgery.

Key words: Cornea, Refractive surgery, Complications, Myopia, Safety, standardization

中图分类号:

R778

李莹. 重视角膜屈光手术操作规范及并发症防治[J]. 山东大学耳鼻喉眼学报, 2021, 35(6): 1-6.

LI Ying. Importance of standardized methods in corneal refractive surgery and the prevention of complications[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(6): 1-6.

参考文献

[1] 李莹. 重视激光角膜屈光手术快速发展中的手术并发症问题[J]. 中华眼科杂志, 2018, 54(10): 721-725. doi:10.3760/cma.j.issn.0412-4081.2018.10.001. LI Ying. Keep an eye on standardized management of laser refractive surgery under its rapid development[J]. Chin J Ophthalmol, 2018, 54(10): 721-725. doi:10.3760/cma.j.issn.0412-4081.2018.10.001.
[2] 张丰菊, 郭宁. 飞秒激光用于角膜屈光手术应注意的问题[J]. 眼科, 2014, 23(5): 289-291. doi:10.13281/j.cnki.issn.1004-4469.2014.05.001. ZHANG Fengju, GUO Ning. Key points on the femtosecond laser assisted corneal refractive surgery[J]. Ophthalmol China, 2014, 23(5): 289-291. doi:10.13281/j.cnki.issn.1004-4469.2014.05.001.
[3] Lim DH, Hyun J, Shin E, et al. Incidence and risk factors of opaque bubble layer formation according to flap thickness during 500-kHz FS-LASIK[J]. J Refract Surg, 2019, 35(9): 583-589. doi:10.3928/1081597X-20190814-01.
[4] Li LY, Schallhorn JM, Ma JN, et al. Risk factors for opaque bubble layer in small incision lenticule extraction(SMILE)[J]. J Refract Surg, 2017, 33(11): 759-764. doi:10.3928/1081597X-20170821-02.
[5] Wu D, Li B, Huang M, et al. Influence of cap thickness on opaque bubble layer formation in SMILE: 110 versus 140 μm[J]. J Refract Surg, 2020, 36(9): 592-596. doi:10.3928/1081597X-20200720-02.
[6] Brar S, Ganesh S, Gautam M, et al. Feasibility, safety, and outcomes with standard versus differential spot distance protocols in eyes undergoing SMILE for myopia and myopic astigmatism[J]. J Refract Surg, 2021, 37(5): 294-302. doi:10.3928/1081597X-20210121-01.
[7] Brar S, Ganesh S, Gautam M, et al. Comparison of clinical outcomes and visual quality using a medium versus small contact glass in patients undergoing SMILE with large corneal diameters[J]. J Refract Surg Thorofare N J, 2021, 37(3): 150-157. doi:10.3928/1081597X-20201222-02.
[8] Moshirfar M, West DG, Miller CM, et al. Incidence, risk, and visual outcomes after repositioning of acute non-traumatic flap dislocations following femtosecond-assisted LASIK[J]. J Clin Med, 2021, 10(11): 2478. doi:10.3390/jcm10112478.
[9] Tsai TH, Peng KL, Lin CJ. Traumatic corneal flap displacement after laser in situ keratomileusis(LASIK)[J]. Int Med Case Rep J, 2017, 10: 143-148. doi:10.2147/imcrj.s128637.
[10] Rapuano CJ. Management of epithelial ingrowth after laser in situ keratomileusis on a tertiary care cornea service[J]. Cornea, 2010, 29(3): 307-313. doi:10.1097/ICO.0b013e3181b7f3c5.
[11] Ting DSJ, Srinivasan S, Danjoux JP. Epithelial ingrowth following laser in situ keratomileusis(LASIK): prevalence, risk factors, management and visual outcomes[J]. BMJ Open Ophthalmol, 2018, 3(1): e000133. doi:10.1136/bmjophth-2017-000133.
[12] 李莹, 张潇, 罗岩, 等. LASIK术后角膜上皮植入的原因及分型[J]. 眼科, 2009, 18(3): 165-168. LI Ying, ZHANG Xiao, LUO Yan, et al. Types and causal analysis of epithelial ingrowth after LASIK[J]. Ophthalmol China, 2009, 18(3): 165-168.
[13] Cosgrove RJ, Borr MJ, Keil ML. Disruption of ingrown epithelium via Nd: YAG laser or DIEYAG. A retrospective case series of Post-LASIK patients[J]. Am J Ophthalmol Case Rep, 2021, 22: 101071. doi:10.1016/j.ajoc.2021.101071.
[14] Chan C, Lawless M, Sutton G, et al. Re-treatment in LASIK: to flap lift or perform surface ablation[J]. J Refract Surg, 2020, 36(1): 6-11. doi:10.3928/1081597x-20191211-02.
[15] Esquenazi S, Bui V. Long-term refractive results of myopic LASIK complicated with intraoperative epithelial defects[J]. J Refract Surg, 2006, 22(1): 54-60.
[16] Leccisotti A, Fields SV. Diffuse lamellar keratitis after LASIK with low-energy femtosecond laser[J]. J Cataract Refract Surg, 2021, 47(2): 233-237. doi:10.1097/j.jcrs.0000000000000413.
[17] Wilson SE, de Oliveira RC. Pathophysiology and treatment of diffuse lamellar keratitis[J]. J Refract Surg, 2020, 36(2): 124-130. doi:10.3928/1081597X-20200114-01.
[18] Titiyal JS, Kaur M, Rathi A, et al. Learning curve of small incision lenticule extraction: challenges and complications[J]. Cornea, 2017, 36(11): 1377-1382. doi:10.1097/ICO.0000000000001323.
[19] 史伟云. 重视角膜上皮病变的诊断和治疗[J]. 中华眼科杂志, 2017, 53(3): 161-163. doi:10.3760/cma.j.issn.0412-4081.2017.03.001. SHI Weiyun. Concerns on the diagnosis and treatment of corneal epitheliopathy[J]. Chin J Ophthalmol, 2017, 53(3): 161-163. doi:10.3760/cma.j.issn.0412-4081.2017.03.001.
[20] Tang X, Liao Z. A clinical study of correlation between ablation depth and corneal subepithelial haze after photorefractive keratectomy[J]. Zhonghua Yan Ke Za Zhi, 1997, 33(3): 204-206.
[21] Santhiago MR, Netto MV, Wilson SE. Mitomycin C: biological effects and use in refractive surgery[J]. Cornea, 2012, 31(3): 311-321. doi:10.1097/ico.0b013e31821e429d.
[22] 中华医学会角膜病学组.激光角膜屈光手术临床诊疗专家共识(2015年)[J].中华眼科杂志,2015(4):249-254. doi:10.3760/cma.j.issn.0412-4081.2015.04.003.
[23] 中国微循环委员会眼微循环屈光专业委员会.中国激光角膜屈光手术围手术期用药专家共识(2019年)[J]. 中华眼科杂志,2019(12):896-903. doi:10.3760/cma.j.issn.0412-4081.2019.12.006.
[24] 阳珊, 李莹, 姜洋.飞秒激光小切口角膜基质透镜取出术后角膜链球菌感染一例[J].中华眼科杂志,2018(6):464-465. doi:10.3760/cma.j.issn.0412-4081.2018.06.013.
[25] Chang YM, Liang CM, Weng TH, et al. Mitomycin C for the prevention of corneal haze in photorefractive keratectomy: a meta-analysis and trial sequential analysis[J]. Acta Ophthalmol, 2021, 99(6): 652-662. doi:10.1111/aos.14704.
[26] Donnenfeld ED, O'Brien TP, Solomon R, et al. Infectious keratitis after photorefractive keratectomy[J]. Ophthalmology, 2003, 110(4): 743-747. doi:10.1016/s0161-6420(02)01936-x.
[27] Sridhar MS, Garg P, Bansal AK, et al. Fungal keratitis after laser in situ keratomileusis[J]. J Cataract Refract Surg, 2000, 26(4): 613-615. doi:10.1016/s0886-3350(99)00459-9.
[28] Donnenfeld ED, Kim T, Holland EJ, et al. Management of infectious keratitis following laser in situ keratomileusis[J]. J Cataract Refract Surg,2005,31(10):2008-2011. doi: 10.1016/j.jcrs.2005.10.030.
[29] Karp CL, Tuli SS, Yoo SH, et al. Infectious keratitis after LASIK[J]. Ophthalmology, 2003, 110(3): 503-510. doi:10.1016/S0161-6420(02)01760-8.
[30] Solomon R, Donnenfeld ED, Holland EJ, et al. Microbial keratitis trends following refractive surgery: results of the ASCRS infectious keratitis survey and comparisons with prior ASCRS surveys of infectious keratitis following keratorefractive procedures[J]. J Cataract Refract Surg, 2011, 37(7): 1343-1350. doi:10.1016/j.jcrs.2011.05.006.
[31] 王忠海, 姜洋, 张庆生, 等. 经上皮准分子激光角膜切削术与准分子激光上皮下角膜磨镶术治疗近视眼的临床效果比较[J]. 中华眼科杂志, 2019, 55(2): 122-126. doi:10.3760/cma.j.issn.0412-4081.2019.02.010. WANG Zhonghai, JIANG Yang, ZHANG Qingsheng, et al. Clinical outcomes after laser epithelial keratomileusis(LASEK)and transepithelial photorefractive keratectomy(TPRK)in myopia[J]. Chin J Ophthalmol, 2019, 55(2): 122-126. doi:10.3760/cma.j.issn.0412-4081.2019.02.010.
[32] Randleman JB, Woodward M, Lynn MJ, et al. Risk assessment for ectasia after corneal refractive surgery[J]. Ophthalmology, 2008, 115(1): 37-50. doi:10.1016/j.ophtha.2007.03.073.
[33] Randleman JB, Trattler WB, Stulting RD. Validation of the Ectasia Risk Score System for preoperative laser in situ keratomileusis screening[J]. Am J Ophthalmol, 2008, 145(5): 813-818. doi:10.1016/j.ajo.2007.12.033.
[34] Nath S, Shen C, Koziarz A, et al. Transepithelial versus epithelium-off corneal collagen cross-linking for corneal ectasia: a systematic review and meta-analysis[J]. Ophthalmology, 2021, 128(8): 1150-1160. doi:10.1016/j.ophtha.2020.12.023.
[35] 中华医学会眼科学分会角膜病学组.中国圆锥角膜诊断和治疗专家共识(2019年)[J].中华眼科杂志,2019(12):891-895. doi:10.3760/cma.j.issn.0412-4081.2019.12.004.
[36] 侯思梦, 周跃华, 张晶, 等. 飞秒激光联合紫外光核黄素角膜交联术治疗圆锥角膜的一年效果[J]. 眼科, 2019,28(6): 413-420. doi:10.13281/j.cnki.issn.1004-4469.2019.06.004. HOU Simeng, ZHOU Yuehua, ZHANG Jing, et al. One year therapeutic effect of riboflavin-ultraviolet corneal collagen crosslinking using femtosecond laser for keratoconus[J]. Ophthalmol China, 2019,28(6): 413-420. doi:10.13281/j.cnki.issn.1004-4469.2019.06.004.
[37] 中华医学会眼科学分会角膜病学组.我国角膜移植术专家共识(2015年)[J].中华眼科杂志,2015(12):888-891. doi:10.3760/cma.j.issn.0412-4081.2015.12.003.
[38] Jiang Y, Li Y, Yang S, et al. Tuck-in Lamellar keratoplasty with an lenticule obtained by small incision lenticule extraction for treatment of Post- LASIK Ectasia[J]. Sci Rep, 2017, 7(1): 17806. doi:10.1038/s41598-017-18201-4.
[39] Jiang Y, Li Y, Liu XW, et al. A novel tectonic keratoplasty with femtosecond laser intrastromal lenticule for corneal ulcer and perforation[J]. Chin Med J(Engl), 2016, 129(15): 1817-1821. doi:10.4103/0366-6999.186639.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed