8 600眼SMILE术中术后并发症观察

目的：观察分析飞秒激光小切口角膜基质透镜取出术（SMILE）术中及术后并发症。方法：回顾性非随机病例研究。选取2015年3月至2019年10月在济南爱尔眼科医院行SMILE矫正且资料完整的患者4 386例（8 600眼），对术中、术后并发症的发生情况进行分析，并通过问卷调查的方式，进行视觉质量的研究。结果：术中244眼（2.84%）发生并发症，其中负压吸引环脱失12眼（0.14%），不透明气泡层（OBL）154眼（1.80%），微切口出血25眼（0.29%），寻找角膜基质透镜困难1眼（0.01%），非计划 分离透镜33眼（0.38%），透镜残留4眼（0.04%），切口撕裂13眼（0.15%），扫描黑区2眼（0.02%）。术 后并发症17眼（0.20%），其中早期弥漫性板层角膜炎8眼（0.09%），术后中期免疫性角膜炎9眼（0.10%）。 术后3个月后过矫>0.75 D者26眼（0.30%），欠矫>0.75 D者1眼（0.01%）；术后需二次增效手术者1眼 （0.01%）。术后视觉质量异常主要为术后初期雾视、眩光、光晕，随着时间的推移均明显改善，术后 6个月，99.30%的患者对手术的综合评价为非常满意。结论：SMILE治疗近视并发症少，未出现影响视力的严重并发症，但安全有效，患者满意度高。

Study of Complications in 8 600 Eyes after Small Incision Lenticule Extraction

Objective: To study and analyze the postoperative complications of small incision lenticule extraction (SMILE). Methods: In this retrospective case series study, 4 386 patients (8 600 eyes) with complete SMILE surgical correction data in Jinan Aier Eye Hospital from March 2015 to October 2019 were selected. During and after the operation, the occurrence of complications was analyzed, and a questionnaire survey was conducted. Visual quality was assessed based on the questionnaire survey. Results: Intraoperative complications were observed in 244 eyes (2.84%), including 12 eyes (0.14%) with negative pressure suction ring loss, 154 eyes (1.80%) with an opaque bubble layer (OBL), 25 eyes (0.29%) with microincision hemorrhage, 1 eye (0.01%) with difficulty in finding the corneal matrix lens, and 33 eyes (0.38%) with unplanned lens separation. In addition, there was lens residue in 4 eyes (0.04%), incision tear in 13 eyes (0.15%), and a scanned black area in 2 eyes (0.02%). Postoperative complications were observed in 17 eyes (0.20%), including diffuse lamellar keratitis in the early postoperative period (0.09%), immune keratitis in the middle postoperative period (0.10%), and no intercorneal bacterial infection in any eyes. Three months after surgery, 26 eyes (0.30%) were overcorrected >0.75 D and 1 eye (0.01%)was undercorrected >0.75 D. One eye (0.01%) needed to undergo a second augmentation operation. Postoperative visual quality abnormalities were mainly fog, glare, and halo in the initial postoperative period, which significantly improved over time. At 6 months after surgery, 99.30% of patients were very satisfied as noted in the comprehensive evaluation of the operation. Conclusions: SMILE surgery has few complications in the treatment of myopia, and there was no serious complication affecting vision in this study. SMILE surgery is safe and effective, and patient satisfaction is high.