LASIK术中角膜瓣下异物的发生和预防

目的:探讨准分子激光原位角膜磨镶术(LASIK)中角膜下异物的发生情况和预防方法。方法:回顾性分析3a中3553例(7065眼)LASIK手术过程,均为规范化操作实施LASIK术。术毕以裂隙灯显微镜检查,如发现角膜瓣下异物,即刻以掀瓣冲洗或手法去除等方法,力争手术当日处理完毕。术后按常规时间复诊观察角膜情况。术后次日以后尽可能不予掀瓣处理异物。统计术中角膜瓣下异物发生的情况,从术者操作技巧及仪器设备等多方面分析可能产生瓣下异物的原因及影响因素。结果:总计发现角膜瓣下异物眼数为674眼,发生率9.5%。连续3aLASIK术中异物的发生率分别为13.2%,10.6%和7.6%。四季之中,以冬季异物的发生率最低;春夏秋季发生率较高,可能与术间抽湿机过度使用有关。常见的角膜瓣下异物有组织碎屑、金属碎屑、细丝、脂质颗粒、血液、睫毛等。术毕当日及时对异物处理后,次日再发现异物的情况明显减少。经术后随访观察3mo~1a,未见部分残留异物出现对角膜透明性或视力的影响。结论:LASIK手术中角膜瓣下异物是常见并发症之一,只要处理及时得当,收效良好。从人员技术、环境设备等多方面加强预防,可明显降低术中异物的发生率。

Observation and prevention of foreign bodies under corneal flaps during LASIK

AIM:To analyze the occurrence and to evaluate the methods of prevention of foreign bodies under corneal flaps during LASIK.METHODS: The LASIK operations of 7 065 eyes of 3 553 cases in the recent 3 years were retrospectively analyzed from various aspects such as the operator, the assistant, the operating skills, the equipment, etc.RESULTS: There were one or more foreign bodies under corneal flaps during LASIK in 674 eyes(9.5%). There were six kinds of foreign bodies such as grains of tissue or metal, thin thread, fat granules, blood cells and eyelashes. The incidence of the first year, the second year and the third year was 13.2%, 10.6%, 7.6% respectively. To compare with other seasons, the winter has the lowest incidence owing to its lower humidity. Treated with timely correct measures, the expectant corrected visual acuity was not influenced. CONCLUSION: Foreign bodies under corneal flaps during LASIK are very common. Caution should be exercised from every aspect during the operation.