山东大学耳鼻喉眼学报 ›› 2021, Vol. 35 ›› Issue (6): 20-24.doi: 10.6040/j.issn.1673-3770.0.2021.008

• • 上一篇    下一篇

SMILE术中主动脱吸的合理运用和被动脱吸的原因分析及处理

陈涛1,李耀宇1,杨马君1,闫洪欣1,刘光溢1,翟长斌2   

  1. 1. 北京丰联嘉悦丽格眼科, 北京 100020;
    2. 首都医科大学附属北京同仁医院 北京同仁眼科中心/北京市眼科学与视觉科学重点实验室, 北京 100730
  • 发布日期:2021-12-10
  • 通讯作者: 翟长斌. E-mail:13601089269@163.com

Active suction loss to treat complications of small-incision lenticule extraction

CHEN Tao1, LI Yaoyu1, YANG Majun1, YAN Hongxin1, LIU Guangyi1, ZHAI Changbin2   

  1. 1. Beijing Feng Lian Jia Yue Li Ge Eye Clinic, Beijing100020, China;
    2. Beijing Tongren Eye center, Beijing Tongren Hospital Capital Mediceal University / Beijing Ophthalmology & Visual Sciences Key Lab, Beijing 100730, China
  • Published:2021-12-10

PDF (PC)

408

摘要： 目的 为了指导全飞秒手术激光扫描过程中负压脱吸及潜在负压脱吸并发症的处理,保证手术顺利进行。 方法 回顾分析SMILE手术患者飞秒激光扫描时负压脱吸及潜在脱吸的原因及处理方法。研究中被动脱吸22只眼,5只眼为扫描透镜底层扫描进程<10%时脱吸,重新扫描;其中2只眼在激光微透镜底部切割进程>10%脱吸,终止SMILE,改为飞秒激光辅助制瓣准分子激光角膜原位磨镶术;2只眼在透镜环切时负压脱吸、9只眼为帽扫描时脱吸、4只眼为扫描切口时脱吸,启动repair程序调整参数重新扫描角膜帽。主动脱吸7只眼:其中2只眼出现扫描黑区行主动脱吸;4只眼因配合差行主动脱吸;二次SMILE补矫术中1只眼行主动脱吸。 结果 扫描过程中出现黑斑时主动脱吸,择日手术术后恢复良好;潜在脱吸患者,术中主动脱吸,患者情绪放松后再次扫描术后恢复良好。 结论 术前注视训练、宣教、稳定患者紧张情绪可有效减少被动负压脱吸。启动负压吸引前吸除眼表多余水分,清洁眼表可有效预防被动负压脱吸。全飞秒手术中预防被动脱吸,有效利用主动脱吸,处理好全飞秒激光扫描过程中的并发症,保证术后效果良好。

关键词: 飞秒激光小切口角膜基质透镜取出术, 主动脱吸, 被动脱吸, 飞秒激光辅助制瓣准分子激光角膜原位磨镶术

Abstract: Objective To guide the treatment of complications, such as suction loss or potential suction loss, during small-incision lenticule extraction(SMILE). Methods Causes and treatment methods of suction loss or potential suction loss during SMILE were retrospectively analyzed at our hospital from January 2018 to April 2019. Twenty-two eyes experienced passive suction loss; five eyes experienced suction loss when the Laser microlens bottom scanning exceeded <10%, necessitating re-scanning; two eyes experienced suction loss when the Laser microlens bottom scanning exceeded >10%, necessitating the termination of SMILE and treatment with femtosecond laser-assisted laser in situkeratomileusis; two eyes experienced suction loss during lens circumcision; nine eyes experienced suction loss during cap scanning; and four eyes experienced suction loss during scanning incision, when the repair program was started to adjust parameters to scan corneal cap again. Active suction loss occurred in seven eyes, including two eyes with a scanning black area, four eyes with poor coordination, and one eye with active suction in the secondary SMILE remediation surgery. Results Patients with active suction loss recovered well owing to treatments of the black spot during scanning; patients with potential suction loss were treated with active suction loss and re-scanned after their mood relaxed, and their recovery was good. Conclusion Preoperative fixation training, education, and stabilization of patients' tension could effectively reduce passive suction loss. Before negative pressure suction, excess water on the ocular surface should be removed, and cleaning the eye surface can effectively prevent passive suction loss. Passive suction loss can be prevented in femtosecond surgery, and active suction loss can be effectively used to deal with complications of the whole femtosecond laser scanning process to ensure good postoperative effects.

Key words: Femtosecond laser small incision lenticule extraction, Active suction loss, Passive suction loss, Femtosecond laser-assisted laser in situkeratomileusis

中图分类号: 

  • R778
[1] Ganesh S, Brar S, Arra RR. Refractive lenticule extraction small incision lenticule extraction: a new refractive surgery paradigm[J]. Indian J Ophthalmol, 2018, 66(1): 10-19. doi:10.4103/ijo.ijo_761_17.
[2] 王雁. “全飞秒激光技术”的最新发展及其在SMILE手术中的应用[J]. 中华眼视光学与视觉科学杂志, 2014, 16(7): 388-393. doi:10.3760/cma.j.issn.1674-845X.2014.07.002. WANG Yan. Latest developments of the all-in-one femtosecond laser and its applications in SMILE surgery[J]. Chin J Optom Ophthalmol Vis Sci, 2014, 16(7): 388-393. doi:10.3760/cma.j.issn.1674-845X.2014.07.002.
[3] Moshirfar M, Shah TJ, Masud M, et al. Surgical options for retreatment after small-incision lenticule extraction: Advantages and disadvantages[J]. J Cataract Refract Surg, 2018, 44(11): 1384-1389. doi:10.1016/j.jcrs.2018.07.047.
[4] Pedersen IB, Ivarsen A, Hjortdal J. Three-year results of small incision lenticule extraction for high myopia: refractive outcomes and aberrations[J]. J Refract Surg, 2015, 31(11): 719-724. doi:10.3928/1081597x-20150923-11.
[5] Ishii R, Shimizu K, Igarashi A, et al. Influence of femtosecond lenticule extraction and small incision lenticule extraction on corneal nerve density and ocular surface: a 1-year prospective, confocal, microscopic study[J]. J Refract Surg, 2015, 31(1): 10-15. doi:10.3928/1081597x-20141218-01.
[6] Miao H, Tian M, Xu Y, et al. Visual outcomes and optical quality after femtosecond laser small incision lenticule extraction: an 18-month prospective study[J]. J Refract Surg, 2015, 31(11): 726-731. doi:10.3928/1081597x-20151021-01.
[7] 王雁, 武志清, 汤欣, 等. 飞秒激光2.0 mm微切口角膜基质透镜取出术屈光矫正效果的临床初步研究[J]. 中华眼科杂志, 2014(9): 671-680. doi: 10.3760/cma.j.issn.0412-4081.2014.09.008. WANG Yan, WU Zhiqing, TANG Xin, et al. Two millimeter micro incision lenticule extraction surgery with minimal invasion: a preliminary clinical report[J]. Chinese Journal of Ophthalmology, 2014(9): 671-680. doi: 10.3760/cma.j.issn.0412-4081.2014.09.008.
[8] 王雁, 鲍锡柳, 汤欣, 等. 飞秒激光角膜微小切口基质透镜取出术矫正近视及近视散光的早期临床研究[J]. 中华眼科杂志, 2013, 49(4): 292-298. doi:10.3760/cma.j.issn.0412-4081.2013.04.002. WANG Yan, BAO Xiliu, TANG Xin, et al. Clinical study of femtosecond laser corneal small incision lenticule extraction for correction of myopia and myopic astigmatism[J]. Chin J Ophthalmol, 2013, 49(4): 292-298. doi:10.3760/cma.j.issn.0412-4081.2013.04.002.
[9] 中华医学会眼科学分会眼视光学组. 我国飞秒激光小切口角膜基质透镜取出手术规范专家共识(2016年)[J]. 中华眼科杂志, 2016, 52(1): 15-21. doi:10.3760/cma.j.issn.0412-4081.2016.01.007.
[10] Jooyeon Son, 周行涛. SMILE和飞秒LASIK术后角膜神经修复的研究进展[J]. 交通医学, 2016, 30(2): 125-128.
[11] 王力翔. SMILE、Fs-LASIK及T-PRK后患者主观视觉质量与共聚焦显微镜、波前像差仪结果的相关性研究[D]. 北京: 北京协和医学院, 2018.
[12] 葛庆曼, 崔传波, 孔德言, 等. 激光扫描共焦显微镜对飞秒激光小切口基质透镜取出术后角膜帽神经修复的动态观察[J]. 中华实验眼科杂志, 2017, 35(2): 151-155. doi: 10.3760/cma.j.issn.2095-0160.2017.02.012. GE Qingman, CUI Chuanbo, KONG Deyan, et al. Dynamic observation of corneal reinnervation after small incision lenticule extraction at cap by confocal microscope[J]. Chinese Journal of Experimental Ophthalmology, 2017, 35(2): 151-155. doi: 10.3760/cma.j.issn.2095-0160.2017.02.012.
[13] 武志清. SMILE术后全眼高阶像差、角膜生物力学特征性变化的临床研究[D]. 天津: 天津医科大学, 2015: 1-59.
[14] Lin FY, Xu YS, Yang YB. Comparison of the visual results after SMILE and femtosecond laser-assisted LASIK for myopia[J]. J Refract Surg Thorofare N J, 2014, 30(4): 248-254. doi:10.3928/1081597X-20140320-03.
[15] Xu YS, Yang YB. Dry eye after small incision lenticule extraction and LASIK for myopia[J]. J Refract Surg, 2014, 30(3): 186-190. doi:10.3928/1081597x-20140219-02.
[16] 张丰菊, 宋彦铮. 角膜屈光手术SMILE的临床安全性、有效性及稳定性评估[J]. 大连医科大学学报, 2015,37(6): 521-525. doi: 10.11724/jdmu.2015.06.01. ZHANG Fengju, SONG Yanzheng. Evaluation of the clinical safety, efficacy, and stability of small incision lenticule extraction[J]. J Dalian Med Univ, 2015,37(6): 521-525. doi: 10.11724/jdmu.2015.06.01.
[17] Sekundo W, Kunert KS, Blum M. Small incision corneal refractive surgery using the small incision lenticule extraction(SMILE)procedure for the correction of myopia and myopic astigmatism: results of a 6 month prospective study[J]. Br J Ophthalmol, 2011, 95(3): 335-339. doi:10.1136/bjo.2009.174284.
[18] 翟长斌. 3D动画模拟技术在SMILE手术培训中的应用[J]. 眼科, 2018,27(4): 310-311. doi:10.13281/j.cnki.issn.1004-4469.2018.04.015. ZHAI Changbin. Application of three-dimensional animation teaching model in SMILE procedure training[J]. Ophthalmol China, 2018,27(4): 310-311. doi:10.13281/j.cnki.issn.1004-4469.2018.04.015.
[19] 马娇楠, 王雁, 张琳, 等. 小切口角膜基质透镜取出术中负压脱失的临床研究[J]. 中华眼科杂志, 2018, 54(12): 890-896. 10.3760/cma.j.issn.0412-4081.2018.12.005. MA Jiaonan, WANG Yan, ZHANG Lin, et al. Clinical study of suction loss in small incision lenticule extraction[J]. Chinese Journal of Ophthalmology, 2018, 54(12): 890-896. 10.3760/cma.j.issn.0412-4081.2018.12.005.
[20] 张丰菊, 李玉. 角膜屈光手术术前的筛查要点[J]. 山东大学耳鼻喉眼学报, 2020, 34(2): 7-12. doi: 10.6040/j.issn.1673-3770.1.2020.014. ZHANG Fengju, LI Yu. Key criteria for screening before corneal refractive surgery[J]. J Otolaryngol Ophthalmol Shandong Univ, 2020,34(2): 7-12. doi: 10.6040/j.issn.1673-3770.1.2020.014.
[21] 李莹, 姜洋. 惟论近视矫正眼外与眼内手术方式的选择[J]. 山东大学耳鼻喉眼学报, 2020,34(2): 1-6. doi: 10.6040/j.issn.1673-3770.1.2020.001. LI Ying, JIANG Yang. A discussion on the choice of surgical methods for correction of myopia[J]. J Otolaryngol Ophthalmol Shandong Univ, 2020,34(2): 1-6. doi: 10.6040/j.issn.1673-3770.1.2020.001.
[22] 李彩红, 赵宏, 帖彪, 等. 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[J]. 国际眼科杂志, 2018,18(4): 713-715. doi: 10.3980/j.issn.1672-5123.2018.4.30. LI Caihong, ZHAO Hong, TIE Biao, et al. Analysis on incidence and management of complications after femtosecond laser-assisted small incision lenticule extraction[J]. Int Eye Sci, 2018,18(4): 713-715. doi: 10.3980/j.issn.1672-5123.2018.4.30.
[23] WU Wenjing, WANG Yan, ZHANG Hui, et al. One-year visual outcome of small incision lenticule extraction(SMILE)surgery in high myopic eyes: retrospective cohort study. BMJ Open, 2016, 6(9): p. e010993. doi: 10.1136/bmjopen-2015-010993.
[24] 苏才培, 杨亚波. 飞秒激光小切口角膜基质透镜取出术操作要点及并发症的预防和处理[J]. 山东大学耳鼻喉眼学报, 2020, 34(2): 13-16. doi:10.6040/j.issn.1673-3770.1.2020.007. SU Caipei, YANG Yabo. Surgical skills required for small incision lenticule extraction(SMILE), and the prevention and management of SMILE-related complications[J]. J Otolaryngol Ophthalmol Shandong Univ,2020, 34(2): 13-16. doi:10.6040/j.issn.1673-3770.1.2020.007.
[1] 彭娇,钟定娟,陈蛟,左筠,王华. 光学区直径与暗瞳直径的关系对不同程度近视患者SMILE术后视觉质量的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(2): 100-107.
[2] 苏才培,杨亚波. 飞秒激光小切口角膜基质透镜取出术操作要点及并发症的预防和处理[J]. 山东大学耳鼻喉眼学报, 2020, 34(2): 13-16.
[3] 赵旸,傅艳燕,吴小影,尹叶薇,向爱群,卢颖,杜凯旋,李元君,胡涂,李杏莉,文丹. 中低度近视SMILE术后超早期视觉质量变化的研究[J]. 山东大学耳鼻喉眼学报, 2020, 34(2): 42-46.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 邓基波,孙奉乾,许安廷 . 大前庭导水管综合征[J]. 山东大学耳鼻喉眼学报, 2006, 20(2): 116 -118 .
[2] 周子宁,金国威 . 喉气管狭窄的预防和治疗进展[J]. 山东大学耳鼻喉眼学报, 2006, 20(5): 462 -465 .
[3] 周斌,李滨 . 鼻内窥镜下鼻窦鼻息肉手术75例疗效观察[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 24 -26 .
[4] 徐赛男,杨雷 . 红霉素促进鼻息肉上皮细胞凋亡的实验研究[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 27 -29 .
[5] 张玉光,韩旭光,张华,王旭,徐湘辉 . 改良穿透性角膜移植术治疗真菌性角膜炎[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 94 -95 .
[6] 刘联合 . 颈深部脓肿37例[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 180 -181 .
[7] 谢治年 ,姬长友 . RNA干扰及其在喉鳞癌研究中的应用[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 200 -203 .
[8] 乔 艺,倪关森,陈文文 . 改良悬雍垂腭咽成形术联合鼻腔手术治疗阻塞性睡眠呼吸暂停综合征38例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 206 -208 .
[9] 汪晓锋,林 昶,程金妹 . 不同龄小鼠内耳中ABAD的表达及临床意义[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 207 -211 .
[10] 凡启军,黄治物,梅 玲,肖伯奎 . 荧光定量PCR测定水杨酸钠作用后大鼠耳蜗基因的表达[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 212 -214 .
网站版权所有 © 2018 《山东大学耳鼻喉眼学报》编辑部　
地址：山东省济南市山大南路27号（250100）电话：+86-0531-88366912 E-mail: ebhxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发