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

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。

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

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.