飞秒激光角膜屈光手术的临床研究进展

目前飞秒激光已广泛应用于激光角膜屈光手术中.激光角膜屈光手术根据飞秒激光的应用可分为两大类:飞秒激光辅助的准分子激光角膜原位磨镶术(FS-LASIK)以及全飞秒激光角膜屈光术,即屈光性透镜取出术(ReLEx).ReLEx又可分为飞秒激光透镜取出术(ReLEx-flex,FLEx)和飞秒激光小切口透镜取出术(ReLEx-smile,SMILE).本文回顾了FS-LASIK手术中瓣的侧切角、厚度、直径、形状等参数的设置,SMILE术中切口大小、位置,以及飞秒激光能量、点间距等参数的最新设置;并对三种手术的预测性、安全性、有效性,对角膜知觉的影响及其优点和不足进行综述.     

飞秒激光透镜切除术的研究进展

近年飞秒激光在屈光手术中主要用于制作角膜瓣.飞秒激光透镜切除术不同于准分子激光联合飞秒的模式,是一种全飞秒术式,革新了角膜屈光手术.该术式具有较好地安全性、可操作性和可预测性.飞秒激光透镜切除术具有较好地应用前景,但需进一步临床探讨.     

飞秒激光术中角膜基质不透明气泡层的研究进展

飞秒激光辅助的准分子激光原位角膜磨镶术(FS-LASIK)和飞秒激光小切口角膜基质透镜取出术(SMILE)是目前主流的角膜屈光手术方式。虽然临床研究显示其具有很高的安全性、有效性和可预测性,但制作角膜瓣或透镜时需要依赖飞秒激光,不可避免地会发生飞秒激光相关并发症,如负压失吸、不透明气泡层(OBL)等。OBL是飞秒激光在角膜组织中发生光爆破作用时产生的二氧化碳和水蒸气聚集体在角膜基质中无法及时排出而形成,是飞秒激光手术特有的并发症。气泡可能会干扰术中操作和影响术后视觉质量。本文就OBL形成的机制、分级和分类、影响因素及其对术中操作和术后效果的影响进行综述,以期为进一步临床工作提供参考和依据。     

飞秒激光在白内障手术中的应用

白内障是我国首位致盲眼病,其手术方式从最早的针拨术到目前成熟的超声乳化术经历了几千年的发展。新近发展的飞秒激光在眼科领域逐渐被认知。飞秒激光在白内障手术晶状体前囊膜切开、核裂解、制作透明角膜切口及角膜松解切口等方面具有独特优势,能有效减少术中并发症,提高患者术后视觉质量,现就飞秒激光在白内障手术中的应用作一综述。     

飞秒激光辅助角膜移植术的护理

总结32例飞秒激光辅助角膜移植术患者的护理,认为做好心理护理、术前完善眼部检查和做好充分的准备,术后严密观察敷料、眼压和角膜植片的情况,做好特殊体位和角膜接触镜的护理,并做好出院指导是提高手术的成功率及预防并发症的关键.     

飞秒激光屈光手术研究进展

飞秒激光以脉冲宽度短、瞬间功率高、重复频率高、单脉冲能量低、热效应小等特点应用于眼科屈光手术领域,成为屈光手术的未来新航向。其基本原理为光致破裂作用,在角膜组织中介导等离子切除,精细而稳定。本文就飞秒激光LASIK手术的参数选择、瓣质量评估、术后角膜创伤愈合与炎症反应以及最新术式FLEx/SMILE的新进展等进行综述。     

飞秒激光在眼科手术中的应用

飞秒激光具有切面平整、精准度高、损伤小及应用范围广等优点,其应用已成为近年眼屈光手术研究的热点.飞秒激光可以替代机械角膜刀,用于准分子激光角膜磨镶术制作角膜瓣,实施全程飞秒激光角膜屈光手术;还可用于老视、青光眼、白内障、角膜病等诸多方面的手术治疗.本文就飞秒激光的切削原理、临床应用以及研究进展作一综述.     

飞秒激光在眼表领域的临床应用

飞秒激光是指激光脉冲作用时间以飞秒为单位的激光,是目前在实验条件下所能获得的最短脉冲的激光,具有最大的切削精确度和最小的周围组织损伤,近年在眼科有广泛应用.在眼表领域,可利用飞秒激光制作角膜瓣完成LASIK手术、制作超薄角膜瓣行前弹力层下角膜磨镶术,还可行飞秒激光辅助的角膜活检、角膜层间墨染、散光性角膜切开术以及制作角膜隧道行角膜基质环植入术.近年来有人利用飞秒激光行角膜基质内切除术治疗屈光不正,完全取代了准分子激光.本文就飞秒激光的作用机制及在眼表领域的临床应用进行综述.     

飞秒激光辅助个体化准分子激光原位角膜磨镶术疗效观察

目的 观察飞秒激光制作角膜瓣的波前像差引导的LASIK手术早期治疗效果,并与常规波前像差引导的LASIK手术比较.方法 在波前像差引导的个体化角膜切削前,分别使用飞秒激光机和Moria M2微型角膜板层刀为各30例(飞秒组和机械组各60只眼)近视患者制作同厚度角膜瓣,手术前后观察裸眼视力、眼波前像差、对比敏感度,并比较两组患者临床效果.结果 术后3个月两组裸眼视力均提高,有效性和安全性指数:飞秒组:1.19;1.20.机械组:1.16;1.15.术后两组等效球镜度数变化相似.两组术后3个月,飞秒组球差增加小于机械组.飞秒组最高空间频率(18c/deg)对比敏感度比术前提高.机械组相同频率对比敏感度术后1月下降,术后3个月恢复至术前水平,结论 与使用Moria M2微型角膜板层刀制作角膜瓣的波前像差引导的个体化LASIK手术比较,使用飞秒激光制作角膜瓣的波前像差引导的个体化LASIK手术后早期,裸眼视力相似,球差增加较少,屈光状态更稳定,高空间频率的对比敏感度增加更多,显示出更好地治疗效果.     

飞秒激光制瓣LASIK术后角膜层间上皮植入

目的探讨飞秒激光制瓣准分子激光原位角膜磨镶术（LASIK）后角膜上皮植入的发生率及防治。方法回顾性系列病例研究。选择天津爱尔眼科医院2013年10月至2014年7月接受飞秒激光制瓣LASIK手术患者1 122例（2 236眼）。术前最佳矫正视力（BCVA）均＞1.0。应用60 kHz的Intralase飞秒激光制作角膜瓣,常规基质切削后完成手术,数码摄像机记录手术全程,术后随诊3个月。结果术后1个月15例（28眼,1.25%）发生角膜层间上皮植入。其中18眼（0.81%）为Ⅰ级上皮植入;8眼（0.36%）为Ⅱ级上皮植入,未出现局部角膜瓣融解及不规则散光;2眼（0.09%）于术后1 d发生Ⅱ级弥漫性层间角膜炎,应用1%醋酸泼尼松龙滴眼液点眼4次/d,1周后消失,但在术后1个月时发生Ⅲ级角膜层间上皮植入伴角膜瓣边缘融解。结论飞秒激光术后上皮植入发生率低,术前严格筛查、规范手术操作,术后密切观察及时处理,是防治角膜层间上皮植入的有效手段。     

飞秒激光辅助超声乳化白内障吸除术角膜切口的形态学改变

目的：观察飞秒激光辅助超声乳化白内障吸除术(2.4mm微切口)及传统超声乳化白内障吸除术(2.4mm微切口)角膜切口的形态学的改变,评估两者切口的稳定性。

方法：本研究为前瞻性对照研究。患者89例99眼接受白内障手术,根据术式分为两组：飞秒激光组：飞秒激光超声乳化手术组44例49眼; 角膜刀组：2.4mm白内障超声乳化手术组45例50眼。术后应用OCTA评估角膜切口形态改变。

结果：术后1d飞秒激光组未发现外切口哆开,角膜刀组发生率为10%(P<0.05); 术后1wk,1、3mo两组均未见外切口哆开。术后1wk,1mo飞秒激光组内切口哆开的发生率分别为47%、10%,均低于角膜刀组(术后1wk为68%,1mo为26%)(P<0.05),术后1d,3mo两组无差异。两组各时间点局部后弹力层脱离的发生率均无差异。

结论：飞秒激光辅助超声乳化白内障吸除术角膜切口早期愈合更好,有效减少早期角膜切口异常构筑的发生。     

Impact of the Femtosecond Laser in Line with the Femtosecond Laser-Assisted Cataract Surgery (FLACS) on the Anterior Chamber Characteristics in Comparison to the Manual Phacoemulsification

Purpose: To assess the alterations of the anterior chamber conditions including laser flare photometry after femtosecond laser-assisted cataract surgery (FLACS) compared to the manual phacoemulsification. Methods: Data of n=70 FLACS (mean age 67.2 ± 8.9 years) and n=40 manual phacoemulsification (mean age 69.5 ± 9.6 years) were analyzed. The procedures were performed by LenSx Alcon, USA, and Alcon Infiniti Vision System, USA. The following parameters were recorded: laser flare photometry (Kowa FM 700, Japan), anterior chamber (AC) depth, AC volume, AC angle (Pentacam, Oculus Inc., Germany), lens density, pupil diameter, endothelial cell count and pachymetry. The analysis was performed preoperatively, immediately after femtosecond laser procedure and one day postoperatively. Results: Between FLACS and the phaco control group, there was a significant difference in the AC depth (p=0.023, 3.77 mm vs. 4.05 mm) one day postoperatively. The AC angle (p=0.016) showed a significant difference immediately after the femto laser treatment. The central and thinnest pachymetry and endothelial cell count did not show a significant difference between the two study cohorts (p=0.165, p=0.291, p=0.979). The phaco cohort (n=40) demonstrated a non-statistically significant difference in the flare photometry of 15.80 photons/ms one postoperative day compared to the FLACS group 26.62 photons/ms (p=0.322). Conclusion: In this study population, no evidence for an additive damage caused by the use of the femtosecond laser was demonstrated. Furthermore, no increase in the central and thinnest corneal thickness and no increased endothelial cell loss was demonstrated by the laser energy.     

飞秒激光辅助的白内障手术研究新进展

近年来,随着白内障超声乳化手术的广泛开展及飞秒激光技术在白内障手术领域的逐渐应用,飞秒激光辅助的白内障手术(femtosecond laser-assisted cataract surgery,FLACS)也逐渐普及,受到了越来越多医生的认可和推广。飞秒激光技术具有极高的精确性、自动化程度和可重复性,因此飞秒激光技术十分适合应用于以精密操作为特点的白内障手术,它可以用于白内障手术过程中进行角膜切口和角膜缘松解切口的制作、前囊膜切开,晶状体碎裂等关键操作。FLACS具有广阔的应用前景,能大大提高手术的可预测性和安全性。FLACS的出现是现代白内障手术最重要的发展之一,随着FLACS的不断发展,白内障手术将迎来新的技术革新。然而,FLACS出现的时间相对较短,仍需要更长期、更全面的数据在未来更好地证明其有效性。我们就目前FLACS的研究进展进行综述。     

飞秒激光联合对称弧形角膜切口对白内障合并角膜散光患者的治疗效果

目的 评估飞秒激光联合对称弧形角膜切口对白内障合并角膜散光患者的治疗效果。方法 前瞻性研究。收集43例(57眼)白内障合并≥0.75 D角膜规则散光的患者,均行飞秒激光超声乳化白内障手术,术中同时采用对称弧形角膜切口矫正角膜散光。弧形切口设置在角膜直径中央8.0 mm处,深度为角膜厚度的85%,术中开口器分离弧形切口。术前及术后均采用Pentacam三维眼前节分析系统记录角膜散光。采用Alpins矢量法分析术后角膜散光变化,并分析散光类型、年龄与散光矫正效果的相关性。结果 术中及术后所有患者均未出现角膜穿透、上皮损伤、角膜上皮增生、切口感染等并发症。术前患眼角膜散光为(1.23±0.31)D,术后3个月患眼角膜散光下降到(0.85±0.34)D,差异有统计学意义(t=4.645,P=0.000)。对患者手术前后角膜散光的变化进行矢量分析,结果显示,目标诱导散光为0.80～2.10(1.23±0.31)D,手术诱导散光为0.00～1.80(0.68±0.45)D,差异向量为0.26～1.70(0.89±0.42)D,矫正指数为0.00～1.01(0.55±0.27),理想值为1,提示总体...     

近视合并高度散光行FS-LASIK术后早期前后表面曲率及散光和前房深度的变化

目的:对FS-LASIK术矫正近视合并高度散光早期前房深度、前后表面曲率及散光的变化进行观察并与较低散光组对比。方法:选取2016-01/2019-05在我院行飞秒制瓣LASIK手术治疗复合性近视散光且3mo内有完整随访记录的患者进行回顾性分析,根据手术设计的散光大小分为两组:A组71例106眼,散光-2.00-5.00D,等效球镜-6.15±1.74D;B组63例106眼,散光-0.25^-1.00D,等效球镜-6.67±1.04D;常规围手术期检查。所有病例按照飞秒制瓣LASIK术式常规操作流程完成手术。比较两组术后前房深度、前后表面曲率及散光。结果:术前和术后1wk,1、3mo两组后表面曲率、散光及前房深度变化无差异(P>0.05)。术后1wk,1、3mo两组前表面曲率无差异(P>0.05)。A组前表面散光术后1wk与1、3mo均有差异(P<0.05),1mo与3mo无差异(P>0.05)。B组前表面散光术后1wk^3mo无差异(P>0.05)。结论:近视合并高度散光行FS-LAISK术后后表面曲率、散光及前房深度无明显变化,前表面曲率在术后1wk^3mo较稳定,但前表面散光数值在术后1wk^3mo时略呈现增加趋势,在术后1~3mo较稳定。     

利用眼反应分析仪评估FS-LASIK和LASEK术后角膜生物力学稳定性

目的：利用眼反应分析仪(ORA)评估飞秒激光辅助的准分子激光原位角膜磨镶术(FS-LASIK)和准分子激光上皮下角膜磨镶术(LASEK)术后角膜生物力学稳定性的差异。

方法：选取2016-01/2017-12于我院眼科视光学中心就诊且行LASEK/FS-LASIK手术的近视患者117例200眼(等效球镜-2.00～-5.00D),其中行FS-LASIK术者64例100眼(FS-LASIK组); 行LASEK术者53例100眼(LASEK组)。分别于术前和术后1、3mo采用ORA检测两组患者的角膜滞后量(CH)和角膜阻力因子(CRF)值,并进行统计分析。

结果：手术前后,两组患者CH和CRF比较,差异均有统计学意义(P<0.05)。术后1、3mo,两组患者CH和CRF均低于术前,差异均有统计学意义(P<0.05)。术后1mo,FS-LASIK组患者CH和CRF均低于LASEK组,差异均有统计学意义(P<0.05)。

结论：LASEK和FS-LASIK两种术式均会对角膜生物力学稳定性产生一定影响,但LASEK手术比FS-LASIK手术产生的影响更小,更安全,可减少术后屈光回退的可能性。     

Alternative Applications of the Femtosecond Laser in Ophthalmology

Purpose: To provide an update of novel applications for the femtosecond (FS) laser in ophthalmology.

Design: Perspective, literature review, case report, and commentary.

Methods: Literature review.

Results: The many advantages of etching flaps with the FS laser for laser in situ keratomileusis (LASIK) have been well established. Alternative applications of the FS have been approved and are now used in clinical practice. In refractive ophthalmology, the FS laser can be used for lenticule extraction to correct myopia and intrastromal biochemical manipulation to correct presbyopia. This laser can be used for preparing host and donor tissue for both full thickness and lamellar keratoplasty. Research is underway, exploring ways to employ the FS laser for different stages of cataract surgery. Cosmetic procedures with FS-assisted tattooing serve to correct leukoria.

Conclusions: Advancements in technology have allowed measurable improvements in the surgical safety, efficiency, speed, and versatility of FS lasers in ophthalmology.     

飞秒激光辅助超乳联合Toric IOL植入术矫正高度近视白内障合并角膜规则散光

目的:通过飞秒激光技术,量化撕囊口直径,测量高度近视白内障合并角膜散光患者术后远、中、近视力,近立体视功能等指标,评估Toric IOL在高度近视的可行性及必要性。方法:前瞻性病例对照研究。选择我院双眼高度近视白内障合并角膜规则散光,并双眼均接受飞秒激光辅助白内障手术的患者,按人工晶状体不同分为两组：A组：Toric IOL组20例40眼,B组：IQ IOL组20例40眼。对比两组患者术前角膜散光、等效球镜及术后7d, 1、3mo最佳矫正远视力、裸眼中视力、近视力、实际残留散光、近立体视锐度、全眼高阶像差、全眼球差等指标。结果:高度近视白内障合并角膜散光患者植入Toric IOL,较IQ组,显著改善了术后7d, 1、3mo裸眼中、近视力,Titmus近立体视锐度及残留散光度(均P<0.05),减少了术后对眼镜的依赖程度;而术后7d, 1、3mo两组最佳矫正远视力、全眼高阶像差及全眼球差无差异(均P>0.05)。结论:高度近视白内障合并角膜散光患者植入Toric IOL,能有效矫正角膜规则散光,提高术后裸眼中、近视力及近立体视功能,减少高度近视患者术后对眼镜的依赖程度,提升双...     

Three-year results of small incision lenticule extraction and wavefront-guided femtosecond laser-assisted laser in situ keratomileusis for correction of high myopia and myopic astigmatism

AIM: To compare and calculate the 3-year refractive results, higher-order aberrations (HOAs), contrast sensitivity (CS) and dry eye parameters after small incision lenticule extraction (SMILE) and wavefront-guided femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for correction of high myopia and myopic astigmatism. METHODS: In this prospective, non-randomized comparative study, 78 eyes with spherical equivalent (SE) of -8.11±1.09 diopters (D) received a SMILE surgery, and 65 eyes with SE of -8.05±1.12 D received a wavefront-guided FS-LASIK surgery with the VisuMax femtosecond laser (Carl Zeiss Meditec, Jena, Germany) for flap cutting. Visual acuity, manifest refraction, CS, HOAs, ocular surface disease index (OSDI) and tear break-up time (TBUT) were evaluated during a 3-year follow-up. RESULTS: The difference of uncorrected distance visual acuity (UDVA) postoperatively was achieved at 1mo and at 3mo, whereas the difference of the mean UDVA between two groups at 3y were not statistically significant (t=-1.59, P=0.13). The postoperative change of SE was 0.89 D in the FS-LASIK group (t=5.76, P=0.00), and 0.14 D in the SMILE group (t=0.54, P=0.59) from 1mo to 3y after surgery. At 3-year postoperatively, both HOAs and spherical aberrations in the SMILE group were obviously less than those in the FS-LASIK group (P=0.00), but the coma root mean square (RMS) was higher in the SMILE group (0.59±0.26) than in the FS-LASIK group (0.29±0.14, P=0.00). The mesopic CS values between two groups were not statistically significant at 3y postoperatively. Compared with the FS-LASIK group, lower OSDI scores and longer TBUT values were found in the SMILE group at 1mo and 3mo postoperatively. With regard to safety, no eye lost any line of CDVA in both groups at 3y after surgery. CONCLUSION: Both SMILE and wavefront-guided FS-LASIK procedures provide good visual outcomes. Both procedures are effective and safe, but SMILE surgery achieve more stable long-term refractive outcome and better control of early postoperative dry eye as compared to FS-LASIK.     

Analysis of the etiologies, treatments and prognoses in children and adolescent vitreous hemorrhage

AIM:To determine the etiologies,treatment modalities and visual outcomes of vitreous hemorrhage(VH;range from birth to 18 y).METHODS:A total of 262 eyes from 210 patients between January 2010 and September 2016 were included.All children underwent an appropriate ocular and systemic examination.Data collected included demographics,clinical manifestations,details of the ocular and systemic examination,management details,final fundus anatomy and visual acuity(VA).RESULTS:The most common etiologies were nontraumatic VH(64.89%),most of which were due to retinopathy of prematurity(ROP;37.10%);while traffic accidents,including 16(21.00%)eyes,was the most common ocular traumas.Surgery,performed in 143(54.58%)eyes,was the most common management modality.The initial mean baseline visual acuity was 2.77±0.21 logarithm of the minimal angle of resolution(log MAR)in children and adolescent with traumatic VH,which was significantly improved to 2.15±1.31 log MAR(P<0.05).CONCLUSION:VH in children and adolescent has a complicated and diverse etiology.ROP is the primary cause of non-traumatic VH,which is the most common etiology.Appropriate treatment of traumatic VH is associated with obvious improvement in visual acuity.The initial VA is one of most important predictors of outcome.